1. 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/ 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 = , p < 0.001
x2 = , 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
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