Falls Among the Elderly with Depression - Essay Example

Falls Among the Elderly with Depression Falls Among the Elderly with Depression Specific Aims Research Problem Depression and falls are both problems commonly experienced by the elderly. These problems are usually not treated because they are not detected. Studies have shown that the elderly with depression and those on anti-depressant or anti-psychotic medication are more likely to fall that those that are not. Fall related injuries are among the most serious accident incurred by the elderly. Fall induced injuries are a major reason for admission to the hospital, and injuries caused by falls are increasing rapidly in the elderly population. It is important to pay attention to this problem in the elderly with depression in order to discover the risk factors involved. Purpose Statement The purpose of this study is to reduce the number of falls among the elderly suffering from depression. Objective of the Study The objective of this study is to determine the set of risk factors existent between depression and falls and the relationship between anti-depressant drug use and falls among the elderly with depression. Research Question Are the elderly who are diagnosed with depression more likely to fall than those who do not suffer from depression? Aim #1 The first aim of this study is to determine the association between antidepressant drug use and falls in the elderly who suffer from depression. Aim #2 The second aim of this study is to determine a set of risk factors (cognitive function, walking speed, limited ADL function, psychological status and living conditions) that predict depression and fall among the elderly in society. Hypothesis 1 Elderly suffering from depression have a higher incidence of falls than those not suffering from depression. Hypothesis 2 The elderly population on anti-depressant medication has a higher incidence of falls that those who do not anti-depressant medication. Literature Review Depression and falls are two common conditions that result in the elderly being taken to the hospital. These conditions impair the health of older people (Biderman, Cwikel, Friend, & Galinsky, 2002, p. 631). The specific aim of this study is to determine a set of risk factors (cognitive function, walking speed, impaired activities of daily living function, psychological status and fear of falling) that predict depression and falls among the elderly in society. A further aim of this research is to determine the associations between antidepressant medicines and falls. Many older adults are threatened by frequent falls and, as a result, their injuries reduce their independence and freedom. This student believes that the more knowledge we have about risk factors for falls among the elderly, the better we can care for them, resulting in fewer falls and injuries in the future. Since the elderly often refuse to accept the fact that they are depressed, this condition often goes untreated or undertreated. “Both conditions are relatively undiagnosed and undertreated in the primary care” (Biderman, Cwikel, Friend, & Galinsky, 2002, p. 632). Studies have shown that both depression and falls are conditions that impair the health of the elderly. In addition, symptoms of depression are found to be common in older people and are associated with an increased risk of falls (Kwan, Lin, Close, & Lord, 2011, p. 612). Falls are common among the elderly, but the risk factors for this phenomenon are not always easy to identify. There is a need to emphasize fall prevention during the treatment of depression in older adults, because studies have shown a strong correlation between falls and depression (Matteo, Francesco, Sergio, & Graziano, 2002, p. 7). Changes between not having and having symptoms of depression are critical to understanding physical disabilities in the elderly. The effects appear to be independent of changes in a person’s cognitive status, which also can have significant adverse effects on physical disability. There is some evidence that an improvement in the level of depression buffers the adverse effects of cognitive decline on activities of daily living disability. Consequently, the worsening of depression and cognitive status independently predicts a subsequent increase in ADL (more disability) and an increased likelihood of dependency, which increases the risk of falls (Li & Yeates, 2009, p. 232). Psychologically, many older adults live alone. This makes cause them to feel isolated from the world they used to love. Therefore, they may seek out attention by falling intentionally. Depression may also contribute to falls because depressed people may be less attentive to environmental hazards. Again, the potential for confusion, which is associated with depression in the elderly, can result in a reduced ability to perceive and respond to environmental hazards (Rawsky, 1998, p. 47). Social support and access to recreational services may also contribute to the overall psychological context that predisposes individuals to falling. Moreover, any sort of fall risk assessment should include brief measures of well-being. These are psychosocial interventions that focus on improving positive aspects of well-being, as well as the reduction of depressive symptoms that may also reduce the incidence and prevalence of falls in the elderly. Both depression and falls are common in older adults. Antidepressants can help decrease the symptoms of depression, which can reduce the likelihood of falling. Some do claim, however, that the use of antidepressants increases the risk of falls, even though it is unclear whether the effect of the drug is independent of concurrent health morbidity (for example, presence and severity of depressive symptoms) (Kerse, Et al., 2008, p. 2423). “Because antidepressants are usually prescribed to the elderly without being reviewed on time, they are thought to contribute to falls through several difference mechanisms as sedation, impaired balance, insomnia, alerting effects and orthostatic hypotension, cardiac conduction or rhythm disturbances” (Darowski, Chambers, & Chambers, 2009, p. 385). The use of antidepressants have long been implicated as a cause of falls in older adults, but there is little to support that the risk of falls associated with certain types of antidepressants are a risk factor. Studies provide evidence that SNRIs are associated with an increased risk of first falls in the elderly, which is similar to that associated with other classes of antidepressants (Gribbin, Hubbard, Smith, & Lewis, 2011, p. 896). Symptoms of depression and chronic pain are associated an increased risk of falling, which is clinically relevant because of the relatively modifiable nature of depression. These findings suggest that the effective management of depressive symptoms and pain could potentially reduce the occurrence of falls and related consequences, which is a growing economic and social burden in an aging society (Eggermont, Penninx, Jones, & Leveille, 2012, p. 233). The risk factors associated with sustaining falls differ, suggesting potential separate mechanisms for single and multiple falls. The use of antidepressants and symptoms of depression are independently associated with an increased risk of falling later in life (Kerse, et. al, 2008, p. 2423). Older adults who experience frequent falls are more likely to be depressed than those who are not. Treatment with antidepressants does help to reduce the symptoms of depression, but that in turn can increase the risk of falling. Theoretical Framework To determine the relationship that could exist between depression and falls, this study will borrow from Mishel’s Theory to test the hypothesis that elderly with depression have a higher incidence of falls than those not suffering from depression. Subsequently, the research will seek to test the hypothesis that older adults taking antidepressants have a higher incidence of falling than those who do not. Falls have long posed a challenge among the elderly. Those who sustain such injuries have always tended to show a lower tendency to regain their initial body condition. The lack of ability to care of one’s self can lead to reduce independence and hence depressive tendency among the elderly. Mishel’s Theory presumes that the inability to be conversant with the end of an illness predisposes one’s self to depressive tendencies. Several studies have been conducted to look at the correlation between the two concepts, albeit in different kinds of settings. Michel’s Theory of Uncertainty attaches the concept of uncertainty to gauge the effect that an illness can have on a patient. In this regard, patients faced with uncertainty could be influenced by the disease or illness recurring, or they could face an uncertain predicament with respect to the illness. Being uncertain with respect to any illness is usually full of stress to the patient. Using Michel’s Theory, it can be shown that a patient having uncertainty with regard to a sustained fall may develop depressive tendencies. The failure to actively be in a position to predict when one would recover from the effects of a fall will certainly predispose a person to develop some depressive tendencies. This research will, therefore, investigate whether or not there is any relationship between falls and depression among the elderly population. At the same time, the study will also investigate the relationship between the elderly using antidepressants and incidences of falling. Limited research has been conducted to the fact that there is a relationship between depression and falls in that depressive tendencies usually predispose patients to falls. In this regard, proper care should be given to the elderly when dealing with problems associated with depression. Concept Map The diagram below shows the relationship between the dependent (cognitive function, walking speed, fear of falling, limited ADL function, or psychological status) and independent variables (depression, falls, uncertainty). Using Mishel’s Theory as a guide, we can see that any presence of an independent variable can result in any of the dependent variables manifesting themselves in an elderly patient. This will likely result in one of the outcomes listed in the concept map. Independent Variable Dependent Variable Research Methodology and Design Methodology The association between antidepressant use and falls in the elderly suffering from depression is not a hidden factor anymore. From day to day examples, it can be easily observed that the correlation between these two is nothing new. This study will use a qualitative design to examine the correlation between antidepressants and falling among the elderly population. Additionally, the determination of a set of risk factors (cognitive function, walking speed, limited ADL function, psychological status and living conditions) that predict depression and falls among the elderly in society will be observed in this paper. Qualitative studies are useful for finding the exact relationship between two factors. Moreover, elasticity related to these related can also be assessed from this type of study. Sample Size A sample size of 20 elderly people will be selected to answer questions in an interview type of setting. The sampling will include 20 participants living in the community who are diagnosed with depression and have had two or more falls within a six-month period, and who are currently taking antidepressants. Participants who are depressed, but are not willing to share information in response to open ended questions will be excluded. Sampling Techniques Participants will be chosen from their homes and senior centers for the purpose of conducting research using convenience sampling. This methodology and design is appropriate for this study because participants will be easily accessible. A sample size of 20 elderly people will reflect the results found in the study. Interviews will be conducted in a semi-structured way. This will pave the way for new questions and new ideas. Data Collection A close observation technique will be used as well. Older adults who are willing to participate in the research will be required to sign a consent letter. This will be detail a clear understanding of what type of participation is involved. Ethical approval and permission will be sought and granted from the Department of Health. Data Analysis The research panel will include a body of six researchers representing a nursing, psychologist, and medical perspective. Participants will have an open discussion, face-to-face interview, and answer open ended questions. All of the information collected will be examined to see if changes in one variable actually cause another variable to change. References Biderman, A., Cwikel, J, Friend, A V., & Galinsky, D. (2002). Depression and falls among community dwelling people: A search for common risk factors, 56(8), 631-6. Darowski, A., Chambers, C., F., S. & Chambers J. D. (2009). Antidepressants and falls in the elderly, 26(5), 381-394. Eggermont, H., P., L., Penninx, W., J., H., B., Jones, N., R., & Leveille, G., S., (2012). Depressive Symptoms, Chronic Pain, and falls in older Community-Dwelling Adults: The Mobilize Boston Study, 60, 230-237. Gribbin, J., Hubbard, R., Gladman, J., Smith, C., & Lewis S. (2011). Serotonin-Norepinephrine Reuptake Inhibitor Antidepressants and the Risk of falls in Older People. Case-control and case-series Analysis of a Large UK Primary, 28(11), 895-902. Kaarin, A., J., Burns, R., Von, S., Chween, & Luszcz, M., A. (2008). Psychological well-being Is an Independent Predictor of falling in an 8-Year Follow-up of Older Adults. The Journals of Gerontology, 63(4), 249-257. Kerse, N., Flicker, L., Pfaff,J. J., Draper, B., Nicola, T., Lautenschlager, Sim, M., Snowdon, J. & Almeida, P., O. (2008). Falls, Depression and Antidepressants in Later Life: A Large Primary Care Appraisal, 3(6) - 2423. Kwan, M. M., Lin, S., Close, C., T., & Lord, S. (2011). Depressive symptoms in addition to visual impairment, reduced strength and poor balance predict falls in older Taiwanese people, 41, 612-617. Li, L., & Conwell, Y. ( 2009). Effects of Changes in Depressive Symtoms and Cognitive Functioning on Physical Disability in Home Care Elders. The Journals of Gerontology, 64A(2), 230-6. Matteo, C., Francesco, L., Sergio, O., & Graziano et al. (2002). Prevalence and Risk Factors for Falls in an Older Community-Dwelling Population, 57(11), 722-6 Rawsky, E. (1998). Review or the literature on falls among elderly. Image - - the Journal of Nursing Scholarship, 30(1), 47- 47. Read More