Falls in older adults with major depressive disorder (MDD): a systematic review and exploratory meta-analysis of prospective studies

Background: Depressive symptomology is now widely recognized as a key risk factor for falls. The evidence regarding the impact of major depressive disorder (MDD) on falls is unclear. A systematic review and exploratory meta-analysis was undertaken to explore the relationship between MDD and falls. Methods: Major electronic database were searched from inception till April 2015. Studies that defined MDD and measured falls prospectively in older adults (60 years) were included. Studies relying on depressive symptomology alone were excluded. The methodological quality of included articles was assessed and study findings were synthesized using an exploratory meta-analysis. Results: From a potential of 415 articles, only three studies met the inclusion criteria. This included 976 unique older adults with a range of mean age from 65 to 83 years. The methodological quality of included studies was satisfactory. None of the included studies' primary aim was to investigate the relationship between MDD and falls. The exploratory meta-analysis demonstrated older adults with MDD are at increased risk of falling compared to non-depressed older adults (odds ratio (OR) 4.0, 95% CI 2.0-8.1, I-2 = 60%, n = 976). Conclusion: There is a paucity of research considering falls in older adults with MDD. Our results demonstrate that the odds of falling appear to be greater among people with MDD (OR 4.0) than in previous meta-analyses that have only considered subthreshold depressive symptoms. Given the distinct nature and challenges with MDD, more research is required to better understand the falls risk in this group.