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      Asociación entre síndrome de caídas y síntomas depresivos en adultos mayores de once comunidades altoandinas del Perú 2013-2017 Translated title: Association between falls and depressive symptoms among elderly people from eleven Peruvian Andean highland communities 2013-2017

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          Abstract

          Objetivo: Determinar si existe asociación entre el síndrome de caídas y la presencia de sintomatología depresiva en adultos mayores de once comunidades altoandinas, entre los años 2013 al 2017. Material y métodos: Estudio retrospectivo, analítico realizado en una muestra de pobladores de 60 años o más residentes de las siguientes localidades: La Jalca, Leimebamba (Amazonas), Llupa, San Pedro de Chaná, Atipayan (Áncash), Pampamarca (Huánuco), Ayahuanco (Ayacucho), Paucarcolla (Puno), Vilca (Huancavelica), Viñac (Lima) y Chacapampa (Huancayo). Se utilizó un instrumento basado en datos generales del paciente, antecedentes patológicos de importancia y examen físico. Resultados: Se entrevistó un total de 411 participantes; 65,94% de los cuales eran de sexo femenino y 65,45% vivían en una zona rural. Un 35,23% del total de caídas ocurrió a consumidores de alcohol; se comprobó un menor promedio de rendimiento físico y de alcance funcional en pacientes con historia de caídas frecuentes y un 48,48% de los mismos tenían sintomatología depresiva. Conclusiones: Los pacientes con síntomas depresivos tienen 1,62 veces más posibilidades de sufrir caídas en su actividad cuotidiana.

          Translated abstract

          Objective: To determine the association between falls and the presence of depressive symptoms in older adults of eleven highland Andean communities between 2013 and 2017. Material and methods: A retrospective, analytical study was conducted in a sample of residents aged 60 years and over, living in the following localities: La Jalca, Leimebamba (Amazonas), Llupa, San Pedro de Chaná, Atipayan (Ancash), Pampamarca (Huánuco), Ayahuanco (Ayacucho), Paucarcolla (Puno), Vilca (Huancavelica), Viñac (Lima) and Chacapampa (Huancayo). An instrument, based on general patient data, important pathological antecedents and physical examination, was utilized. Results: A total of 411 patients were interviewed, 65.94% of whom were female, and 65.45% lived in a rural area. Alcohol users accounted for 35.23% of total falls; a lower average physical performance and functional range were detected in patients who experienced falls, and 48.48% of the same had depressive symptoms. Conclusions: Patients with depressive symptoms have a 1.62 times higher chance to suffer a fall in their daily activity.

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          Balance and gait in the elderly: A contemporary review

          Background The prevalence of balance and gait deficits increases with age and is associated with the increased incidence of falls seen in the elderly population; these falls are associated with significant morbidity and mortality. Objectives To review changes in gait and balance associated with aging and the effect of visual perturbations on gait and balance in the elderly to provide a basis for future research. Methods PubMed and Cochrane Library were searched for articles from 1980 to present pertaining to gait and balance in older adults (>60) and younger adults (<60). Search terms included balance, posture, gait, locomotion, gait variability, gait disorders, gait disturbance, elderly, aging, falls, vision, visual, vestibular, and virtual reality. The references section of queried articles was also used to find relevant studies. Studies were excluded if subjects had a diagnosed gait or balance disorder. Results Elderly adults show age‐related decline in sensory systems and reduced ability to adapt to changes in their environment to maintain balance. Elderly adults are particularly dependent on vision to maintain postural stability. Distinct changes in spatiotemporal gait parameters are associated with aging, such as slower gait and increased gait variability, which are amplified with exposure to visual perturbations. Increased gait variability, specifically with mediolateral perturbations, poses a particular challenge for elderly adults and is linked to increased falls risk. Virtual reality training has shown promising effects on balance and gait. Conclusion Elderly adults show age‐related decline in balance and gait with increased gait variability and an associated increased risk of falls. Level of Evidence 5
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            The complex interplay of depression and falls in older adults: a clinical review.

            Depression and falls have a significant bidirectional relationship. Excessive fear of falling, which is frequently associated with depression, also increases the risk of falls. Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways. The management of depression in fall-prone individuals is challenging, since antidepressant medications can increase the risk of falls, selective serotonin reuptake inhibitors may increase the risk of fragility fractures, and data are lacking about the effect of fall rehabilitation programs on clinically significant depression. Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive-behavioral therapy should be considered for the first-line treatment of mild depression in older fallers. Antidepressant medications are indicated to treat moderate to severe depression in fall-prone individuals, but with appropriate precautions including low starting dose and slow dose titration, use of psychotropic monotherapy whenever possible, and monitoring for orthostatic hypotension and hyponatremia. To date, there have been no recommendations for osteoporosis monitoring and treatment in individuals prescribed antidepressant medications, beyond the usual clinical guidelines. However, treatment of the older depressed person who is at risk of falls provides the opportunity to inquire about his or her adherence with osteoporosis and fracture prevention guidelines.
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              Depressive symptoms increase fall risk in older people, independent of antidepressant use, and reduced executive and physical functioning.

              Depressive symptoms and antidepressant use are associated with greater fall risk in older people. This prospective study investigated interactions between depressive symptoms, antidepressant use and physical and cognitive function measures in relation to injurious or multiple falls in a large sample of community-living older people. Four-hundred and eighty-eight community-dwelling older people aged 70 years and over, underwent a comprehensive psychological, cognitive and physiological assessment and were prospectively monitored for falls over a 12-month follow up period. Substantial depressive symptoms were defined by a Geriatric Depression Scale (GDS) (15-item) score ≥5 and fallers were defined as people who had at least one injurious or two non-injurious falls during follow-up. In univariate analyses, the presence of depressive symptoms (RR=1.50; 95% CI=1.06-2.11), antidepressant use (RR=1.56; 95% CI=1.08-2.27), high physiological fall risk (RR=1.61; 95% CI=1.20-2.15) and poorer executive functioning (RR=1.40; 95% CI=1.05-1.88) were significant risk factors for falls. Multivariate models revealed that depressive symptomatology and antidepressant use were independent of each other, and independent of the presence of a high physiological fall risk and poorer executive functioning in the prediction of falls. Fall risk increased with the number of risk factors present: i.e. by 55% in participants with any two risk factors (RR=1.55; 95% CI=1.17-2.04) and by 144% in participants with three or four risk factors (RR=2.44; 95% CI=1.75-3.43). The study findings indicate that higher depressive symptoms and antidepressant use predict falls over 12-months, independent of reduced executive and physical functioning. Treatment of depressive symptoms using non-pharmacological approaches should be considered as part of fall prevention programs, especially in populations at high risk of falls.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rnp
                Revista de Neuro-Psiquiatría
                Rev Neuropsiquiatr
                Universidad Peruana Cayetano Heredia. Facultad de Medicina (Lima, , Peru )
                0034-8597
                January 2019
                : 82
                : 1
                : 11-18
                Affiliations
                [02] Lima orgnameUniversidad Científica del Sur orgdiv1Facultad de Ciencias de la Salud orgdiv2Carrera de Medicina Humana Perú
                [01] Lima orgnameUniversidad Científica del Sur Perú
                [03] Lima orgnameUniversidad de San Martin de Porres orgdiv1Facultad de Medicina Humana orgdiv2Centro de Investigación del Envejecimiento Perú
                Article
                S0034-85972019000100003
                10.20453/rnp.v82i1.3481
                0dd78677-98ff-4237-a714-ec7b0fa7070c

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 31 January 2019
                : 24 March 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 8
                Product

                SciELO Peru

                Categories
                Artículos originales

                elderly,Depression,falls,Andes,Depresión,caídas,adulto mayor
                elderly, Depression, falls, Andes, Depresión, caídas, adulto mayor

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