School of Physical Therapy METHODS – DATA ANALYSIS Relationship of Depression and Medications on the Incidence of Falls Among People with Late Effects of Polio Carolyn P Da Silva, PT, DSc, NCS,1 Bianca Zuckerman, PT, DPT1,2 Rhoda Olkin, PhD3 1Texas Woman’s University, Houston, TX, 2The Center for Pediatric Therapy, Spring, TX, 3California School of Professional Psychology, San Francisco, CA INTRODUCTION METHODS – DATA ANALYSIS DISCUSSION Post-Polio Syndrome affects (PPS) ~25-50% of individuals who have survived polio. Symptoms of PPS include progressive muscle weakness, fatigue, muscle &/or joint pain, muscle atrophy, & respiratory difficulty1. Such symptoms contribute to an increased number of risk factors for falls in older adults, thus leading to an increased incidence of falls among the polio survivor population. Risk factors for falls in older adults include: use of ≥4 medications, balance or gait instability, postural hypotension, vision impairment, & home hazards2-4. Rate of polio survivors who fell in one year was 4x that of other adults over 555. 84% of individuals with PPS reported falling & 95% had a fear of falling6. Anti-depressant & psychoactive medication use is strongly associated with falls in community dwelling older adults7. 40% of older adults with PPS scored in the moderate to severe category for depressive symptoms on the Centers for Epidemiologic Studies Short Depression Scale8. Geriatric Depression Scale-15 (GDS-15) is commonly used to measure depression but has not been used on PPS population. SPSS 19.0 used for data entry & analysis All returned survey data entered Completed surveys with GDS-15 scores, medication lists, & fall history used to test null hypothesis Score ≥5 on GDS-15 used to indicate depression9 ≥4 medications defined as risk for falling2-4 in community dwelling elders α = 0.010 Independent samples t-test performed to analyze a relationship between number of medications taken & falls Chi square analyses performed to assess: Association of psychoactive medications & falls Number of medications & risk for falls Self-report of depression & GDS-15 score Depression & treatment of depression with medication Depression & falls Previous fall-related studies have been performed on fear of falling, balance confidence, quality of life, osteoporosis, & fractures of individuals with PPS6,10. Few studies have assessed relationship of depression & medications on incidence of falls in polio survivor population. Although polypharmacy is a risk factor for falls in community dwelling elders, our study found no significant relationship between falls &: Number of medications used Taking ≥4 medications Taking psychoactive medications Our study demonstrated that self-report of depression & GDS-15 score tend to be in agreement in polio survivor population. Furthermore, those who self-identify as being depressed/score for depression on GDS-15 are being treated with anti-depressants. Physicians seem to be comfortable prescribing anti-depressants to older adults11, & anti-depressants appear to be effective in treating depression in elderly individuals12. However, our study’s sample indicated 42% continued to report depression while taking anti-depressant medication. Recent studies demonstrate a high rate of benzodiazepine use among elderly & suggest that benzodiazepines do not adequately treat depressive symptomology13. Depression is a risk factor for falls in community dwelling elderly2,14. Our study also found there to be a relationship between depression & falls in polio surviving community. Clinical relevance If anti-depressants are not adequately treating depression for a community that has 4x the fall rate of older adults5, then maximizing fall risk reduction may not be occurring sufficiently in the polio survivor community. Strengths 58% return rate on surveys, with 99% usable surveys for depression analysis & 49% usable surveys for medication analysis GDS-15 standardized for community dwelling elders & other neurologic populations, but not for polio survivor community Limitations 16% invalid surveys due to missing medication data/lack of GDS-15 completion Did not measure other depression treatments such as counseling Lack of ethnic diversity among sample population RESULTS Independent t-test for Relationship Between Number of Medications Taken & Falls Variable Fallen in Last 12 Mos. (n = 91) Mean (SD) Not Fallen in Last 12 Mos. (n = 55) t p # of Medications 5.01 (3.843) 5.11 (3.635) -0.153 0.879 PURPOSES & HYPOTHESIS The purposes of this study were to determine if a relationship exists between: Number of medications taken & incidence of falls Use of psychoactive medications & falls Self-report of depression & GDS-15 score Depression (self-report &/or GDS-15) & use of anti-depressant medications Depression (self-report &/or GDS-15) & falls, and if Number of medications & risk for falls is different for subjects with PPS as compared to community dwelling elders without PPS Null Hypothesis: There is no relationship between rate of falling, self-reported &/or GDS-15 score for depression, number of medications taken, or use of psychoactive medication in polio survivors with & without PPS. x2 = 1.345, p = 0.324 x2 = 1.478, p = 0.298 PARTICIPANTS CONCLUSIONS Surveys sent by mail/email through the Texas Polio Survivors’ Association (TPSA) Participants were members or friends of members of TPSA Participants provided informed consent by returning the completed survey No personal identifiable data were collected Mean age: 67 years old (range 37 to 91) Polypharmacy & the use of psychoactive medications do not increase the risk for falls among this population. Depression is accurately identified & treated through medication among polio survivors, although under-treatment of depression may be occurring. Furthermore, depression appears to have a strong association with risk for falling in the polio surviving community. 300 surveys mailed 173 returned 172 completed with GDS-15 146 completed with medications x2 = 35.718, p < 0.001 x2 = 16.820, p < 0.001 ACKNOWLEDGEMENTS METHODS - SURVEYS We wish to thank the following for their aid in our research: Pat Lindsay & the organization of TPSA, for their assistance in distribution & providing funding for postage on the mailed surveys. Doris Scarborough & the Bay Area Polio Survivors’ Association Mary Watson, PhD for statistical assistance B Zuckerman assisted with study for partial fulfillment of DPT degree requirements at Texas Woman’s University. Developed with input of the International Polio Clinics Directors’ Network Consisted of self-report questions about demographic information, general health, medication use, use of mobility devices, home/work environment, fall questions, balance confidence, & depression Geriatric Depression Scale short form (GDS-15) x2 = 7.476, p < 0.010 TWU School of Physical Therapy TWU School of Physical Therapy TWU School of Physical Therapy