The Mediating Effect of Depression in the Relationship between Muscle Strength of Extremities and Falls among Community-Dwelling Elderly

Hyoung-Sook Park; Kyung-Yeon Park

doi:10.4040/jkan.2008.38.5.730

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Park and Park: The Mediating Effect of Depression in the Relationship between Muscle Strength of Extremities and Falls among Community-Dwelling Elderly

Original Article

J Korean Acad Nurs 2008;38(5):730-738.

Published online: 12 October 2008

DOI: https://doi.org/10.4040/jkan.2008.38.5.730

The Mediating Effect of Depression in the Relationship between Muscle Strength of Extremities and Falls among Community-Dwelling Elderly

Hyoung-Sook Park¹, Kyung-Yeon Park²

¹Professor, College of Nursing, Pusan National University, Busan, Korea

²Full-time Lecturer, Department of Nursing, Silla University, Busan, Korea

Address reprint requests to : Park, Kyung-Yeon Department of Nursing, Silla University, San 1-1 Gwaebeop-dong, Sasang-gu, Busan 617-736, Korea Tel: 82-51-999-5461 Fax: 82-51-999-5470 E-mail: kypark@silla.ac.kr

Received 14 August 2008 Revised 16 August 2008 Accepted 7 October 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the mediating effect of depression in the relationship between muscle strength of extremities and falls among community-dwelling elderly.

Methods

Two hundred forty-seven participants were recruited from a public health center, a hall for the aged and a school for the aged in B city. Face-to-face interviews were conducted using questionnaires from May to September of 2007. Data was analyzed with descriptive statistics, Pearson correlation, and multiple regression using the SPSS WIN 14.0 program.

Results

There was a significantly negative relationship between muscle strength of lower extremities and falls, muscle strength of left upper extremity and falls, and muscle strength of right upper extremity and falls. Depression positively correlated with falls. Depression showed mediating effects between muscle strength of extremities and falls. Weakness of muscle strength of extremities increased depression and the increased depression increased the frequencies of falls.

Conclusion

For the effective management and prevention of community-dwelling older adults’ falls, exercise programs including depression-decreasing strategies should be established. These exercise programs can decrease depression which is the mediator role between the degrees of muscle strength of extremities and falls.

Keywords: Elderly, Extremities, Muscle strength, Falls, Depression

References

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Figure 1.

Mediating effect of depression in the relationship between muscle strength of extremities and falls.

Table 1.

General Characteristics of Participants (N=247)

Characteristics	n	%
Gender
Male	38	15.4
Female	209	84.6
Age (yr)
65-69	16	6.5
70-79	138	55.8
80 or more	93	37.7
Mean±SD	77.9±5.4
Education
None	133	53.9
Elementary school	65	26.3
Middle school or higher	49	19.8
Spouse
Yes	58	23.5
No	189	76.5
Living arrangement
Children offspring	117	47.4
Spouse	43	17.4
Solitude	86	34.8
Others	1	0.4
Perceived economic status
High	6	2.4
Middle	120	48.6
Low	121	49.0
Perceived health status
Good	47	19.0
Moderate	81	32.8
Poor	119	48.2
Regular exercise
Yes	119	48.2
No	128	51.8
Pre-existing chronic disease
Yes	168	68.0
No	79	32.0

Table 2.

Descriptive Statistics of Research Variables (N=247

Variables	Mean	SD	Actual range	Reference range
M. strength of lower ext. (Frequency)	12.67	4.46	0-28
Male	14.45	4.22	4-26	8-18
Female	12.35	4.43	0-28	8-16
M. strength of upper ext. (Hand grip)
Left hand (kg)	14.89	5.66	0-35
Male	21.91	6.58	0-35	30-40
Female	13.61	4.42	0-24	17-24
Right hand (kg)	15.20	5.50	0-36
Male	21.94	6.21	0-36	30-40
Female	13.98	4.36	0-33	17-24
Depression	7.30	3.82	0-15	0-5
Falls
Frequency	0.68	1.13	0-4
	n	%
Yes	84	34.01
1	38	45.24
2	20	23.81
3	15	17.86
4 or more	11	13.10
No	163	65.99

M.=Muscle; Ext.=Extremities.

Table 3.

Correlations among Study Variables (N=247)

	M. strength. of lower ext. r (p)	M. strength of left upper ext. r (p)	M. strength of right upper ext. r (p)	Depression r (p)
M. strength of lower ext.
M. strength of left upper ext.	.412 (<.001)
M. strength of right upper ext.	.444 (<.001)	.781 (<.001)
Depression	-.254 (<.001)	-.300 (<.001)	-.298 (<.001)
Falls	-.140 (.028)	-.170 (.007)	-.177 (.005)	.264 (<.001)

M.=Muscle; Ext.=Extremities.

Table 4.

Mediating Effects of Depression in the Relationship between Muscle Strength of Extremities and Falls (N=247)

Predictors	F	β	R²	Additional R²	Mediating effect
Muscle strength of lower extremity (MSLE)
Equation 1. MSLE → depression	16.877***	-.254***	.064	-
Equation 2. MSLE → falls	4.914*	-.140*	.020	-
Equation 3. Depression → falls	9.941***	.244***	.075	-
MSLE → falls		-.078		.006	Yes
Muscle strength of left upper extremity (MSLUE)
Equation 1. MSLUE → depression	24.161***	-.300***	.090	-
Equation 2. MSLUE → falls	7.294**	-.170**	.029	-
Equation 3. Depression → falls	10.422***	.234***	.079	-
MSLUE → falls		-.100		.009	Yes
Muscle strength of right upper extremity (MSRUE)
Equation 1. MSRUE → depression	23.800***	-.298***	.089	-
Equation 2. MSRUE → falls	7.966**	-.177**	.031	-
Equation 3. Depression → falls	10.659***	.232***	.080	-
MSRUE → falls		-.109		.011	Yes

^* p<.05

^** p<.01

^*** p<.001.

Equation 1. IV → mediator to check beta and R²; Equation 2. IV → DV to check beta and R² (it should be significant to test mediator effect); Equation 3. Step 1: mediator → DV to check beta and R²; Step 2: IV → DV to check beta and R².

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