Gender differences in the effect of depression and cognitive impairment on risk of falls among community-dwelling older adults

Background: The impact of the interrelationship between depression and cognitive impairment on risk of falls remains unclear. In addition, gender differences should be considered to further understand the relationships between depression, cognitive impairment, and risk of falls. Methods: Older adults who completed the Living Profiles of Older People Survey in Korea were included. In total, 14,055 participants completed the baseline survey, and 7,150 participants completed a follow-up survey after 3 years. We classified participants into 4 groups based on depression and cognitive impairment. Results: Using generalized estimating equation models, older adults with depression but without cognitive impairment had a higher risk of falls (OR=1.49, 95% CI=1.35-1.63), compared to a reference group with neither depression nor cognitive impairment. However, older adults who had cognitive impairment but not depression had a similar risk of falls (OR=1.03, 95% CI=0.91-1.16) to the reference group. Finally, older adults who had both depression and cognitive impairment had the highest risk of falls (OR=1.95, 95% CI=1.73-2.20) compared to the reference group. In addition, depression seemed to have a bigger effect on the risk of falls in men compared to women (p for interaction < 0.001). Limitations: These results should be interpreted with caution, considering the use of screening tool for defining depression or cognitive impairment, and lack of information on psychotropic medication use. Conclusions: Depression alone or depression combined with cognitive impairment was associated with higher risk of falls in older adults. In addition, gender differences in the risk of falls was noted.