Association of depressive symptoms, gait and dynamic balance with risk of falling in older adults discharged from the emergency department after a fall: a prospective observational study

BACKGROUND: Depressive symptoms are an established fall-risk factor in older adults, potentially mediated by gait and dynamic balance impairments. However, this relationship remains unexamined in older individuals discharged from the emergency department (ED) following a fall - a group at particularly high risk for recurrent falls. Therefore, this study examined whether depressive symptoms predict 12-month prospective fall risk in this population, and whether gait and dynamic balance impairments act as mediators. METHODS: This prospective sub-study analysed participants from the SeFallED study aged ≥ 60 years who had recently been discharged from the ED following a fall. Data were collected through home visits, gait analyses, and monthly follow-up interviews. Depressive symptoms were assessed using the Depression in Old Age Scale. Gait speed, stride length, swing and double support time were combined into a single gait performance factor using principal component analysis, while dynamic balance was quantified by mediolateral and anteroposterior margin of stability. Ordinal logistic regression analysis investigated the association between depressive symptoms and fall risk, while causal mediation analysis examined gait and dynamic balance as mediators. RESULTS: In a sample of 143 participants, depressive symptoms (OR 3.74, 95% CI 1.35-10.37, p = 0.011) and higher mediolateral margin of stability (OR 1.36, 95% CI 1.07-1.73, p = 0.011) independently predicted higher prospective fall risk, whereas gait performance was negatively associated with fall risk (OR 0.47, 95% CI 0.28-0.80, p = 0.005). Neither gait nor dynamic balance impairments significantly mediated the association between depressive symptoms and falls. CONCLUSIONS: Depressive symptoms, alongside gait and dynamic balance impairments, represent modifiable indicators of future fall risk following ED presentation after a fall. Integrating mood and mobility assessments into post-ED falls prevention strategies could help mitigate fall risk in this high-risk population. TRIAL REGISTRATION: Prospectively registered on 4 November 2021 in the Deutsches Register für Klinische Studien, (DRKS00025949; Date of registration in DRKS: 2021-11 - 04).