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Original Article
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
Journal of Korean Academy of Nursing 2008;38(5):730-738.
DOI: https://doi.org/10.4040/jkan.2008.38.5.730
Published online: October 12, 2008

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

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

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: August 14, 2008   • Revised: August 16, 2008   • Accepted: October 7, 2008

Copyright © 2008 Korean Society of Nursing Science

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.

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  • 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
Figure 1.
Mediating effect of depression in the relationship between muscle strength of extremities and falls.
jkan-38-730f1.jpg
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) Falls 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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        The Mediating Effect of Depression in the Relationship between Muscle Strength of Extremities and Falls among Community-Dwelling Elderly
        J Korean Acad Nurs. 2008;38(5):730-738.   Published online October 12, 2008
        DOI: https://doi.org/10.4040/jkan.2008.38.5.730
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      The Mediating Effect of Depression in the Relationship between Muscle Strength of Extremities and Falls among Community-Dwelling Elderly
      Image
      Figure 1. Mediating effect of depression in the relationship between muscle strength of extremities and falls.

      Figure 1.

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

      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

      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.

      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) Falls 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.

      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.
      Table 1. General Characteristics of Participants (N=247)

      Table 2. Descriptive Statistics of Research Variables (N=247

      M.=Muscle; Ext.=Extremities.

      Table 3. Correlations among Study Variables (N=247)

      M.=Muscle; Ext.=Extremities.

      Table 4. Mediating Effects of Depression in the Relationship between Muscle Strength of Extremities and Falls (N=247)

      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.

      Table 1.

      Table 2.

      Table 3.

      Table 4.

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