“Healthy aging" goal: the complex associations between senile age depression, fear of falling and risk of falls. A systematic review and meta-analysis of the literature.

Introduction: Depression rates in older people worldwide vary from 10% to 15% of community-dwelling older persons. The high incidence of falls and the so-called fear of falling (FOF), with a prevalence ranging from 20% to 85%, are two other problems related to depression in old age; it was initially considered a post- fall syndrome, which later as a fall-independent event. Aims: Study aims to conduct a systematic review and meta-analysis to bridge the existing gap in literature about the association between depressive symptomatology, FOF, use of antidepressant therapy and falls, also identifying a possible effect of the study quality on the outcome. Methods: The selection of studies was carried out between May 20, 2020, and July 27, 2020 and only observational clinical trials, written in English, with participants aged more or equal to 60 years affected by diagnosis of depression or treatment for depression mentioned both as a clinical diagnosis in older patient, and as a predictor/consequence of falls were included. The systematic review was performed according to the PRISMA guidelines for reporting systematic reviews and meta-analysis, and the protocol was recorded in the PROSPERO. Results and discussion: The screening process led to the inclusion of 18 articles. Many of the studies showed that depression caused the subsequent increase in the number of falls, but no association between depression and falls, in contrast to other review and meta- analysis works: our work includes a substantial number of studies, with a relatively recent publication date, including patients with depression, clearly evaluating the association between depression and falls. Results all seem to confirm the interdependent association between the presence of FOF and the risk of fall, despite the high percentage of cross-sectional studies prevents inferring on the direction of the association. Therapeutic interventions aimed at decrease rate of falls reducing depressive symptoms and FOF.