Abstract
Background: Fear of falling has been linked to activity restriction, functional decline, decreased quality of life and increased risk of falling. Factors that distinguish persons with a high concern about falling from those with low concern have not been systematically studied. Objective: This study aimed to expose potential health-related, functional and psychosocial factors that correlate with fear of falling among independently living older women who had fallen in the past year. Methods: Baseline data of 409 women aged 70-80 years recruited to a randomised falls prevention trial (DEX) (NCT00986466) were used. Participants were classified according to their level of concern about falling using the Falls Efficacy Scale International (FES-I). Multinomial logistic regression analyses were performed to explore associations between health-related variables, functional performance tests, amount of physical activity, quality of life and FES-I scores. Results: 68% of the participants reported a moderate to high concern (FES-I ≥20) about falls. Multinomial logistic regression showed that highly concerned women were significantly more likely to have poorer health and quality of life and lower functional ability. Reported difficulties in instrumental activities of daily living, balance, outdoor mobility and poorer quality of life contributed independently to a greater concern about falling. Conclusions: Concern about falling was highly prevalent in our sample of community-living older women. In particular, poor perceived general health and mobility constraints contributed independently to the difference between high and low concern of falling. Knowledge of these associations may help in developing interventions to reduce fear of falling and activity avoidance in old age.
References
1.
Delbaere K, Close J, Brodaty H, Sachdev P, Lord S: Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study. BMJ 2010;341:c4165.
2.
Deshpande N, Metter E, Lauretani F, Bandinelli S, Guralnik J, Ferrucci L: Activity restriction induced by fear of falling and objective and subjective measures of physical function: a prospective cohort study. J Am Geriatr Soc 2008;56:615-620.
3.
Austin N, Devine A, Dick I, Prince R, Bruce D: Fear of falling in older women: a longitudinal study of incidence, persistence, and predictors. J Am Geriatr Soc 2007;55:1598-1603.
4.
Delbaere K, Crombez G, Vanderstraeten G, Willems T, Cambier D: Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study. Age Ageing 2004;33:368-373.
5.
Yardley L, Smith H: A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist 2002;42:17-23.
6.
Myers A, Powell L, Maki B, Holliday P, Brawley L, Sherk W: Psychological indicators of balance confidence: relationship to actual and perceived abilities. J Gerontol A Biol Sci Med Sci 1996;51:M37-M43.
7.
Friedman S, Munoz B, West S, Rubin G, Fried L: Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc 2002;50:1329-1335.
8.
Arfken C, Lach H, Birge S, Miller J: The prevalence and correlates of fear of falling in elderly persons living in the community. Am J Public Health 1994;84:565-570.
9.
Scheffer A, Schuurmans M, van Dijk N, van der Hooft T, de Rooij S: Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 2008;37:19-24.
10.
Lord S: Predictors of nursing home placement and mortality of residents in intermediate care. Age Ageing 1994;23:499-504.
11.
Filiatrault J, Desrosiers J, Trottier L: An exploratory study of individual and environmental correlates of fear of falling among community-dwelling seniors. J Aging Health 2009;21:881-894.
12.
Howland J, Lachman M, Peterson E, Cote J, Kasten L, Jette A: Covariates of fear of falling and associated activity curtailment. Gerontologist 1998;38:549-555.
13.
Zijlstra G, van Haastregt J, van Eijk J, van Rossum E, Stalenhoef P, Kempen G: Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing 2007;36:304-309.
14.
Kempen G, van Haastregt J, McKee K, Delbaere K, Zijlstra G: Socio-demographic, health-related and psychosocial correlates of fear of falling and avoidance of activity in community-living older persons who avoid activity due to fear of falling. BMC Public Health 2009;9:170.
15.
Lach H: Incidence and risk factors for developing fear of falling in older adults. Public Health Nurs 2005;22:45-52.
16.
Stretton C, Latham N, Carter K, Lee A, Anderson C: Determinants of physical health in frail older people: the importance of self-efficacy. Clin Rehabil 2006;20:357-366.
17.
Sharaf A Ibrahim H: Physical and psychosocial correlates of fear of falling among older adults in assisted living facilities. J Gerontol Nurs 2008;34:27-35.
18.
Uusi-Rasi K, Kannus P, Karinkanta S, et al: Study protocol for prevention of falls: a randomized controlled trial of effects of vitamin D and exercise on falls prevention. BMC Geriatr 2012;12:12.
19.
Podsiadlo D Richardson S: The timed ‘up & go': a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142-148.
20.
Guralnik J, Simonsick E, Ferrucci L, et al: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol Med Sci 1994;49:M85-M94.
21.
Guralnik J, Ferrucci L, Pieper C, et al: Lower extremity functions and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol Med Sci 2000;55A:M221-M231.
22.
Husu P, Suni J, Pasanen M, Miilunpalo S: Health-related fitness tests as predictors of difficulties in long-distance walking among high-functioning older adults. Aging Clin Exp Res 2007;19:444-450.
23.
Stewart A, Mills K, King A, Haskell W, Gillis D, Ritter P: CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci Sport Exer 2001;33:1126-1141.
24.
Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C: Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing 2005;34:614-619.
25.
Kempen G, Todd C, Van Haastregt J, et al: Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: results from Germany, the Netherlands and the UK were satisfactory. Disabil Rehabil 2007;29:155-162.
26.
FES-I-FIN Questionnaire: The UKK Institute for Health Promotion Research (online, updated 2011). Available at www.ukk-instituutti.fi/ammattilaisille/testaaminen/kaatumispelkokysely (accessed April 12, 2013).
27.
Delbaere K, Close J, Mikolaizak A, Sachdev P, Brodaty H, Lord S: The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age Ageing 2010;39:210-216.
28.
De Leo D, Diekstra R, Lonnqvist J, et al: LEIPAD, an internationally applicable instrument to assess quality of life in the elderly. Behav Med 1998;24:17-27.
29.
Bech P, Olsen L, Kjoller M, Rasmussen N: Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 mental health subscale and the WHO-five well-being scale. Int J Methods Psychiatr Res 2003;12:85-91.
30.
Bech P: Measuring the dimensions of psychological general well-being by the WHO-5. QoL Newslett 2004;32:15-16.
31.
Visschedijk J, Achterberg W, van Balen R, Hertogh C: Fear of falling after hip fracture: A systematic review of measurement instruments, prevalence, interventions, and related factors. J Am Geriatr Soc 2010;58:1739-1748.
32.
Evitt C, Quigley P: Fear of falling in older adults: a guide to its prevalence, risk factors, and consequences. Rehabil Nurs 2004;29:207-210.
33.
Seematter-Bagnoud L, Santos-Eggimann B, Rochat S, et al: Vulnerability in high-functioning persons aged 65 to 70 years: the importance of the fear factor. Aging Clin Exp Res 2010;22:212-218.
34.
Li F, Fisher K, Harmer P, McAuley E, Wilson N: Fear of falling in elderly persons: association with falls, functional ability, and quality of life. J Gerontol B Psychol Sci Soc Sci 2003;58:P283-P290.
35.
Karinkanta S, Piirtola M, Sievanen H, Uusi-Rasi K, Kannus P: Physical therapy approaches to reduce fall and fracture risk among older adults. Nat Rev Endocrinol 2010;6:396-407.
36.
Zijlstra G: Interventions to reduce fear of falling in community-living older people: a systematic review. J Am Geriatr Soc 2007;55:603-615.
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2013
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