# Mechanisms of Increased Fall Risk among Older Adults with Depression: A Causal Mediation Analysis

> **NIH NIH R21** · UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA · 2020 · $144,737

## Abstract

Project Summary
The goal of this project is to investigate and quantify the direct and mediated associations between major
depressive disorder, clinically significant depressive symptoms, and falls, using data from a large, nationally-
representative longitudinal cohort study of older adults in the US. Falls often lead to injury, disability,
substantial health service costs and are the leading cause of injury-related mortality in adults age 65 and older.
Risk for and recovery from falls is determined by several factors including environmental hazards, physiological
vulnerability, cognition, medications, mental health, and social support. While extensive research literature
describes the role of environment and physiology in fall risk, little is known about the role of mental health.
Evidence suggests that individuals with major depressive disorder (the most common mental health disorder
among older adults) may be up to four times as likely to experience an unintentional fall and more likely to
experience injury because of a fall than their non-depressed counterparts. Several correlates of depression
have been implicated as potential mediators or moderators of this association, such as antidepressant
medication use, cognitive impairment, frailty, and diminished social networks, but the relative importance of
these mechanisms is unknown. This project will address this important gap in knowledge by identifying and
quantifying key mechanistic pathways between depression and falls, using a novel causal mediation analytic
approach. This study will use longitudinal data from the nationally-representative Health and Retirement Study
spanning from 2006 to 2010 to address the following specific aims: Aims 1 & 2: Determine the relative and
absolute extent to which the associations between major depressive disorder, clinically significant depressive
symptoms and fall risk are mediated by frailty, cognitive impairment, and antidepressant medications. Aim 3:
To estimate the direct and serially mediated effects of depression on functional abilities (instrumental activities
of daily living and activities of daily living) through falls. By providing evidence of the relative and absolute risk
of falls associated with depression, this study will provide key information at two complementary levels. First,
describing the relative influence of different fall mechanisms will inform the development of comprehensive
strategies to treat depression in older adults with vulnerability to falls and fall-related injuries. Second, by
providing quantitative evidence of different paths from depression to falls and fall-related functional impairment,
this project will inform the development and prioritization of policies and strategies aimed at fall prevention for
older adults in general.

## Key facts

- **NIH application ID:** 9981594
- **Project number:** 5R21AG064310-02
- **Recipient organization:** UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
- **Principal Investigator:** Matthew Christopher Lohman
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $144,737
- **Award type:** 5
- **Project period:** 2019-08-01 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9981594

## Citation

> US National Institutes of Health, RePORTER application 9981594, Mechanisms of Increased Fall Risk among Older Adults with Depression: A Causal Mediation Analysis (5R21AG064310-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/9981594. Licensed CC0.

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