Mindfulness, Depression, and Fall Risk in Low-Income Older Adults Original Research
Main Article Content
Keywords
Mental Well-Being, Aging, Fall Prevention
Abstract
Introduction: Mindfulness, through mind-body practices, promotes awareness and presence. Its practice, along with reduced depression, may improve balance and lower fall risk in older adults. This study examined the association between mindfulness, depression, and fall risk among low-income, community-dwelling older adults.
Methods: A descriptive cross-sectional study was conducted with 103 community-dwelling, low-income older adults, including 16 males and 87 females, with a mean age = 75.70 years (95% CI ± 7.19). Mindfulness was assessed with the Mindful Attention Awareness Scale (MAAS), depression using the Patient Health Questionnaire (PHQ-9) and fall risk with the CDC’s checklist for elderly accidents and injuries. Multiple regression analysis was conducted.
Results: Mindfulness was negatively correlated with fall risk (r=-.437, p<.001), while depression was positively correlated with fall risk (r=.486, p<.001). These variables explained 31.1% of the variance in fall risk (R² = .311, p < .001). Mindfulness (β = -.262, p =.006) and depression (β = .306, p =.001), respectively, were significantly associated with fall risk.
Conclusions: This study demonstrates that mindfulness and depression are predictors of fall risk. Community-dwelling low-income older adults may benefit from mind-body exercises. These exercises can help them become more aware and enhance their mental health, which may lower their risk of falling.
References
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19. Choi SD, Andrade EL. Multiple-Level Fall Risks Associated with Socioeconomic Factors Among Community-Dwelling Older Adults: A Systematic Review. 2022:10-27.
20. Brady D, Kohler U, Zheng H. Novel Estimates of Mortality Associated With Poverty in the US. JAMA Intern Med. Jun 1 2023;183(6):618-619. doi:10.1001/jamainternmed.2023.0276
21. Maruszewska A, Ambroży T, Rydzik Ł. Risk factors and socioeconomic determinants of falls among older adults. Frontiers in Public Health. 2025;13:1571312.
22. Namoos A, Thomson N, Olson C, Aboutanos M. Physical Injury and Psychological Impact: Understanding the High Risk of Depression on Older Adults with Recurrent Falls. Advances in Geriatric Medicine and Research. 2024;6(4):e240008. e240008. doi:10.20900/agmr20240008
23. Hoang P, Moore K, Kwan M. Examining the Feasibility of a Mindfulness Intervention for the Prevention of Falls: A Pilot Study. Can J Aging. Dec 2020;39(4):626-633. doi:10.1017/S0714980820000033
24. Kakara R, Bergen G, Burns E. Understanding the association of older adult fall risk factors by age and sex through factor analysis. Journal of applied gerontology. 2023;42(7):1662-1671.
25. Thiamwong L, Xie R, Park J-H, Lighthall N, Loerzel V, Stout J. Optimizing a technology-based body and mind intervention to prevent falls and reduce health disparities in low-income populations: protocol for a clustered randomized controlled trial. JMIR research protocols. 2023;12(1):e51899.
26. Poverty Thresholds. The United States Census Bureau. Accessed October 5, 2025 https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html
27. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. Nov 1975;12(3):189-98. doi:10.1016/0022-3956(75)90026-6
28. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. Nov 2009;41(4):1149-60. doi:10.3758/BRM.41.4.1149
29. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. Journal of personality and social psychology. 2003;84(4):822.
30. Black DS, Sussman S, Johnson CA, Milam J. Psychometric assessment of the Mindful Attention Awareness Scale (MAAS) among Chinese adolescents. Assessment. Mar 2012;19(1):42-52. doi:10.1177/1073191111415365
31. Kroenke K, Spitzer RL, Williams JB. The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine. 2001;16(9):606-613.
32. Rubenstein LZ, Vivrette R, Harker JO, Stevens JA, Kramer BJ. Validating an evidence-based, self-rated fall risk questionnaire (FRQ) for older adults. Journal of safety research. 2011;42(6):493-499.
33. Nithman RW, Vincenzo JL. How steady is the STEADI? Inferential analysis of the CDC fall risk toolkit. Arch Gerontol Geriatr. Jul-Aug 2019;83:185-194. doi:10.1016/j.archger.2019.02.018
34. Xue Y, Lu J, Zheng X, et al. The relationship between socioeconomic status and depression among the older adults: the mediating role of health promoting lifestyle. Journal of affective disorders. 2021;285:22-28.
35. Pereira MEA, Santos GS, Almeida CR, et al. Association between Falls, Fear of Falling and Depressive Symptoms in Community-Dwelling Older Adults. Healthcare (Basel). Aug 16 2024;12(16)doi:10.3390/healthcare12161638
36. Kvelde T, McVeigh C, Toson B, et al. Depressive symptomatology as a risk factor for falls in older people: systematic review and meta‐analysis. Journal of the American Geriatrics Society. 2013;61(5):694-706.
37. Kim JH, Song JH, Wee JH, Lee JW, Choi HG. Depressive Symptoms, Subjective Cognitive Decline, and Subjective Sleep Quality Are Associated with Slips and Falls: Data from the Community Health Survey in Korean Adults. Gerontology. 2022;68(5):518-528. doi:10.1159/000518007
38. Potter GG. Depression and cognitive impairment in older adults. Psychiatric Times. 2007;24(13):23-23.
39. Forbes M, Lotfaliany M, Mohebbi M, et al. Depressive symptoms and cognitive decline in older adults. International psychogeriatrics. 2024;36(11):1039-1050.
40. Reangsing C, Rittiwong T, Schneider JK. Effects of mindfulness meditation interventions on depression in older adults: A meta-analysis. Aging Ment Health. Jul 2021;25(7):1181-1190. doi:10.1080/13607863.2020.1793901
41. Hofmann SG, Gómez AF. Mindfulness-Based Interventions for Anxiety and Depression. Psychiatr Clin North Am. Dec 2017;40(4):739-749. doi:10.1016/j.psc.2017.08.008
42. Fiocco AJ, Mallya S. The importance of cultivating mindfulness for cognitive and emotional well-being in late life. Journal of evidence-based complementary & alternative medicine. 2015;20(1):35-40.
43. Lee EKP, Wong B, Chan PHS, et al. Effectiveness of a mindfulness intervention for older adults to improve emotional well‐being and cognitive function in a Chinese population: A randomized waitlist‐controlled trial. International Journal of Geriatric Psychiatry. 2022;37(1)
44. Robinson JE, Kiely J. Preventing falls in older adults: can improving cognitive capacity help? Cogent Psychology. 2017;4(1):1405866.
45. Segev-Jacubovski O, Herman T, Yogev-Seligmann G, Mirelman A, Giladi N, Hausdorff JM. The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk? Expert review of neurotherapeutics. 2011;11(7):1057-1075.
46. Sardeli AV, Sartori CR, Santos WM, de Freitas Brandão A, Chacon-Mikahil MPT. Dispositional mindfulness influences the balance control in elderly. Journal of Innovation and Healthcare Management. 2019;2:1-9.
47. Szanton SL, Wenzel J, Connolly AB, Piferi RL. Examining mindfulness-based stress reduction: perceptions from minority older adults residing in a low-income housing facility. BMC Complement Altern Med. May 31 2011;11:44. doi:10.1186/1472-6882-11-44.
2. Rogers ME, Rogers NL, Takeshima N, Islam MM. Methods to assess and improve the physical parameters associated with fall risk in older adults. Prev Med. Mar 2003;36(3):255-64. doi:10.1016/s0091-7435(02)00028-2
3. Aging NIo. Falls and Fractures in Older Adults: Causes and Prevention. National Institutes of Health. Updated September 12, 2022. 2025. https://www.nia.nih.gov/health/falls-and-falls-prevention/falls-and-fractures-older-adults-causes-and-prevention
4. Asante D, Rio J, Stanaway F, Worley P, Isaac V. Psychological distress, multimorbidity and health services among older adults in rural South Australia. J Affect Disord. Jul 15 2022;309:453-460. doi:10.1016/j.jad.2022.04.140
5. Lohman MC, Mezuk B, Fairchild AJ, Resciniti NV, Merchant AT. The role of frailty in the association between depression and fall risk among older adults. Aging Ment Health. Sep 2022;26(9):1805-1812. doi:10.1080/13607863.2021.1950616
6. Loewenthal J, Berning MJ, Wayne PM, Eckstrom E, Orkaby AR. Holistic frailty prevention: The promise of movement-based mind-body therapies. Aging Cell. Jan 2024;23(1):e13986. doi:10.1111/acel.13986
7. Parra DC, Wetherell JL, Van Zandt A, Brownson RC, Abhishek J, Lenze EJ. A qualitative study of older adults' perspectives on initiating exercise and mindfulness practice. BMC Geriatr. Dec 23 2019;19(1):354. doi:10.1186/s12877-019-1375-9
8. Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. Jan 31 2019;1(1):Cd012424. doi:10.1002/14651858.CD012424.pub2
9. Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. 2003;
10. Chang MY, Lin CL, Wu TM, Chu MC, Huang TH, Chen HY. Eight forms of moving meditation for preventing falls in community-dwelling middle-aged and older adults. Forsch Komplementmed. 2013;20(5):345-52. doi:10.1159/000355842
11. Li F, Harmer P, Fisher KJ, et al. Tai Chi and fall reductions in older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. Feb 2005;60(2):187-94. doi:10.1093/gerona/60.2.187
12. Iaboni A, Flint AJ. The complex interplay of depression and falls in older adults: a clinical review. Am J Geriatr Psychiatry. May 2013;21(5):484-92. doi:10.1016/j.jagp.2013.01.008
13. Kvelde T, McVeigh C, Toson B, et al. Depressive symptomatology as a risk factor for falls in older people: systematic review and meta-analysis. J Am Geriatr Soc. May 2013;61(5):694-706. doi:10.1111/jgs.12209
14. Gambaro E, Gramaglia C, Azzolina D, Campani D, Molin AD, Zeppegno P. The complex associations between late life depression, fear of falling and risk of falls. A systematic review and meta-analysis. Ageing Res Rev. Jan 2022;73:101532. doi:10.1016/j.arr.2021.101532
15. Kabataş Yıldız M, Orak OS. The effect of the Mindfulness-Based Stress Reduction program on the level of perceived stress and geriatric depression in older adults: a randomised controlled study. Psychogeriatrics. Mar 2023;23(2):261-272. doi:10.1111/psyg.12929
16. Devereux-Fitzgerald A, Powell R, French DP. The Acceptability of Physical Activity to Older Adults Living in Lower Socioeconomic Status Areas: A Multi-Perspective Study. Int J Environ Res Public Health. Nov 10 2021;18(22)doi:10.3390/ijerph182211784
17. Annear MJ, Cushman G, Gidlow B. Leisure time physical activity differences among older adults from diverse socioeconomic neighborhoods. Health Place. Jun 2009;15(2):482-490. doi:10.1016/j.healthplace.2008.09.005
18. Jiang Y, Wang M, Liu S, Ya X, Duan G, Wang Z. The association between sedentary behavior and falls in older adults: A systematic review and meta-analysis. Front Public Health. 2022;10:1019551. doi:10.3389/fpubh.2022.1019551
19. Choi SD, Andrade EL. Multiple-Level Fall Risks Associated with Socioeconomic Factors Among Community-Dwelling Older Adults: A Systematic Review. 2022:10-27.
20. Brady D, Kohler U, Zheng H. Novel Estimates of Mortality Associated With Poverty in the US. JAMA Intern Med. Jun 1 2023;183(6):618-619. doi:10.1001/jamainternmed.2023.0276
21. Maruszewska A, Ambroży T, Rydzik Ł. Risk factors and socioeconomic determinants of falls among older adults. Frontiers in Public Health. 2025;13:1571312.
22. Namoos A, Thomson N, Olson C, Aboutanos M. Physical Injury and Psychological Impact: Understanding the High Risk of Depression on Older Adults with Recurrent Falls. Advances in Geriatric Medicine and Research. 2024;6(4):e240008. e240008. doi:10.20900/agmr20240008
23. Hoang P, Moore K, Kwan M. Examining the Feasibility of a Mindfulness Intervention for the Prevention of Falls: A Pilot Study. Can J Aging. Dec 2020;39(4):626-633. doi:10.1017/S0714980820000033
24. Kakara R, Bergen G, Burns E. Understanding the association of older adult fall risk factors by age and sex through factor analysis. Journal of applied gerontology. 2023;42(7):1662-1671.
25. Thiamwong L, Xie R, Park J-H, Lighthall N, Loerzel V, Stout J. Optimizing a technology-based body and mind intervention to prevent falls and reduce health disparities in low-income populations: protocol for a clustered randomized controlled trial. JMIR research protocols. 2023;12(1):e51899.
26. Poverty Thresholds. The United States Census Bureau. Accessed October 5, 2025 https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html
27. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. Nov 1975;12(3):189-98. doi:10.1016/0022-3956(75)90026-6
28. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. Nov 2009;41(4):1149-60. doi:10.3758/BRM.41.4.1149
29. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. Journal of personality and social psychology. 2003;84(4):822.
30. Black DS, Sussman S, Johnson CA, Milam J. Psychometric assessment of the Mindful Attention Awareness Scale (MAAS) among Chinese adolescents. Assessment. Mar 2012;19(1):42-52. doi:10.1177/1073191111415365
31. Kroenke K, Spitzer RL, Williams JB. The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine. 2001;16(9):606-613.
32. Rubenstein LZ, Vivrette R, Harker JO, Stevens JA, Kramer BJ. Validating an evidence-based, self-rated fall risk questionnaire (FRQ) for older adults. Journal of safety research. 2011;42(6):493-499.
33. Nithman RW, Vincenzo JL. How steady is the STEADI? Inferential analysis of the CDC fall risk toolkit. Arch Gerontol Geriatr. Jul-Aug 2019;83:185-194. doi:10.1016/j.archger.2019.02.018
34. Xue Y, Lu J, Zheng X, et al. The relationship between socioeconomic status and depression among the older adults: the mediating role of health promoting lifestyle. Journal of affective disorders. 2021;285:22-28.
35. Pereira MEA, Santos GS, Almeida CR, et al. Association between Falls, Fear of Falling and Depressive Symptoms in Community-Dwelling Older Adults. Healthcare (Basel). Aug 16 2024;12(16)doi:10.3390/healthcare12161638
36. Kvelde T, McVeigh C, Toson B, et al. Depressive symptomatology as a risk factor for falls in older people: systematic review and meta‐analysis. Journal of the American Geriatrics Society. 2013;61(5):694-706.
37. Kim JH, Song JH, Wee JH, Lee JW, Choi HG. Depressive Symptoms, Subjective Cognitive Decline, and Subjective Sleep Quality Are Associated with Slips and Falls: Data from the Community Health Survey in Korean Adults. Gerontology. 2022;68(5):518-528. doi:10.1159/000518007
38. Potter GG. Depression and cognitive impairment in older adults. Psychiatric Times. 2007;24(13):23-23.
39. Forbes M, Lotfaliany M, Mohebbi M, et al. Depressive symptoms and cognitive decline in older adults. International psychogeriatrics. 2024;36(11):1039-1050.
40. Reangsing C, Rittiwong T, Schneider JK. Effects of mindfulness meditation interventions on depression in older adults: A meta-analysis. Aging Ment Health. Jul 2021;25(7):1181-1190. doi:10.1080/13607863.2020.1793901
41. Hofmann SG, Gómez AF. Mindfulness-Based Interventions for Anxiety and Depression. Psychiatr Clin North Am. Dec 2017;40(4):739-749. doi:10.1016/j.psc.2017.08.008
42. Fiocco AJ, Mallya S. The importance of cultivating mindfulness for cognitive and emotional well-being in late life. Journal of evidence-based complementary & alternative medicine. 2015;20(1):35-40.
43. Lee EKP, Wong B, Chan PHS, et al. Effectiveness of a mindfulness intervention for older adults to improve emotional well‐being and cognitive function in a Chinese population: A randomized waitlist‐controlled trial. International Journal of Geriatric Psychiatry. 2022;37(1)
44. Robinson JE, Kiely J. Preventing falls in older adults: can improving cognitive capacity help? Cogent Psychology. 2017;4(1):1405866.
45. Segev-Jacubovski O, Herman T, Yogev-Seligmann G, Mirelman A, Giladi N, Hausdorff JM. The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk? Expert review of neurotherapeutics. 2011;11(7):1057-1075.
46. Sardeli AV, Sartori CR, Santos WM, de Freitas Brandão A, Chacon-Mikahil MPT. Dispositional mindfulness influences the balance control in elderly. Journal of Innovation and Healthcare Management. 2019;2:1-9.
47. Szanton SL, Wenzel J, Connolly AB, Piferi RL. Examining mindfulness-based stress reduction: perceptions from minority older adults residing in a low-income housing facility. BMC Complement Altern Med. May 31 2011;11:44. doi:10.1186/1472-6882-11-44.
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Oct 8, 2025
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Mindfulness, Depression, and Fall Risk in Low-Income Older Adults: Original Research. (2025). Research in Health and Medicine, 5(1). https://doi.org/10.53520/rdhs2025.104164
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Copyright, 2025 by the authors. This work is licensed under the Creative Commons Attribution 4.0 International License.