Depression – AND its treatments – are fall risks

Here’s my latest article on McKnight’s Long-Term Care News:


Depression – AND its treatments – are fall risks

Feeling “down” takes on a wicked double-meaning for some seniors. Even conscientious providers could be unaware of it, let alone know what to do about it.

As McKnight’s Staff Writer Emily Mongan points out in “Depression treatments may increase risk of falls in SNF residents, study shows,” a psychosocial treatment for depression increased the likelihood of resident falls. I spoke with Suzanne Meeks, Ph.D., first author of the study, to discuss the problem and the results of her research.

Meeks and her colleagues studied the impact of the Behavioral Activities Intervention (BE-ACTIV) on depressed nursing home residents. They determined that the risk of falls in the treatment group was six times that of the control group, a statistically significant number.

Meeks told me all treatments for depression, including medication and behavioral interventions, increase the chance of falls. When an individual is no longer depressed, he or she has more energy to stand and walk, thus creating more opportunities to fall. If depression has immobilized them for some time, deconditioning may exacerbate the problem.

Meeks points out that more than 81% of her research subjects in both treatment and control groups were receiving antidepressants, suggesting that the behavioral intervention activated the residents more than the medication.

It’s important to treat people for depression despite the increased risk for falls because, as Meeks states, “depression is a fall risk.” Other researchers have found that the risk of falls increases when an individual has more of the following risk factors: depressive symptoms, antidepressant use, high physiological fall risk, and poorer executive function. Any two of these risk factors increase the likelihood of a fall by 55%. Participants with three or four risk factors were 155% more likely to fall — 155%!

The BE-ACTIV intervention

The BE-ACTIV model was quite successful in reducing depression, Meeks and her colleagues found, as described in an earlier article about their work. Study subjects in the 10-week treatment group were encouraged and assisted to participate in pleasant activities such as regularly scheduled group programs, in-room crafts and self-care such as haircuts. Compared to the “treatment as usual” control group, BE-ACTIV was “superior … in moving residents to full remission from depression.”

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Depression – AND its treatments – are fall risks

Carer Helping Senior Man With Walking Frame

1 thought on “Depression – AND its treatments – are fall risks”

  1. That’s an interesting question, George, and I suppose it depends what you mean by “retirement home.” Many people who move into assisted living homes are making the decision to downsize and are physically and cognitively well enough to make friends and find pleasant activities in their new communities. It’s a huge step to acknowledge that you can’t do all the things you did before to live independently and that you need help now and may need more in the future. I think the biggest obstacle for assisted living homes is the reluctance people have to give up their independence, acknowledge the need for help and move into a new phase of life. Some people may become depressed following this transition because it’s a major and challenging adjustment, but the alternative — living alone, isolated and needing assistance but not getting it — can be far more depressing.

    When people come to a nursing home setting, it’s following a medical crisis that leaves them with the need for skilled nursing care. It’s not so much a decision to come to the facility but an outside event thrust upon them, which can be more difficult to handle emotionally. While they’re adapting to having unexpectedly left their homes, they’re also dealing with the loss of physical abilities and the need to rely on others for very personal care. It’s not surprising that many people become depressed. Despite this, and despite the bad press that nursing homes get, there are wonderful people who live and work there and most residents find a way to have a pleasant life regardless of its limitations.

    In any setting, the most important factor in attracting new members is the interpersonal experience of potential customers. You could have the most beautiful campus in the world and if no one answers the phone when new prospects call or the tour guide on your initial visit has a bad attitude, you’re not going to want to move in or choose that home for your mother.


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