The impact of fear of falling on health-related quality of life in community-dwelling older adults: mediating effects of depression and moderated mediation effects of physical activity

BACKGROUND

The fear of falling is a common issue among older adults that negatively affects physical and psychological aspects of health-related quality of life, regardless of actual fall events. Interventions aimed at reducing fear of falling, independent of falls, may improve older adults' quality of life. This study examined the moderated mediation effect of physical activity in how fear of falling affects health-related quality of life through depression in community-dwelling older adults.

METHODS

This study used secondary data from the Korea Centers for Disease Control and Prevention's 2019 Community Health Survey. The study included 73,738 adults aged 65 years or older. The researchers used the fear of falling scale, International Physical Activity Questionnaire, Patient Health Questionnaire-9, and EuroQol 5 Dimension as research tools, and performed descriptive statistics, Pearson's correlation coefficient, and SPSS PROCESS macro analysis. The study used the bootstrapping method to assess the adjusted mediating effect by resampling 5,000 times, and determined statistical significance with a 95% confidence interval.

RESULTS

In the model in which fear of falling affects health-related quality of life by mediating depression, the moderated mediation effect of physical activity was statistically significant, as the bootstrapping result did not include 0 in the 95% confidence interval (Index of moderated mediation [95% CI] = 0.006 [0.004-0.007], 0.008 [0.006-0.009]). Depression and health-related quality of life impairment decreased as the level of physical activity increased through inactivity, minimal activity, and health promotion activities, as the negative mediating effects decreased.

CONCLUSION

Physical activity reduces depression and improves health-related quality of life by influencing older adults' fear of falling. Community-based programs are needed to encourage and support older adults in maintaining moderate physical activity to manage the depression caused by fear of falling, which is common among older adults, and to improve their health-related quality of life.

Digital music and movement intervention to improve health and wellbeing in older adults in care homes: a pilot mixed methods study

BACKGROUND

Low physical activity among older adults is related to adverse health outcomes such as depression and loneliness, poor physical function and increased risk of falls. This study was designed to increase physical activity through a digital, group-based, physical activity and music intervention and to examine its effectiveness on social, mental and physical health outcomes.

METHODS

Participants were 34 older adults (65 years +) recruited across four care homes in Scotland to a pilot study. Surveys were administered at baseline and post-intervention, comprising measures of fear of falling, depression and anxiety, loneliness, sleep satisfaction and quality of life. A battery of physical function tests and saliva sampling for cortisol and dehydroepiandrosterone hormone analysis were also conducted at each time point. Additionally, process evaluation measures (recruitment, intervention fidelity, attendance, retention rates and safety) were monitored. The intervention comprised 12 weeks of three prescribed digital sessions per week: movement and music (n = 2) and music-only (n = 1), delivered by an activity coordinator in the care home. Post-intervention interviews with staff and participants were conducted to gain qualitative data on the acceptability of the intervention.

RESULTS

An average of 88% of prescribed sessions were delivered. Pre- to post-intervention intention-to-treat analysis across all participants revealed significant improvements in anxiety, salivary DHEA, fear of falling and loneliness. There were no significant improvements in health-related quality of life, perceived stress, sleep satisfaction or physical function tests, including handgrip strength. Qualitative analysis highlighted benefits of and barriers to the programme.

CONCLUSIONS

The digital movement and music intervention was deemed acceptable and delivered with moderate fidelity, justifying progression to a full-scale trial. Although a proper control group would have yielded more confident causal relationships, preliminary psychosocial and biological effects were evident from this trial. To show significant improvements in physical function, it is likely that a bigger sample size providing sufficient power to detect significant changes, greater adherence, longer intervention and/or higher exercise volume may be necessary.

TRIAL REGISTRATION

The trial is registered at ClinicalTrials.gov, number NCT05601102 on 01/11/2022.

Effect of fear of falling on turning performance among patients with chronic stroke

BACKGROUND

Turning difficulties have been reported in stroke persons, but studies have indicated that fall history might not significantly affect turning performance. Fear of falling (FOF) is common after a fall, although it can occur in individuals without a fall history.

RESEARCH QUESTION

Could FOF have an impact on turning performance among chronic stroke patients?

METHODS

This cross-sectional study recruited 97 stroke persons. They were instructed to perform 180° and 360° turns, and their performance was represented by angular velocity. FOF was evaluated using the Falls Efficacy Scale-International (FES-I). Falls that occurred 12 months prior to the study assessment were recorded.

RESULTS

A higher FES-I score was significantly correlated with a decline in angular velocity in all turning tasks after adjustment for demographic data. The correlation remained significant after controlling for falls history. Participants with a high level of FOF exhibited significantly slower angular velocities during all turning tasks compared with those with a low level of FOF. Participants with a moderate level of FOF had a significantly slower angular velocity than did those with a low level of FOF during the 360° turn to the paretic side only.

SIGNIFICANCE

A higher level of FOF, regardless of fall history, was significantly associated with a reduced angular velocity during turning. A high level of FOF affected turning performance in all tasks. Turning performance may not be affected by fall experience. Anxiety about falling may have a greater effect on turning performance than does fall history.

Impact of activity limitations due to fear of falling on changes in frailty in Korean older adults: a longitudinal study

This study investigated the frailty change patterns among Korean older adults during 2006-2020 and the effect of activity limitations induced by the fear of falling (FOF) on these patterns. We employed a descriptive longitudinal design utilizing data from Waves 1 to 8 of the Korean Longitudinal Study of Aging. The exclusion criteria were a baseline age < 65 years, frailty index (FI) captured only at baseline, and death or unknown survival status. Multilevel modeling, combining regression equations at two levels, was used to examine the effect of activity limitations due to FOF on frailty, adjusting for other confounding factors. An increase in FI (1.97; p < .001) was demonstrated in participants who had experienced falls versus those who had not in the past 2 years. Notably, those facing activity limitations due to FOF exhibited a more significant increase in FI (4.62; p < .001) compared with those without; frailty progression intensified over time in the former (0.54, p < .001). Activity limitations due to FOF had a more pronounced impact on frailty than falls; moreover, these activity limitations accelerated the progression of frailty. Healthcare providers must prioritize addressing FOF by employing both physical and psychological interventions to mitigate activity limitations and ultimately decelerate frailty.

Moving the needle on implementing fall prevention programs in Saudi Arabia: assessing knowledge and perceptions of fall risk among community-dwelling older women

BACKGROUND

Saudi Arabia, like many nations globally, is experiencing a demographic shift towards an aging population. With this demographic shift, falls and the fear of falling (FOF) emerge as serious public health concerns among community-dwelling older adults. Addressing misconceptions and enhancing awareness regarding fall risks among older adults holds significant importance, offering insights for informing targeted interventions and enhancing well-being. This study aimed to examine knowledge and perceptions of fall risk among community-dwelling older women in Saudi Arabia.

METHODS

A cross-sectional study was conducted with 150 Saudi older women, with a mean age (SD) of 63.98 (4.90) years. Participants completed questionnaires assessing fall history, fall knowledge, fall perception, the Falls Efficacy Scale-International (FES-I), Timed Up and Go (TUG), and the Barthel Index. Fall knowledge and perception were assessed using previously constructed statements translated into Arabic and carried out in interviewer-administered forms.

RESULTS

Nearly half of the participants reported experiencing at least one fall in the previous 12 months. Despite good knowledge of falls, some gaps were identified, particularly regarding the awareness of social isolation as a consequence of falls. Participants demonstrated positive perceptions towards fall prevention programs but also highlighted misconceptions regarding aging and falls. FOF was prevalent, with higher levels identified among participants without a history of falls.

CONCLUSION

Multidimensional strategies are needed to address falls and FOF among community-dwelling older women in Saudi Arabia. Leveraging existing knowledge and perceptions towards fall prevention and implementing evidence-based interventions can reduce the burden of falls and enhance health outcomes in older adults. Future research should focus on diverse samples and evaluate the feasibility of implementing fall prevention interventions within Saudi Arabia's healthcare systems.

Using machine learning algorithms to detect fear of falling in people with multiple sclerosis in standardized gait analysis

INTRODUCTION

Multiple sclerosis (MS) is the most common chronic inflammatory disease of the central nervous system. The progressive impairment of gait is one of the most important pathognomic symptoms which are associated with falls and fear of falling (FOF) in people with MS (pwMS). 60 % of pwMS show a FOF, which leads to restrictions in mobility as well as physical activity and reduces the quality of life in general. Therefore, early detection of FOF is crucial because it enables early implementation of rehabilitation strategies as well as clinical decision-making to reduce progression. Qualitative and quantitative evaluation of gait pattern is an essential aspect of disease assessment and can provide valuable insights for personalized treatment decisions in pwMS. Our objective was to identify the most appropriate clinical gait analysis methods to identify FOF in pwMS and to detect the optimal machine learning (ML) algorithms to predict FOF using the complex multidimensional data from gait analysis.

METHODS

Data of 1240 pwMS was recorded at the MS Centre of the University Hospital Dresden between November 2020 and September 2021. Patients performed a multidimensional gait analysis with pressure and motion sensors, as well as patient-reported outcomes (PROs), according to a standardized protocol. A feature selection ensemble (FS-Ensemble) was developed to improve the classification performance. The FS-Ensemble consisted of four filtering methods: Chi-square test, information gain, minimum redundancy maximum relevance and ReliefF. Gaussian Naive Bayes, Decision Tree, k-Nearest Neighbor, and Support Vector Machines (SVM) were used to identify FOF.

RESULTS

The descriptive analysis showed that 37 % of the 1240 pwMS had a FOF (n = 458; age: 51 ± 16 years, 76 % women, median EDSS: 4.0). The FS-Ensemble improved classification performance in most cases. The SVM showed the best performance of the four classification models in detecting FOF. The PROs showed the best F1 scores (Early Mobility Impairment Questionnaire F1 = 0.81 ± 0.00 and 12-item Multiple Sclerosis Scale F1 = 0.80 ± 0.00).

CONCLUSION

FOF is an important psychological risk factor associated with an increased risk of falls. To integrate a functional early warning system for fall detection into MS management and progression monitoring, it is necessary to detect the relevant gait parameters as well as assessment methods. In this context, ML strategies allow the integration of gait parameters from clinical routine to support the initiation of early rehabilitation measures and adaptation of course-modifying therapeutics. The results of this study confirm that patients' self-assessments play an important role in disease management.

Association between fear of falling and mortality in middle-aged and older adults: A systematic review and meta-analysis

BACKGROUND

Fear of falling (FOF) has emerged as a significant public health issue, contributing to excess disability among middle-aged and older adults. The association between FOF and mortality remains unclear.

METHODS

Prominent electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycINFO, Scopus, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang Database) were searched from inception until October 21, 2023 (data updated on June 9, 2024), for cohort or longitudinal studies investigating the association between FOF and mortality. The heterogeneity between studies was quantitatively assessed using I2. A fixed-effect model calculated the pooled effect size.

RESULTS

A total of seven cohort studies, including 27,714 participants, were analyzed in this systematic review and meta-analysis. The meta-analysis results demonstrated a positive association between FOF and mortality, with a significant increase in the risk of mortality for those with FOF (hazard ratio [HR]:1.29, 95 % confidence interval [CI]: 1.19-1.41, p < 0.05). Subgroup analysis indicated that age, male sex, clinical diagnosis of depression, number of chronic diseases, activity restriction due to FOF, and FOF levels were associated with mortality.

CONCLUSIONS

FOF and mortality have a positive association, which needs to be confirmed by further prospective studies with large samples and long-term follow-up to provide evidence for clinicians to intervene in FOF to reduce mortality in middle-aged and older adults.

Sarcopenia in older adults is associated with static postural control, fear of falling and fall risk: A study of Romberg test

BACKGROUND

As a geriatric syndrome, sarcopenia may exacerbate static postural control and increase fall risk among older adults. The Romberg test, a simple method to assess static postural control, has the potential to predict fall, but has rarely been used to assess static postural control and fall risk in sarcopenic older adults.

RESEARCH QUESTION

How does sarcopenia increase fall risk by affecting static postural control?

METHODS

Forty-four older adults performed the Romberg test and were included for analyses. Romberg parameters, including Center of Pressure (CoP), Center of Mass (CoM) and Displacement Angle (DA), were collected under eyes-open/eyes-closed conditions. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Fall risk was assessed using the Morse Elderly Fall Risk Assessment Scale (MFS), and fear of falling was evaluated using the Falls Efficacy Scale-International (FES-I). Multivariate linear regression models were conducted to examine the associations of sarcopenia with Romberg test parameters, fear of falling, and fall risk.

RESULTS

Sarcopenic older adults had higher scores of both fear of falling and fall risk (P<0.001 and =0.006, respectively), and worse static postural control parameters (P values ranging from <0.001-0.043) than healthy controls, demonstrated by the multivariate linear regression models. Most of the Romberg test parameters were significantly associated with fear of falling score, especially under eyes-closed condition, and fear of falling was further associated with higher fall risk score (β=0.90, P=0.001). Meanwhile, the presence of sarcopenia also significantly increased fall risk score (β=10.0, P<0.001).

SIGNIFICANCE

Sarcopenia may increase fall risk in older adults via worsen static postural control ability and increase fear of falling. Paying attention and making efforts to prevent sarcopenia may help to alleviate postural control dysfunction, decrease fear of falling, so as to reduce fall risk and prevent severe injuries caused by fall accidents.

The association of cardiometabolic multimorbidity and fear of falling among older adults: Data from the national health and aging trends study

OBJECTIVES

Cardiometabolic diseases (CMDs) have been individually associated with fall-related outcomes, but their combined effect on fear of falling (FOF) has not been investigated. This study aims to examine the association between cardiometabolic multimorbidity and FOF in older adults.

METHODS

Data from the National Health and Aging Trends Study, 4,295 community-dwelling older adults ≥ 65 years were analyzed in this longitudinal study. CMDs were assessed at baseline, including heart disease, diabetes, stroke, and hypertension. FOF was evaluated by asking participants if they worried about falling in the past month. Data were analyzed using multi-adjusted logistic regression.

RESULTS

Cardiometabolic multimorbidity was associated with a higher risk of FOF. The combination of heart disease and diabetes showed the highest risk of FOF (OR = 3.47, 95 % CI: 1.63-7.40).

CONCLUSIONS

These findings underscore the need for targeted interventions to mitigate the combined impact of cardiometabolic multimorbidity on FOF in older adults.

Effect of Otago exercise on fear of falling in older adults: a systematic review and meta-analysis

BACKGROUND

Approximately 40-70% of older adults who have experienced falls develop fear of falling (FOF), with the incidence rate in nursing home residents reaching as high as 79.4%. An increasing number of studies have focused on the effect of the Otago Exercise Programme (OEP) on reducing FOF among older adults, yet comprehensive analysis is lacking due to regional and demographic variations. Therefore, this study integrates the relevant literature to provide evidence supporting interventions aimed at alleviating FOF among older adults.

OBJECTIVE

To evaluate the impact of OEP on FOF in older adults through meta-analysis.

METHODS

We searched ten databases using computer systems, covering all records up to May 1, 2024. Two researchers independently conducted the literature screening, bias risk assessment, and data extraction. We performed data analysis using RevMan 5.3 and Stata 15.0 software, assessed result stability through sensitivity analysis, and examined publication bias with funnel plots and Egger's test.

RESULTS

Sixteen RCTs were included. Meta-analysis revealed that the OEP significantly reduced FOF among older adults [SMD = 0.96, 95%CI (0.68, 1.23), P < 0.00001]. Subgroup analysis revealed that interventions lasting more than 16 weeks [SMD = 1.12, 95%CI (0.75, 1.49), P < 0.00001], with a frequency of more than twice a week [SMD = 0.99, 95%CI (0.64, 1.35), P < 0.00001], and for older adults in community and nursing institutions [SMD = 1.03, 95%CI (0.50, 1.57), P = 0.0002] were more effective. A comparison of the 16-week and 24-week interventions revealed that the latter had better outcomes [SMD = 0.87, 95%CI (0.66, 1.08), P = 0.0004].

CONCLUSION

Current evidence indicates that OEP effectively reduces FOF among older adults. It is recommended that interventions last for more than 24 weeks, occur more than twice a week, and suitable for application among older adults in community settings or elder care institutions.

The association of fear of falling and falls with sedentary behavior in people with multiple sclerosis

OBJECTIVE

Sedentary behavior, falls, and fear of falling (FoF) are specific concerns for people with MS (pwMS). Considering the relatively high incidence and potential linkage, it is surprising that this triple relationship has as yet not been extensively investigated in pwMS. Thus, the present study aimed to examine the correlates of sedentary behavior with FoF and falls in pwMS.

METHODS

Fifty pwMS, 30 women, were admitted to this cross-sectional study. Primary outcome measures included physical activity and sedentary behavior metrics measured by accelerometry, fall status, and FoF. Additional measures included mobility clinical tests, cognition, perceived fatigue, depression, and anxiety. The sample was divided into two subgroups according to the daily Metabolic Equivalent of Task (MET) rate scores; <1.5 was defined as sedentary, ≥1.5 were defined as non-sedentary. Multivariate analysis of variance and linear regression analyses assessed the relationships by using an alpha of 0.05.

RESULTS

Sixty-four percent of the sample were classified as sedentary. The sedentary subgroup reported more FoF than the non-sedentary subgroup (32.5 (S·D. = 11.3) vs. 29.9 (S.D. = 9.5); however, no differences were found in fall status between the subgroups. No differences were found for depression, anxiety, cognition, and perceived fatigue between the subgroups. Furthermore, according to the linear regression analysis, FoF explained 23.9% of the variance pertaining to the daily MET rate when controlling for age, gender, disease duration, and disability.

CONCLUSIONS

Clinicians are encouraged to incorporate the issue of FoF during standard management, which may represent an opportunity to improve care and reduce sedentary behavior in pwMS.

Information processing speed and disease severity predict real-world ambulation in persons with multiple sclerosis

BACKGROUND

Impairments in real-world gait quality and quantity are multifaceted for individuals with multiple sclerosis (MS), encompassing mobility, cognition, and fear of falling. However, these factors are often examined independently, limiting insights into the combined contributions they make to real-world ambulation.

RESEARCH QUESTION

How do mobility, cognition, and fear of falling contribute to real-world gait quality and quantity in individuals with MS?

METHODS

Twenty individuals with MS underwent a series of cognitive assessments, including the Paced Auditory Serial Addition Test (PASAT), Symbol Digits Modalities Test (SDMT), Stroop Test, and the Selective Reminding Test (SRT). Participants also completed the Falls Efficacy Scale - International (FES-I) and walking impairment using the Patient Determined Disease Steps (PDDS). Following the in-lab session, participants wore an inertial sensor on their lower back and asked to go about their typical daily routines for three days. Metrics of gait speed, stride regularity, time spent walking, and total bouts were extracted from the real-world data.

RESULTS

Significant correlations were found between both real-world gait speed and stride regularity and the SDMT, FES-I, and PDDS. Backward linear regression analysis was conducted for gait speed and stride regularity, with PDDS and SDMT included in the final model for both metrics. These variables explained 63% of the variance in gait speed and 69% of the variance in stride regularity. Results were not significant for gait quantity after adjusting for age and sex.

SIGNIFICANCE

The study's results provide insight regarding the roles of cognition, walking impairment, and fear of falling on real-world ambulation. Deeper understanding of these contributions can inform the development of targeted interventions that aim to improve walking. Additionally, the absence of significant correlations between gait metrics, cognition, and fear of falling with gait quantity underscores the need for further research to identify factors that increased walking in this population.

Falls prevention is more than just promoting physical health: evaluation of the group-based, out-patient prevention program 'Staying safe and active in old age - falls prevention'

Introduction

The aim of this study was to evaluate the German falls prevention program 'Staying safe and active in old age - falls prevention', which is already established in practice.

Methods

The single-arm intervention study consisted of two time points, 6 months apart, to evaluate the multifactorial falls prevention program (n = 125 at Time 2). We observed the groups and their trainers and assessed which behavior change techniques (BCTs) were used. According to our evaluation framework, changes in the following three domains were assessed: (a) fall-related variables (i.e. number of falls, fear of falling), (b) physical functioning (i.e. performance-based gait speed, coordination, self-reported leg strength, balance, as well as habitual execution of the exercises), and (c) psychosocial functioning (i.e. quality of life, activities of daily living, mobility, and loneliness). Linear mixed models were used to determine changes in each variable.

Results

Demonstration of behavior was the most frequently used BCT. The program showed significant benefits for fear of falling, balance, coordination, habitual execution, and loneliness over time (Cohen's d between -0.59 and 1.73). Number of falls, gait speed, coordination (dual task), activities of daily living, and quality of life were maintained (Cohen's d between -0.26 and 0.30), whereas leg strength and mobility decreased significantly at Time 2 (Cohen's d = -0.55 and -0.36).

Discussion

Group-based falls prevention programs may facilitate social integration among older adults and may also enhance and maintain physical functioning in old age.Trial registration: German Clinical Trials Register identifier: DRKS00012321.

Prevalence and Factors Associated with Fear of Falling in the Elderly Attending a Tertiary Hospital in South-South Nigeria

BACKGROUND

Fear of falling is a loss of confidence in balance which affects the quality of life of the elderly. Falls in older people can result in disability, death, financial stress on the family, and higher medical expenses. A significant proportion of those who fall are said to be afraid of falling. This study determined the prevalence and the factors associated with the fear of falling in the elderly attending the Rivers State University Teaching Hospital, Port Harcourt.

METHODS

This was a cross-sectional study of patients, 60 years and older, attending the Family Medicine clinic in the hospital. A questionnaire was used to collect data on the socio-demographic characteristics, history of chronic illness and lifestyle of the respondents. It also included the Modified Fall Efficacy scale to assess the fear of falling in the respondents and the functional assessment of the respondents was also carried out using the Timed Up and Go Test (TUG). Descriptive analysis and logistic regression were done to determine the factors associated with the fear of falling in the elderly.

RESULTS

A total of 292 patients consented to participate, Fear of falling was prevalent in 58 (19.9%) of the participants. The female gender was found to have 50% lower odds of having a fear of falling than their male counterparts (O.R.=0.541, 95% C. I=0.327-0.896) An association was found between reduced frequency of physical activity and fear of falling. (χ2=10.25 P-value=0.006) An association was found between fear of falling and TUG as those with a fear of falling took a longer time to complete the TUG test.

CONCLUSION

The study suggests that healthcare professionals should routinely investigate the fear of falling in geriatric care to devise preventive and intervention strategies to combat the fear of falling among the elderly.

A mixed-methods study examining perceptions of fear of falling among community-dwelling people who use wheelchairs full-time

Objective: There is growing evidence that fear of falling (FOF) is common in people who use wheelchairs full-time and negatively influence their performance of daily activities and quality of life. The purpose of this study was to gain an in-depth understanding of perceptions related to FOF among people who use wheelchairs full-time.Methods: Mixed-method analysis was conducted using semi-structured interviews and surveys to gain insight into FOF. Surveys included demographic information; Spinal Cord Injury-Fall Concerns Scale (SCI-FCS); a questionnaire that directly assesses FOF and associated activity curtailment; and Fall Control Scale (FCS).Results: Among 39 participants (age = 43.1 ± 15.6 years, disability duration = 21.2 ± 11.1 years), 27 participants (69%) reported FOF. Participants with less perceived ability to control falls indexed by FCS reported higher SCI-FCS scores, indicating greater FOF (rs = -0.384, p = 0.016). Qualitative findings revealed that participants felt that FOF developed due to sustaining fall-related injuries or limited ability to recover from a fall. Some participants perceived falling as a part of their lives. They believed that it was not the cause of developing FOF.Conclusions: Among people who use wheelchairs full-time, FOF is prevalent and may develop due to fears of sustaining injuries or being unable to get up after falling. Developing an evidenced-based education protocol aimed at managing falls (e.g., establishing a fall recovery strategy and education on techniques to reduce injury during falls) is needed to minimize FOF people who use wheelchairs full-time.

Relationship between fear of falling and quality of life in nursing home residents: The role of activity restriction

This study investigates the mediating role of activity restriction in the relationship between the fear of falling and health outcomes. This was a cross-sectional study with convenience sampling of 316 nursing home residents. Generalized structural equation modeling was conducted to test the mediating role. The results showed that residents with fear of falling were more likely to restrict their activities and residents who often or always restricted activities reported lower levels of quality of life and higher levels of depression. Severe activity restriction accounted for 75 % of the total effect of fear of falling on quality of life and 69 % of the total effect of fear of falling on depression. Fall prevention efforts should focus on strategies or interventions to reduce residents' excessive fear of falling and promote activity engagement. Physical and social activities will not only prevent future falls but also improve residents' quality of life and mental health.

Walking (and talking) the plank: dual-task performance costs in a virtual balance-threatening environment

We evaluated the effects of engaging in extemporaneous speech in healthy young adults while they walked in a virtual environment meant to elicit low or high levels of mobility-related anxiety. We expected that mobility-related anxiety imposed by a simulated balance threat (i.e., virtual elevation) would impair walking behavior and lead to greater dual-task costs. Altogether, 15 adults (age = 25.6 ± 4.7 yrs, 7 women) walked at their self-selected speed within a VR environment that simulated a low (ground) and high elevation (15 m) setting while speaking extemporaneously (dual-task) or not speaking (single-task). Likert-scale ratings of cognitive and somatic anxiety, confidence, and mental effort were evaluated and gait speed, step length, and step width, as well as the variability of each, was calculated for every trial. Silent speech pauses (> 150 ms) were determined from audio recordings to infer the cognitive costs of extemporaneous speech planning at low and high virtual elevation. Results indicated that the presence of a balance threat and the inclusion of a concurrent speech task both perturbed gait kinematics, but the virtual height illusion led to increased anxiety and mental effort and a decrease in confidence. The extemporaneous speech pauses were longer on average when walking, but no effects of virtual elevation were reported. Trends toward interaction effects arose in self-reported responses, with participants reporting more comfort walking at virtual heights if they engaged in extemporaneous speech. Walking at virtual elevation and while talking may have independent and significant effects on gait; both effects were robust and did not support an interaction when combined (i.e., walking and talking at virtual heights). The nature of extemporaneous speech may have distracted participants from the detrimental effects of walking in anxiety-inducing settings.

The influence of false interoceptive feedback on emotional state and balance responses to height-induced postural threat

Postural threat elicits a robust emotional response (e.g., fear and anxiety about falling), with concomitant modifications in balance. Recent theoretical accounts propose that emotional responses to postural threats are manifested, in part, from the conscious monitoring and appraisal of bodily signals ('interoception'). Here, we empirically probe the role of interoception in shaping emotional responses to a postural threat by experimentally manipulating interoceptive cardiac feedback. Sixty young adults completed a single 60-s trial under the following conditions: Ground (no threat) without heart rate (HR) feedback, followed by Threat (standing on the edge of a raised surface), during which participants received either false heart rate feedback (either slow [n = 20] or fast [n = 20] HR feedback) or no feedback (n = 20). Participants provided with false fast HR feedback during postural threat felt more fearful, reported feeling less stable, and rated the task more difficult than participants who did not receive HR feedback, or those who received false slow HR feedback (Cohen's d effect size = 0.79 - 1.78). However, behavioural responses did not significantly differ across the three groups. When compared to the no HR feedback group, false slow HR feedback did not significantly affect emotional or behavioural responses to the postural threat. These observations provide the first experimental evidence for emerging theoretical accounts describing the role of interoception in the generation of emotional responses to postural threats.

The global prevalence of and risk factors for fear of falling among older adults: a systematic review and meta-analysis

BACKGROUND

As a common psychological problem among older adults, fear of falling was found to have a wide range prevalence in different studies. However, the global prevalence of it was unknown and a lack of the large sample confirmed its risk factors.

OBJECTIVES

To report the global prevalence of fear of falling and to explore its risk factors among older adults for further developing precise interventions to systematically manage FOF.

DESIGN

A systematic review and meta-analysis was conducted by PRISMA guidelines.

METHODS

Searches were conducted in PubMed, Web of Science, EMBASE, the Cochrane Library and the manual search in August 20, 2022, updated to September 2, 2023. Observational studies published in English were included and two researchers independently screened and extracted the data. Fixed or random effects mode was used to estimate the pooled prevalence of and risk factors for fear of falling. Heterogeneity resources were analyzed by subgroup and sensitivity analysis. Publication bias was assessed through funnel plots, Egger's test and Begg's test.

RESULTS

A total of the 153 studies with 200,033 participants from 38 countries worldwide were identified. The global prevalence of fear of falling was 49.60%, ranging from 6.96-90.34%. Subgroup analysis found the estimates pooled prevalence of it was higher in developing countries (53.40%) than in developed countries (46.7%), and higher in patients (52.20%) than in community residents (48.40%). In addition, twenty-eight risk factors were found a significant associations with fear of falling, mainly including demographic characteristics, physical function, chronic diseases and mental problems.

CONCLUSION

The global prevalence of FOF was high, especially in developing countries and in patients. Demographic characteristics, Physical function, chronic diseases and mental problems were a significant association with FOF. Policy-makers, health care providers and government officials should comprehensively evaluate these risk factors and formulate precise intervention measures to reduce FOF.

TRIAL REGISTRATION

The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD42022358031.

Fear of falling and common symptoms of multiple sclerosis: Physical function, cognition, fatigue, depression, and sleep - A systematic review

BACKGROUND

Fear of falling (FOF) is a common concern among persons with multiple sclerosis (MS) and affects the performance of their daily living activities. Falls may result in FOF, leading to worsening of symptoms of MS, physical deconditioning, and exposure to future falls. This may trigger a vicious cycle between FOF and falls. A better understanding of the relationship between FOF and symptoms of MS may be helpful to develop a conceptual model to guide fall prevention interventions.

OBJECTIVE

To synthesize the correlational and predictive relationships between FOF and common symptoms of MS.

METHODS

Databases including PubMed, Embase, Web of Science, Scopus, CINHAL, PsycINFO, and SPORTDiscuss were searched from inception to October 2023. Studies examining correlations and/or predictions between FOF and common MS symptoms that include measures of gait, postural control, fatigue, cognition, pain, sleep, depression, and anxiety were identified by two independent reviewers. Both reviewers also conducted the methodological quality assessment of the included studies.

RESULTS

Twenty-three studies with a total of 2819 participants were included in the review. Correlational findings indicated that increased FOF was significantly associated with greater walking deficits (lower gait speed, smaller steps), reduced mobility, and poorer balance. Increased FOF was also significantly correlated with higher cognitive impairments, more fatigue, sleep disturbances, and depression. Decreased gait parameters, reduced balance, lower physical functions, cognitive impairments, and sleep deficits were found as significant predictors of increased FOF.

CONCLUSION

Evidence indicates significant correlational and bidirectional predictive relationships exist between FOF and common MS symptoms. A comprehensive conceptual framework accounting for the interaction between FOF and MS symptoms is needed to develop effective falls prevention strategies.

Factors associated with concerns about falling and activity restriction in older adults after hip fracture: a mixed-methods systematic review

PURPOSE

To investigate factors contributing to concerns about falling and activity restriction in the community among older adults who had a hip fracture.

METHODS

A mixed method systematic review with a convergent segregated approach. We searched Medline, Embase, PsycInfo, PEDRo, CINAHL and the Cochrane library. Results were synthesised narratively considering physical, psychological, environmental, care, and social factors and presented in tables. Critical appraisal was completed in duplicate.

RESULTS

We included 19 studies (9 qualitative, 9 observational, 1 mixed methods) representing 1480 individuals and 23 factors related to concerns about falling and activity restriction. Physical factors included falls history, comorbidities, balance, strength, mobility and functionality. Psychological factors included anxiety and neuroticism scores, perceived confidence in/control over rehabilitation and abilities, and negative/positive affect about the orthopaedic trauma, pre-fracture abilities and future needs. Environmental factors included accessibility in the home, outdoors and with transport. Social and care factors related to the presence or absence of formal and informal networks, which reduced concerns and promoted activity by providing feedback, advice, encouragement, and practical support.

CONCLUSION

These findings highlight that to improve concerns about falling and activity restriction after hip fracture, it is important to: improve physical and functional abilities; boost self-confidence; promote positive affect; involve relatives and carers; increase access to clinicians, and; enhance accessibility of the home, outdoors and transport. Most factors were reported on by a small number of studies of varying quality and require replication in future research.

Physical-activity interventions to reduce fear of falling in frail and pre-frail older adults: a systematic review of randomized controlled trials

BACKGROUND

Frailty in older adults leads to progressive deterioration of their physical condition and makes them prone to develop Fear of Falling (FoF). Physical-activity interventions appear to be effective in managing the components of frailty but there is no clear evidence to determine whether physical-activity may affect FoF in frail and pre-frail older adults.

OBJECTIVE

Τhis systematic literature review aims to synthesize evidence on the relationship between the physical interventions to ameliorate balance, strength, and mobility and FoF reduction in frail and pre-frail older adults.

METHODS

Studies assessing physical-activity interventions for frail and pre-frail older adults aged 60 years and older were identified in English through searches in PubMed, ScienceDirect, and Cochrane Central Register of Controlled Trials databases till February 2023. Study quality was assessed, and a qualitative synthesis of results was performed.

RESULTS

A total of 13 studies published were included. All of them were Randomized Control Trials and the most frequent assessment tool used to assess FoF (10 of 13 studies) was the Fall Efficacy Scale-International (FES-I). Six studies were assessed as having a low risk of bias. Cumulatively, the findings of this review indicate that physical-activity interventions are effective in reducing the FoF of frail and pre-frail older adults.

CONCLUSION

The results are encouraging and recapitulate the positive role of physical interventions in FoF reduction. However, future research would benefit from longer follow-up periods, longer intervention duration, and participation of interdisciplinary teams.

Effects of body awareness therapy on balance and fear of falling in patients with chronic obstructive pulmonary disease: a randomized controlled trial

BACKGROUND

Assessment of extrapulmonary comorbidities is essential in chronic obstructive pulmonary disease (COPD). Deterioration of balance and increasing fear of falling are two of the most significant extrapulmonary manifestations. Although pulmonary rehabilitation (PR) is well-known and effective for COPD patients, there is a need for alternative treatments to enhance balance and alleviate concerns about falling. This study aimed to investigate the effect of Body Awareness Therapy (BAT), in addition to the PR program, on balance and fear of falling in patients with COPD.

METHODS

Forty-three patients were randomized into two groups: the BAT + PR group (BAT: once a week, 60 min + PR: 30 min, seven days of the week) or the PR group (PR: 30 min, seven days of the week) for eight weeks. Primary (balance, fear of falling) and secondary (dyspnea, muscle strength, functional capacity) outcomes were assessed at two different times: the baseline and end of the eight weeks.

RESULTS

Significant improvements were found in dynamic balance (reaction time η2 = 0.777, movement velocity η2 = 0.789, endpoint excursion η2 = 0.687, maximal excursion η2 = 0.887), static balance on firm ground (eyes opened η2 = 0.679, eyes closed η2 = 0.705), dyspnea (η2 = 0.546), muscle strength (η2 = 0.803), and functional capacity (η2 = 0.859) of the BAT + PR group (p < 0.05 for all). The improvement in fear of falling was significantly greater in the BAT + PR group than in the PR group (p < 0.001, η2 = 0.331).

CONCLUSION

The BAT method added to PR was more effective than PR alone in improving balance and reducing the fear of falling in COPD patients.

TRIAL REGISTRATION

This randomized controlled study was registered at clinicaltrials.gov, NCT04212676 , Registered 28 December 2019.

Poor sleep health predicts the onset of a fear of falling among community-dwelling older adults

INTRODUCTION

A greater fear of falling predicts disability, falls, and mortality among older adults. Although poor sleep has been identified as a relevant risk factor for fear of falling among older adults, evidence is primarily shown in cross-sectional studies using isolated sleep characteristics. Less is known about whether prior fall experiences change the sleep health-fear of falling link among older adults. We investigated the longitudinal relationship between sleep health and the incidence of fear of falling among community-dwelling older adults and how the association differed between those with or without prior fall experiences.

METHODS

Data were from individuals who completed the sleep module in the National Health and Aging Trends Study (2013-2014; n = 686). Fear of falling was assessed with a single item. Multidimensional sleep health was measured with self-reported sleep items based on the SATED model (ie, sleep satisfaction, daytime alertness, timing, efficiency, and duration). Covariates included sociodemographics, assistive device usage, health, risky behavior, and sleep medications. Multiple logistic regression was used to analyze the data.

RESULTS

Poor sleep health was associated with the onset of fear of falling at 1-year follow-up (odds ratios=1.20, 95% confidence interval=1.02-1.41). Moreover, poor sleep health increased the odds of having fear of falling among individuals without prior falls experiences and elevated the already heightened risks of developing fear of falling among those who fell at baseline.

CONCLUSIONS

Given that fear of falling and experiencing a fall each increase the risk of the other occurring in the future, improving sleep health may prevent older adults from stepping into the vicious cycle of fear of falling and falls.

Demographics moderated the association of symptom burden with falls and fall-related outcomes

OBJECTIVES

To examine whether (1) prior-year symptom burden predicted later-year falls and fall-related outcomes and (2) demographics moderated the longitudinal effects of symptom burden on falls and fall-related outcomes among community-dwelling older adults.

METHODS

We used 2011-2018 National Health and Aging Trends Study data that included 9,060 community-dwelling older adults (contributed 34,327 observations). Falls and fall-related outcomes included self-reported falls, multiple falls, fear of falling (FOF), and FOF limiting activity. Symptom burden was defined as the presence of pain, insomnia, breathing difficulty, depressive symptoms, anxiety, and fatigue, and calculated the number of symptoms (range from 0 to 6). Binomial logistic regression was used to examine the associations between symptom burden and falls and fall-related outcomes and the moderation effects of demographic factors.

RESULTS

The majority of the sample were aged between 65 and 79 years old (57.7%), non-Hispanic White (70.5%), and female (58.4%). Each additional symptom was associated with an increased risk of falls (Adjusted Odds Ratio [AOR]: 1.13, 95% CI: 1.10-1.15), multiple falls (AOR: 1.15, 95% CI: 1.12-1.18), FOF (AOR: 1.20, 95% CI: 1.18-1.23), and FOF limiting activity (AOR: 1.24, 95% CI: 1.20-1.28). Age, race/ethnicity, education, and living arrangement statistically significantly moderated the relationships between symptom burden and falls and fall-related outcomes.

CONCLUSIONS

Symptom burden predicted falls, multiple falls, FOF and FOF limiting activity, and demographics may differentially modify this risk. Individually tailored symptom assessment and management plans should be incorporated into fall risk assessment and interventions for community-dwelling older adults living.