Fear of falling among community-dwelling older adults: A scoping review to identify effective evidence-based interventions

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.

Association between Falls, Fear of Falling and Depressive Symptoms in Community-Dwelling Older Adults

BACKGROUND

Longevity increases pose public health challenges, especially in managing falls and their psychological impacts on older adults. Limited evidence exists on the relationship between a fear of falling (FOF), previous falls, and depressive symptoms among community-dwelling older adults.

OBJECTIVE

To evaluate the association between falls, FOF, and depressive symptoms in community-dwelling older adults.

METHODS

This cross-sectional study, conducted in 2018, included 400 older adults from a Basic Health Unit in São Paulo, Brazil. The Geriatric Depression Scale (GDS-15) and the International Falls Efficacy Scale (FES-I) were used, along with self-report questionnaires on fall history. Linear and logistic regression were used to analyze the relationships between variables.

RESULTS

The mean age was 75.2 (SD = 8.53) years, with 63.2% being female. Depressive symptoms were observed in 18.3% of the participants, while 90.5% reported a fear of falling (FOF). More than half (63.0%) experienced falls, with 49.5% occurring in the last year. Factors such as the female gender, negative health perceptions, and functional dependence were associated with depressive symptoms. Adjusted analyses indicated that both a fear of falling (FOF) (B = 0.043; p = 0.012) and a history of falls (B = 0.725; p = 0.015) were associated with depressive symptoms.

CONCLUSIONS

Falls, FOF, and depressive symptoms are interlinked among older adults, underscoring the need for targeted interventions to improve their mental and physical health.

Fear of Falling Carries Over into Overprotection in Old Age: A Cross-Lagged Panel Analysis

Fear of falling might result in overprotection by one's social environment. In turn, feeling dependent could increase fear of falling. However, the association between fear of falling and perceived overprotection and its temporal order is unknown. This longitudinal study explores this potential mutual longitudinal association. This study presents secondary analyses from a larger trial. We tested the association between fear of falling and perceived overprotection in a cross-lagged path model controlled for falls, health-related quality of life, age, gender, and trial condition. N = 310 participants (M = 70 years, range: 64-92) completed self-reports at Time 1, 7 (Time 2), and 11 weeks (Time 3) after baseline assessment. We found a positive association from fear of falling to perceived overprotection (β = .12, 95% CI[0.02, 0.21], p = .02; β = .10; [0.01, 0.18], p = .03). The reversed cross-lagged paths were not significant. Findings suggest higher fear of falling translates into perceived overprotection, which may in turn increase loss of independence in old age.

The relationship between fear of falling and functional ability following a multi-component fall prevention program: an analysis of clinical data

OBJECTIVES

The first objective was to evaluate clinical data from a multi-component fall prevention program. The second objective was to explore the relationship between physical function and fear of falling (FoF).

METHODS

Adults (N = 287, mean age = 76 years) who participated in the Building Balance Program between 2011-2020 were assessed with five physical function measures and two FoF measures. Repeated measures ANOVA controlling for age and sex were performed to assess change from baseline. Linear regressions were conducted to evaluate how physical function explained variations in FoF.

RESULTS

There were significant improvements between pre and post-program Berg Balance Scale (BBS) scores (p < .001), Timed-Up and Go (TUG) times (p < .001), 30 second Chair-Stand (30 CST repetitions) (p < .001), Functional Reach (FR) distance (p < .001), gait speed (p < .001), single item-FoF score (p < .001), and short Falls Efficacy Scale-International (FES-I score) (p < .001). After controlling for sex on all regression analyses, age, and pre-program gait speed explained variations in pre-program short FES-I scores (Adjusted R2 = 0.19). Age, pre-program BBS and 30 CST repetitions explained variations in pre-program level of FoF (Adjusted R2 = 0.25). Variations in post-program short FES-I scores (Adjusted R2 = 0.17) were explained by age, post-program TUG times and FR distance after controlling for age and sex. Robust regressions indicated variations in post-program level of FoF explained by age, post-program TUG and FR distance with a two-way interaction between age and FR.

CONCLUSION

A multi-component fall prevention program improved physical function and decreased FoF. A small association between physical function and FoF similar between pre- and post-program conditions was identified.

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.

Development of Fear of Falling after proximal femoral fracture

Background: Proximal femoral fracture is common in older people. Beyond a long recovery process and significant permanent functional limitations, older people often experience subsequent Fear of Falling. The phenomenon of Fear of Falling is not fully understood; qualitative research is underrepresented but can provide insights into the experience of those affected. Objectives: We aimed to explore the experiences of Fear of Falling development and to what extent it affects peoples' life after proximal femoral fracture. Methods: We conducted semi-structured, in-depth interviews with nine older people, aged between 61 and 88, who participated in a prospective observational study. Interview data were analysed through inductive content analysis. Results: Six major themes emerged: The development of Fear of Falling; the effect of FoF and hope for recovery; alternating between moments of fear and security; fear of helplessness and of losing independence; strategies for dealing with Fear of Falling and maintaining independence; need of support by health care professionals. Conclusion: To identify and support older people in coping with Fear of Falling (after proximal femoral fracture), strategies for dealing with Fear of Falling across occupational groups and all healthcare settings should be implemented. Nurses have a key role in this process.

Prevalence and outcomes of fear of falling in older adults with falls at the emergency department: a multicentric observational study

PURPOSE

Fear of falling (FOF) may result in activity restriction and deconditioning. The aim of the study was to identify factors associated with FOF in older patients and to investigate if FOF influenced long-term outcomes.

METHODS

Multicentric, observational, prospective study including patients 65 years or older attending the emergency department (ED) after a fall. Demographical, patient- and fall-related features were recorded at the ED. FOF was assessed using a single question. The primary outcome was all-cause death. Secondary outcomes included new fall-related visit, fall-related hospitalisation, and admission to residential care. Logistic regression and Cox regression models were used for statistical analyses.

RESULTS

Overall, 1464 patients were included (47.1% with FOF), followed for a median of 6.2 years (2.2-7.9). Seven variables (age, female sex, living alone, previous falls, sedative medications, urinary incontinence, and intrinsic cause of the fall) were directly associated with FOF whereas use of walking aids and living in residential care were inversely associated. After the index episode, 748 patients (51%) died (median 3.2 years), 677 (46.2%) had a new fall-related ED visit (median 1.7 years), 251 (17.1%) were hospitalised (median 2.8 years), and 197 (19.4%) were admitted to care (median 2.1 years). FOF was associated with death (HR 1.239, 95% CI 1.073-1.431), hospitalisation (HR 1.407, 95% CI 1.097-1.806) and institutionalisation (HR 1.578, 95% CI 1.192-2.088), but significance was lost after adjustment.

CONCLUSION

FOF is a prevalent condition in older patients presenting to the ED after a fall. However, it was not associated with long-term outcomes. Future research is needed to understand the influence of FOF in maintenance of functional capacity or quality of life.

Fear of falling, quality of life, and daily functional activity of elderly women with and without a history of falling: a cross-sectional study

Background

This study aimed to evaluate the fear of falling, quality of life, and daily functional activity of older women aged 60 years or older with or without a history of falling.

Materials and methods

Two hundred older adult women were recruited for the cross-sectional study in Iran. This cross-sectional study collected data from July to August 2023 through convenience sampling. The researchers collected data using a five-part questionnaire, that collected information that included demographic characteristics, the Fall Efficacy Scale in the Elderly-International Version (FES-I), 12-item Quality of Life assessment (SF-12), Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL).

Results

FES-I score in older women with a history of falls was significantly higher than those without a history of falls [median: 38.0, interquartile range (IQR): 31.5-44.0 versus median: 22.0, IQR: 20.0-30.0; P<0.001]. The median quality-of-life score using the SF-12 was significantly lower in women with a history of falls than in those without a history of falls (median: 25.0, IQR: 21.0-30.0 versus median: 35.0, IQR: 31.0-39.0; P<0.001). The ADL scores were significantly lower among women with a history of falls than those without (P<0.001). A similar result was obtained for IADL scores (P<0.001).

Conclusion

Overall, this study's findings highlight the adverse impact of a history of falls on three key factors: fear of falling, quality of life, and daily functional activity (including both basic and instrumental activities). The findings delineate that, ultimately, the history of falls can serve as a valuable indicator for better understanding trends in elderly care and addressing the associated challenges.

Contributing factors and interventions for fear of falling in stroke survivors: a systematic review

OBJECTIVES

The purpose of this study was to provide a comprehensive overview of the prevalence, measurement tools, influencing factors, and interventions for fear of falling (FOF) in stroke survivors.

METHODS

A PRISMA-guided systematic literature review was conducted. PubMed, EMBASE, Cochrane, and Web of Science were systematically searched. The search time was up to February 2023. All observational and experimental studies investigating FOF in stroke patients were included. The assessment tool of the Joanna Briggs Institute was used to assess the quality of the included studies and the risk of bias assessment. (PROSPERO: CRD42023412522).

RESULT

A total of 25 observational studies and 10 experimental studies were included. The overall quality of the included studies was "low" to "good." The most common tool used to measure the FOF was the Falls Efficacy Scale-International (FES-I). The prevalence of FOF was 42%- 93.8%. Stroke survivors with physical impairments have the highest prevalence of FOF. The main risk factors for the development of FOF in stroke survivors were female gender, use of assistive devices, balance, limb dysfunction, and functional mobility. The combination of cognitive behavioral and exercise interventions is the most effective strategy.

CONCLUSIONS

This review suggests that the prevalence of FOF in stroke survivors is high and that understanding the factors associated with FOF in stroke patients can help develop multifactorial prevention strategies to reduce FOF and improve quality of life. In addition, a uniform FOF measurement tool should be used to better assess the effectiveness of interventions for stroke survivors.

ETHICS APPROVAL

PROSPERO registration (CRD42023412522).

The association between depressive symptoms with fear of falling and cognitive decline in older adults in the Korean community: An analysis of the Korean Longitudinal Study of Aging (KLoSA), 2006-2020

OBJECTIVES

This study aimed to investigate the effects of fear of falling (FOF) on cognitive decline in older adults in the Korean community, depending on the presence of accompanying depressive symptoms.

METHODS

A total of 6263 individuals were included in the final analysis. Based on their baseline evaluation results for depressive symptoms and FOF, the subjects were divided into four groups: "normal control" (NC, n = 3783), "depression only" (Dep-only, n = 291), "fear of falling only" (FOF-only, n = 1755), and "depression with fear of falling" (Dep-FOF, n = 434). Cognitive decline was defined as a loss of more than three points in the K-MMSE score in participants with at least two years of follow-up. We examined the association between FOF accompanied by depressive symptoms and cognitive decline using a multivariate Cox proportional hazard model.

RESULTS

Cognitive decline occurred in 76.3%, 68.5%, 63.9%, and 56.4% of the Dep-FOF, FOF-only, Dep-only, and NC groups, respectively. Our findings suggest that individuals with FOF do not always have cognitive decline (HR = 1.03, 95% CI = 0.95-1.12, P = 0.43) compared to individuals without FOF. Furthermore, depressive symptoms with FOF are associated with a higher risk of cognitive decline (HR = 1.23, 95% CI = 1.08-1.41, P = 0.002) in community-dwelling older adults in Korea.

CONCLUSION

Healthcare providers should be attentive to community-dwelling older adults who experience both depressive symptoms and FOF because our findings suggest that this unique combination increases the risk of cognitive decline.

Scale development to evaluate differences between concern about falling and fear of falling: the concern and fear of falling evaluation

Purpose

Individuals with multiple sclerosis (MS) experience fear of falling (FOF), which is associated with negative health and quality-of-life consequences. Prior research has used FOF and concern about falling (CAF) interchangeably, but persons with MS report that CAF and FOF represent separate constructs that lie on a continuum. Unfortunately, no scale exists to understand the differences between CAF and FOF. Therefore, we developed a novel questionnaire, the Concern and Fear of Falling Evaluation (CAFFE), in which respondents rank their CAF and FOF on a continuum across various activities. This study aims to describe the scale development process and examine its psychometric properties.

Methods

In a single online survey, MS participants responded to demographic questionnaires, indicated whether they experience CAF and FOF, and completed the CAFFE. Psychometric evaluation of the CAFFE involved internal consistency, split-half cross validation, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).

Results

Out of 1,025 respondents, 64.6% reported CAF and 47.2% reported FOF. The EFA yielded a two-factor solution encompassing activities in open (factor 1) and closed environments (factor 2). The CFA replicated this two-factor solution and the CAFFE demonstrated excellent internal consistency (α = 0.98).

Conclusion

The 27-item CAFFE is a highly reliable and valid measure capturing the tipping point at which point CAF moves to FOF. Future research should seek to define the tipping point from the MS community, as CAF may be an adaptive mechanism, whereas FOF may be a maladaptive behavior.

Designing ergonomic toilets and bathrooms for older adults: A study on anthropometric dimensions and recommendations

AIMS

This study aimed to evaluate the ergonomic design of toilets and bathroom equipment for older adults using anthropometric measurements.

DESIGN

This was a descriptive cross-sectional study.

METHODS

Data were collected from 2,721 people aged ≥ 65 years in Turkey. Fourteen anthropometric measurements were evaluated. Body dimension characteristics were described using minimum, maximum, and arithmetic means and standard deviations and the 5th, 25th, 50th, 75th, and 95th percentiles.

RESULTS

The measurements showed that companies generally do not design bathroom toilet equipment that is suitable for older adults.

CONCLUSION

This study provides advice to designers and manufacturers on how to adapt their products to the bathroom according to users' body characteristics in order to increase person-environment fit for older people.

Current practices of physiotherapists in Switzerland regarding fall risk-assessment for community-dwelling older adults: A national cross-sectional survey

Background

Falls can strongly impact older people's quality of life, health, and lifestyle. Multifactorial assessment can determine an individual's risk of falling as the first step for fall prevention intervention. Physiotherapists have an essential role to play in assessing fall risk by older adults living in the community. In the absence of published data on this topic in Switzerland, this study investigated the current practices of physiotherapists to determine whether those are in line with recommendations.

Methods

An anonymous cross-sectional survey was undertaken among physiotherapists practising in Switzerland between the 21st of November and the 31st of December 2020. A priori and exploratory hypotheses were tested. Responses to open-ended questions were grouped into themes for analysis.

Results

A total of 938 questionnaires from all three language regions of Switzerland was analysed. Participants worked in different settings, with a higher representation of private practice self-employees (56%). Standardised fall risk assessments or instruments were used by 580 (62%) participants, while 235 (25%) preferred subjective assessment of fall risk only. Differences in fall risk assessment were observed according to the workplace setting (adjusted OR 1.93, 95% CI 1.37 to 2.7) and education level (trend test, p<0.001). The standardised assessments most frequently employed were the Berg Balance Scale (58%), the Timed-Up-and-Go (57%) and the Tinetti Balance Assessment tool (47%). Risk factors for falls were frequently queried, particularly history of falls (88%), home hazards (84%), and functional ability (81%). Technical resources (40%), knowledge (30%), and time (22%) were common barriers to implement a systematic fall risk assessment.

Conclusions

This study provides an overview of the current practices of physiotherapists in Switzerland in fall risk assessment. There is still room to optimise the standardisation and systematisation of this assessment to implement a best practice strategy and prevent avoidable falls.

Fear of falling: Scoping review and topic analysis using natural language processing

Fear of falling (FoF) is a major concern among older adults and is associated with negative outcomes, such as decreased quality of life and increased risk of falls. Despite several systematic reviews conducted on various specific domains of FoF and its related interventions, the research area has only been minimally covered by scoping reviews, and a comprehensive scoping review mapping the range and scope of the research area is still lacking. This review aims to provide such a comprehensive investigation of the existing literature and identify main topics, gaps in the literature, and potential opportunities for bridging different strains of research. Using the PRISMA-ScR guidelines, we searched the Cochrane Database of Systematic Reviews, CINAHL, Embase, MEDLINE, PsycInfo, Scopus, and Web of Science databases. Following the screening process, 969 titles and abstracts were chosen for the review. Pre-processing steps included stop word removal, stemming, and term frequency-inverse document frequency vectorization. Using the Non-negative Matrix Factorization algorithm, we identified seven main topics and created a conceptual mapping of FoF research. The analysis also revealed that most studies focused on physical health-related factors, particularly balance and gait, with less attention paid to cognitive, psychological, social, and environmental factors. Moreover, more research could be done on demographic factors beyond gender and age with an interdisciplinary collaboration with social sciences. The review highlights the need for more nuanced and comprehensive understanding of FoF and calls for more research on less studied areas.

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

BACKGROUND

The lack of health care coverage, low education, low motivation, and inconvenience remain barriers to participating in fall prevention programs, especially among low-income older adults. Low-income status also contributes to negative aging self-perceptions and is associated with a high perceived barrier to care. Existing fall prevention intervention technologies do not enable participants and practitioners to interact and collaborate, even with technologies that bring viable strategies to maintain independence, prevent disability, and increase access to quality care. Research is also limited on the use of technology to enhance motivation and help individuals align their perception with physiological fall risk. We developed a novel, 8-week Physio-Feedback Exercise Program (PEER), which includes (1) technology-based physio-feedback using a real-time portable innovative technology-the BTrackS Balance Tracking System, which is reliable and affordable, allows for home testing, and provides feedback and tracks balance progression; (2) cognitive reframing using the fall risk appraisal matrix; and (3) peer-led exercises focusing on balance, strength training, and incorporating exercises into daily activities.

OBJECTIVE

This study consists of 3 aims. Aim 1 is to examine the effects of the technology-based PEER intervention on fall risk, dynamic balance, and accelerometer-based physical activity (PA). Aim 2 is to examine the effects of the PEER intervention on fall risk appraisal shifting and negative self-perceptions of aging. Aim 3 is to explore participants' experiences with the PEER intervention and potential barriers to accessing and adopting the technology-based PEER intervention to inform future research.

METHODS

This is an intention-to-treat, single-blinded, parallel, 2-arm clustered randomized controlled trial study. We will collect data from 340 low-income older adults at baseline (T1) and measure outcomes after program completion (T2) and follow-up at 3 months (T3) and 6 months (T4). Participants will be enrolled if they meet all the following inclusion criteria: aged ≥60 years, cognitively intact, and able to stand without assistance. Exclusion criteria were as follows: a medical condition precluding exercise or PA, currently receiving treatment from a rehabilitation facility, plan to move within 1 year, hospitalized >3 times in the past 12 months, and does not speak English or Spanish.

RESULTS

As of August 2023, the enrollment of participants is ongoing.

CONCLUSIONS

This study addresses the public health problem by optimizing a customized, technology-driven approach that can operate in low-resource environments with unlimited users to prevent falls and reduce health disparities in low-income older adults. The PEER is a novel intervention that combines concepts of physio-feedback, cognitive reframing, and peer-led exercise by motivating a shift in self-estimation of fall risk to align with physiological fall risk to improve balance, PA, and negative aging self-perception.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05778604; https://www.clinicaltrials.gov/ct2/show/study/NCT05778604.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51899.

Overcoming waves of helplessness: The meaning of experiencing fear of falling

Fear of falling (FOF) is prevalent among older adults. While the phenomenon has been conceptually defined and the factors associated with FOF are evident in the nursing literature, the deeply personal experience of this fear from the perspective of older adults is often overlooked. The aim of this study was to explore the meaning of experiencing FOF among older adults (N = 4). Each participant was interviewed twice using van Manen's interpretive phenomenological methodology. Four major interpretive themes emerged: Loss of Self, Part of my Existence, Remaining Safe Within the Boundaries of Fear, and The Exhausting Appraisal of Relationships. While the older adults struggled to manage their FOF, a deeper meaning was expressed during a relentless striving for self-preservation. While FOF can be an experience of overwhelming helplessness, the older adults in this study demonstrated personal resiliency, a perspective that is often lacking in the current literature.

A systematic review of fear of falling and related constructs after hip fracture: prevalence, measurement, associations with physical function, and interventions

BACKGROUND

Hip fracture is a common and debilitating injury amongst older adults. Fear of falling (FoF) and related constructs (balance confidence and falls efficacy) may impede rehabilitation after hip fracture. An updated systematic review to synthesize existing literature on FoF after hip fracture is needed. This review focussed on four research questions: In the hip fracture population: (1) What is the prevalence of FoF?; (2) What FoF assessment tools are validated? (3) What is the relationship between FoF and physical function?; (4) What interventions are effective for reducing FoF?

METHODS

A systematic search was undertaken in EBSCO Health, Scopus and PsychINFO in January 2021 (and updated December 2022) for articles on FoF after hip fracture. Data in relation to each research question was extracted and analysed. The quality of the studies was appraised using the 'Risk of Bias Tool for Prevalence Studies', 'COSMIN Risk of Bias checklist for Patient-reported outcome measures', modified version of the 'Appraisal Tool for Cross-sectional studies', and the 'Cochrane Risk of Bias 2' tools for each research question, respectively.

RESULTS

36 studies (37 articles) with 5099 participants were included (mean age 80.2 years and average 78% female). Prevalence rates for FoF after hip fracture ranged between 22.5% and 100%, and prevalence tended to decrease as time progressed post hip fracture. The 'Falls Efficacy Scale - International' (FES-I) and 'Fear of Falling Questionnaire - Revised' (FFQ-R) were found to be reliable, internally consistent, and valid tools in hip fracture patients. FoF after hip fracture was consistently associated with measures of physical function including balance, gait speed, composite physical performance measures and self-reported function. Ten of 14 intervention studies were considered high risk of bias. Exercise-based interventions with or without a psychological component were not effective in reducing FoF after hip fracture compared to a control condition.

CONCLUSION

FoF is prevalent after hip fracture and is consistently associated with poorer physical function. Only two instruments (FES-I and FFQ-R) have been validated for measuring FoF in the hip fracture population. However, there remains a need for larger, higher quality randomised controlled trials targeting FoF after hip fracture in order to guide clinical practice.

TRIAL REGISTRATION

PROSPERO registration: CRD42020221836.

The effect of mobility-related anxiety on walking across the lifespan: a virtual reality simulation study

Older adults who report a fear of falling are more likely to subsequently fall, yet, some gait anxiety-related alterations may protect balance. We examined the effect of age on walking in anxiety-inducing virtual reality (VR) settings. We predicted a high elevation-related postural threat would impair gait in older age, and differences in cognitive and physical function would relate to the observed effects. Altogether, 24 adults (age (y) = 49.2 (18.7), 13 women) walked on a 2.2-m walkway at self-selected and fast speeds at low (ground) and high (15 m) VR elevation. Self-reported cognitive and somatic anxiety and mental effort were greater at high elevations (all p < 0.001), but age- and speed-related effects were not observed. At high VR elevations, participants walked slower, took shorter steps, and reduced turning speed (all p < 0.001). Significant interactions with age in gait speed and step length showed that relatively older adults walked slower (β = - 0.05, p = 0.024) and took shorter steps (β = - 0.05, p = 0.001) at self-selected speeds at high compared to low elevation settings. The effect of Age on gait speed and step length disappeared between self-selected and fast speeds and at high elevation. At self-selected speeds, older adults took shorter and slower steps at high elevation without changing step width, suggesting that in threatening settings relatively older people change gait parameters to promote stability. At fast speeds, older adults walked like relatively younger adults (or young adults walked like older adults) supporting the notion that people opt to walk faster in a way that still protects balance and stability in threatening settings.

The Influence of Knee Extensor and Ankle Plantar Flexor Strength on Single-Leg Standing Balance in Older Women

Impaired balance is a significant risk factor for falls among older adults. The precise impact of lower-extremity muscles, including the proportion of muscle strength, on the performance of single-leg standing balance tests in older individuals is very interesting. The aim of this study is to examine the correlation between the knee extensor (KE), ankle plantar flexor (AP) muscle strength, and performance in single-leg standing balance tests in older females. Additionally, it aims to evaluate the combined proportion of KE and AP muscle strength in maintaining balance during single-leg standing. A total of 90 older females (mean age 67.83 ± 8.00 years) were recruited. All participants underwent maximum voluntary isometric contraction (MVIC) testing of the KE and AP muscles, as well as single-leg standing balance tests with eyes open (SSEO) and eyes closed (SSEC). To examine the influence of KE and AP muscle strength on balance performance, multiple regression analysis was conducted. Low correlations were found between SSEO and MVIC of KE and AP muscles, but moderate correlations were found with percentage of MVIC to body weight ratio (%MVIC/BW). The best model for SSEO included 0.99 times of the %MVIC/BW of AP and 0.66 times that of KE muscles as independent predictor variables (r = 0.682). In conclusion, AP muscle strength was found to have a greater impact on single-leg standing balance compared with KE muscle strength.

"Being careful": How much caution is enough? The relational context of fear of older adult falling in older adult-family caregiver dyads

Family caregivers play an important role in coping with older adult falls; however, their perspectives on fear of older adult falling are lacking from the falls prevention literature. A mixed-method design (N=25 dyads) with interview and survey data examined linguistic characteristics and coping strategies used by older adult and family caregiver dyads to manage fear of older adult falling. Fear of older adult falling consisted of both affective (e.g., worry) and cognitive (e.g., cautious) properties. Family caregivers more frequently used affective words and first-person plural pronouns ("we" language) when talking about fear of older adult falling, while older adults more frequently used cognitive and first-and-second person singular pronouns ("I", "you"). The concept of "being careful" was shared within dyads. However, dyad partners differed in their perspectives of what constituted "being careful" and the possibilities of future falling. Findings suggest that the need for family-centered interventions to prevent falls are needed.

Fear of falling: scoping review and topic analysis protocol

INTRODUCTION

Fear of falling (FoF) is a major challenge for the quality of life among older adults. Despite extensive work in previous scoping and systematic reviews on separate domains of FoF and interventions related to FoF, very little attention has been devoted to a comprehensive scoping review mapping the range and scope of this burgeoning area of study, with only a few exceptions. This scoping review aims to provide an overarching review mapping FoF research by identifying main topics, gaps in the literature and potential opportunities for bridging different strains of research on FoF. Such a comprehensive scoping review will allow the subsequent creation of an interdisciplinary theoretical and empirical framework, which may help push forward policy and practice innovations for people living with FoF.

METHODS AND ANALYSIS

Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR), seven main databases will be searched from 2000 to the date of the start of the review: Cochrane Database of Systematic Reviews, CINAHL, Embase, MEDLINE, PsycInfo, Scopus and Web of Science. The review will include original research in English, published between 2000 and January 2023. Quality checks will be conducted collegially. Data will be extracted and analysed using PRISMA-ScR charting tools and conventions.

ETHICS AND DISSEMINATION

No ethics approval is required for the review. The results will be submitted to a peer-reviewed journal and presented at academic conferences. The outcomes will be disseminated through social media, opinion pieces and science communication platforms to reach a wider audience.

REGISTRATION

The scoping review was registered with the Open Science Framework (https://osf.io/gyzjq).

Tridirectional association between probable depression, fear of falling and falls among middle-aged and older adults in Thailand

PURPOSE

Depression is a major issue in the aging population, which may be related to fear of falling (FOF) and falls contributing to increased morbidity and mortality. The aim of the study was to assess the tridirectional associations between probable depression (PD), FOF and falls in a longitudinal study in Thailand.

METHODS

Longitudinal data of participants (≥45 years; N = 3708) from two consecutive waves (in 2015 and 2017) of the Health, Aging and Retirement in Thailand (HART) study were analysed. PD was assessed with the Center for Epidemiologic Studies Depression Scale, self-reported FOF and history of falls.

RESULTS

Having no PD in 2015 and PD in 2017 (aOR: 2.35, 95% CI: 1.67 to 3.30), and having both PD in 2015 and 2017 (aOR: 3.46, 95% CI: 1.92 to 6.23) were positively associated with incident FOF with activity avoidance, and no FOF in 2015 and FOF in 2017 (aOR: 2.29, 95% CI: 1.77 to 2.95), and both FOF in 2015 and 2017 (aOR: 2.38, 95% CI: 1.69 to 3.36) were positively associated with incident PD. Two or more falls in 2015 (aOR: 2.03, 95% CI: 1.29 to 3.19) was positively associated with incident PD, and both PD in 2015 and 2017 (aOR: 3.10, 95% CI: 1.40 to 6.48) were positively associated with incident multiple (≥2) falls.

CONCLUSIONS

We found tridirectional associations between PD, FOF and falls. It is suggested to screen and manage older adults for PD, FOF and fall history simultaneously.

A Multidimensional Approach for Nurse Practitioners to Screen Fall Risk and Fear of Falling in Community-Dwelling Older Adults

Nurse practitioners are essential in the care of the older adult population. Older adults are at high risk for falls; therefore, nursing assessment should include psychological and physiological measures. Fear of falling is a primary psychological contributor to fall risk. The Falls Efficacy Scale International short; Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths, and Injuries fall risk scale; and Balance Tracking System (BTrackS) balance test are reliable, efficient tools for assessment. Data obtained from these multifactoral tools may inform mobility interventions and education for the patient, further meeting a national safety goal of reducing falls in the older adult population.

Psychometric Properties of the Falls Efficacy Scale-International, Cut-off Points, and Validating its Short Version Among Iranian Older People

Objectives

Older people have a fear of falling, which is far more difficult than falling itself. We measured the extent of this feeling using a short and valid Falls Efficacy Scale-International (FES-I) 7-item questionnaire for the aging community in Iran.

Methods

The present psychometric work deals with outlining the validation and translation of FES-I (short version) among 9117 Persian-speaking elderly people with a mean age of 70.2±8.3 years (54.1% female and 45.9% male) in July 2021. Investigations were performed on confirmatory factor analysis, exploratory factor analysis, internal consistency, and construct validity along with test-retest reliability, receiver operating characteristic analysis, inter-rater, and convergent validity.

Results

72.4% of the subjects were living alone, 92.9% required support in activities of daily living, and 93.0% experienced falling in the past two years. A one-factor solution was assigned by exploratory factor analysis for FES-I. Thus, this model was proved by the confirmatory factor analysis with valid fit indices. Based on Cronbach's alpha, intra-cluster correlation coefficient, and McDonald's omega (≥ 0.80), internal consistency was confirmed. The exact cut-off value was represented by the receiver operating characteristic analysis for male/female and between with/without fear of falling among older samples with higher measures of specificity and sensitivity. Moreover, a significant effect of age, aging in place, loneliness, hospitalization rate, frailty, and sense of anxiety (effect size ≥ 0.80, p ≤ 0.05) on fear of falls was detected using analysis of variance.

Conclusions

The psychometric properties of the original scale were preserved by the Persian version of FES-I seven items as a self-reported measure of fear of falling. It could be assuredly a measure in both community and clinical settings. The possible uses and limitations of the Iranian FES-I were also discussed.

Longitudinal associations of concurrent falls and fear of falling with functional limitations differ by living alone or not

Background

Falls and fear of falling (FOF) are independent risk factors for functional limitations in older adults. However, the combined effect of falls and FOF on functional limitations and the moderating role of living alone or not is unclear. We aimed to examine (1) the independent and combined effect of falls and FOF on functional limitations in older adults and (2) whether living alone moderates these associations.

Methods

We used data from the National Health and Aging Trends Study (NHATS) and included 5,950 U.S. community-dwelling older adults aged 65 and older from Round 1 (Year 2011) and Round 2 (Year 2012). Falls and FOF were ascertained by asking participants whether they had any falls in the last year and whether they had worried about falling in the previous month at R1. Assessed functional limitations included any difficulties with mobility, self-care, or household activities at R2. Poisson regression models were used to examine the longitudinal associations of falls and FOF with functional limitations and the moderation effects of baseline living alone.

Results

Of the 5,950 participants, 16.3% had falls only; 14.3% had FOF only; 14.3% had both, and 55.1% had neither at baseline. In the adjusted model, those who experienced concurrent falls and FOF in R1 had a higher risk of functional limitations at R2 than those with neither (Mobility: Incidence risk ratio [IRR] = 1.34, 95% CI: 1.24-1.45; Self-care: IRR = 1.18, 95% CI: 1.11-1.26; Household: IRR = 1.20, 95% CI: 1.11-1.30). Moreover, living alone significantly moderated the longitudinal associations of concurrent falls and FOF with mobility activity limitations.

Conclusion

The findings suggest that strategies to improve falls and FOF together could potentially help prevent functional limitations. Older adults who live with others and have falls or FOF should receive interventions to promote their mobility activities.

Age differences in factors affecting fear of falling among community-dwelling older adults: A cross-sectional study

Our objective was to explore the determining factors of fear of falling (FOF) in community-dwelling older adults of different ages. A total of 541 community-dwelling older adults aged 65 years and older were investigated and separated into a younger group (n=347) and an older group (n=194). FOF was measured and possible factors affecting FOF were investigated. The prevalence of high FOF in the older group was significantly higher than that in the younger group. Poor sleep quality, low muscle strength, and multimorbidity were independent risk factors for high FOF in the younger group. While poor gait and balance were independent risk factors for high FOF, other factors, such as sex, marital status, education level, drinking status, cognitive ability, and muscle strength were also found to have a significant association with high FOF in the older group. Therefore, differential prevention strategies for high FOF should be considered for community-dwelling older adults of different ages.

Is fear of falling key to identifying gait and balance abnormalities in community-dwelling older adults? Protocol of a mixed-methods approach

INTRODUCTION

The ageing population poses an increasing burden to public health systems, particularly as a result of falls. Falls have been associated with poor gait and balance, as measured by commonly used clinical tests for poor gait and balance. Falls in older adults have the potential to lead to long-term issues with mobility and a fear of falling (FoF). FoF is measured by a variety of instruments; the Falls Efficacy Scale International (FES-I) version is widely used within clinical and research arenas. The ability of the FoF, as measured by the FES-I to predict gait and balance abnormalities (GABAb) has not previously been measured; this study aims to be the first to investigate this prospective relationship.

METHODS AND ANALYSES

To investigate the ability of the FES-I to predict GABAb a mixed-methods approach will be used, including quantitative, qualitative and health economics approaches. Initially the ability of the FES-I to identify poor gait and balance will be investigated, along with whether the measure is able to assess change in gait and balance in response to exercise training. The ability of an online FES-I tool to assess poor gait and balance in an alternative pre-existing online strength and balance programme will also be investigated. Interviews will be carried out to investigate participant experiences and motivations of those that are offered Age UK Strength and Balance Training, along with the views of healthcare professionals and Age UK staff involved within the process.

ETHICS AND DISSEMINATION

NHS REC Approval has been granted (IRAS ID 314705). Study participation is voluntary; participants will be provided with all necessary information within the participant information sheet, with written consent being sought. Study findings will be disseminated through manuscripts in peer-reviewed journals, at scientific conferences and in a short report to participants and the funding body.

Associations Between Changes in Depression/Anxiety Symptoms and Fall Worry Among Community-Dwelling Older Adults

Using the 2019 and 2020 National Health and Aging Trend Study, we examined the association between fall worry and changes in depression/anxiety symptoms among community-dwelling older adults age 70+ (N = 3333). Past-month fall worry in 2020 included any fall worry (30.9%) and activity-limiting fall worry (34.0% of those with any fall worry). Changes in depression/anxiety symptoms referred to an increase or decrease in the Patient Health Questionnaire-4 symptom categories between 2019 and 2020. Those with fall worry, compared to those without, had significantly higher rates of moderate/severe depression/anxiety symptoms in 2019 and increased depression/anxiety symptoms over time. Multivariable analysis results show that increased depression anxiety symptoms were associated with higher risks of any and activity-limiting fall worry, controlling for previous year's fall worry, fall incidents, and other health- and fall-related covariates. Older adults need to be screened for both depression/anxiety and fall worry. Effective psychosocial and behavioral interventions for both conditions are needed.

Overlap of Physical, Cognitive, and Social Frailty Affects Ikigai in Community-Dwelling Japanese Older Adults

This study aimed to investigate whether the overlap of physical, cognitive, and social frailty affects Ikigai in community-dwelling Japanese older adults. Participants were 116 community-dwelling older adult Japanese men and women. Associations of physical, cognitive, and social frailty with falls, daily living assessment, and Ikigai were analyzed by group comparisons and multivariate analyses. Physical, cognitive, and social frailty were associated with the risk of falls and Ikigai. An increase in the number of frailty category overlaps was associated with an increased risk of falls and decrease in Ikigai. Multivariate analyses adjusted for confounding factors showed that physical and cognitive frailty were related to Ikigai. In conclusion Two or more overlapping numbers of physical, cognitive, and social frailty had adverse effects on Ikigai in community-dwelling Japanese older adults.

Classification of Center of Mass Acceleration Patterns in Older People with Knee Osteoarthritis and Fear of Falling

(1) Background: The preoccupation related to the fall, also called fear of falling (FOF) by some authors is of interest in the fields of geriatrics and gerontology because it is related to the risk of falling and subsequent morbidity of falling. This study seeks to classify the acceleration patterns of the center of mass during walking in subjects with mild and moderate knee osteoarthritis (KOA) for three levels of FOF (mild, moderate, and high). (2) Method: Center-of-mass acceleration patterns were recorded in all three planes of motion for a 30-meter walk test. A convolutional neural network (CNN) was implemented for the classification of acceleration signals based on the different levels of FOF (mild, moderate, and high) for two KOA conditions (mild and moderate). (3) Results: For the three levels of FOF to fall and regardless of the degree of KOA, a precision of 0.71 was obtained. For the classification considering the three levels of FOF and only for the mild KOA condition, a precision of 0.72 was obtained. For the classification considering the three levels of FOF and only the moderate KOA condition, a precision of 0.81 was obtained, the same as in the previous case, and finally for the classification for two levels of FOF, a high vs. moderate precision of 0.78 was obtained. For high vs. low, a precision of 0.77 was obtained, and for the moderate vs. low, a precision of 0.8 was obtained. Finally, when considering both KOA conditions, a 0.74 rating was obtained. (4) Conclusions: The classification model based on deep learning (CNN) allows for the adequate discrimination of the acceleration patterns of the moderate class above the low or high FOF.

Impaired ankle inversion proprioception during walking is associated with fear of falling in older adults

Background

Ankle proprioception plays a critical role in lower limb movement control. However, the relationship between ankle proprioception and fear of falling (FOF) in older people is still unclear.

Objective

(1) This study aims to develop a new device for measuring ankle inversion proprioceptive discrimination sensitivity during walking, i.e., the Ankle Inversion Discrimination Apparatus–Walking (AIDAW), and assess the test–retest reliability of the AIDAW in both young and older adults; (2) to evaluate the discriminant validity of the measure by comparing ankle proprioception during walking between the two groups; and (3) to explore convergent validity by determining to what extent the AIDAW proprioceptive scores correlate with Fall Efficacy Scale-International (FES-I) scores.

Materials and methods

The AIDAW was purpose-built to test ankle inversion proprioceptive discrimination sensitivity during walking. The area under the receiver operating curve (AUC) was calculated as the proprioceptive discrimination score. In total, 54 adults volunteered. Test–retest reliability was evaluated in 12 young and 12 older adults, and another 15 young and 15 older adults completed the comparison study. FOF was assessed by using the FES-I.

Results

The test–retest reliability intraclass correlation coefficient ICC _(3,1) value for the whole group was 0.76 (95% CI: 0.52–0.89). The ICC values of the young and older groups were 0.81 (95% CI: 0.46–0.94) and 0.71 (95% CI: 0.26–0.91), respectively. The Minimal Detectable Change with 90% confidence (MDC₉₀) values for the young and older groups were 0.03 and 0.11, respectively. There was a significant difference between the AIDAW proprioceptive sensitivity scores for the young and older groups (0.78 ± 0.04 vs. 0.72 ± 0.08, F = 5.06, p = 0.033). Spearman’s correlation analysis showed that the FES-I scores were significantly and negatively correlated with the AIDAW scores (rho = −0.61, p = 0.015), with higher FOF associated with worse ankle proprioception.

Conclusion

The AIDAW is a reliable and valid device for measuring ankle proprioception during walking in both young and older adults. Ankle inversion proprioceptive discrimination sensitivity during walking was found to be impaired in the elderly compared to young adults. This impairment was found to be strongly associated with FOF, suggesting that assessment and intervention for ankle proprioception in this population are needed to reduce the risk of falls.

The cross-cultural adaptation and factor analysis of the Turkish version of Iconographical Falls Efficacy Scale Long Version

BACKGROUND

Iconographical Falls Efficacy Scale (Icon-FES) is the first visual scale for fear of falling. Unlike the others, Icon-FES, including 30 items offers a unique perspective to assess the fear of falling by providing more precise contexts.

OBJECTIVES

The study aimed to introduce the 30-item Icon-FES, the first visual content fear of falling scale, into Turkish and to explore its psychometric properties.

METHODS

First, the Turkish language validity of Icon-FES was ensured by following the forward-backward translation protocol. A total of 150 older adults independent in their daily living activities were included in the study. Falls Efficacy Scale International (FES-I) and Activities Specific Balance and Confidence Scale (ABC), which are frequently preferred in the literature for the same purpose, were used to provide the criterion validity of the scale. The exploratory factor analysis method was utilised for the construct validity of the scale.

RESULTS

Factor analysis revealed a two-factor structure. 52.22% of the total variance was explained with single-factor analysis. In the criterion validity analysis, while there was a strong positive correlation between Icon-FES and FES-I (r = 0.910, p < 0.01), a strong negative correlation was found between Icon-FES and ABC (r = -0.887, p < 0.01). The Cronbach Alpha value for the internal consistency of the scale was calculated as 0.965. The intraclass correlation coefficient between two measurements performed one-week interval was found to be 0.985 (p < 0.001).

CONCLUSION

The study showed that Icon-FES is a valid, reliable and rapid result assessment tool for community-dwelling older adults without cognitive dysfunction.

Recurrent but not single report of fear of falling predicts cognitive decline in community-residing older adults

OBJECTIVES

Literature regarding the association of fear of falling (FOF), a common concern in aging, and cognition is scarce. Moreover, whether frequency of FOF endorsement influences age-related cognitive decline has not been reported. Here we determined whether FOF status (no FOF, single-report FOF, recurrent FOF), predicted decline in global cognitive function (GCF), memory, and attention/executive functions.

METHODS

Participants were community-residing older adults (n = 421; mean age = 76.29 ± 6.48; %female = 56.06). FOF was assessed bimonthly through yes/no responses to "do you have a fear of falling?" during the first year of the study. Recurrent status required two or more FOF endorsements. GCF was assessed using Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); composite scores were used to assess memory as well as attention/executive functions. Cognitive measures were administered annually for up to six years.

RESULTS

Stratification of the cohort by FOF status showed that 81 participants reported recurrent FOF, 60 participants endorsed FOF once and 280 participants reported no FOF. Linear mixed effects models revealed that compared to no FOF, recurrent FOF was associated with worse declines in GCF (estimate=-0.03, p=.006), memory (estimate=-0.04, p=.012) and attention/executive functions (estimate=-0.04, p=.006). Comparisons between single-report FOF and no FOF, however, were not significant.

CONCLUSIONS

These findings demonstrate that recurrent but not single-report FOF is a risk factor for cognitive decline in community-residing older adults.

The effect of group-based Otago exercise program on fear of falling and physical function among older adults living in nursing homes: A pilot trial

This pilot trial explored the feasibility of group-based Otago exercise program (OEP) and its impact on fear of falling (FOF) and physical function among Chinese older adults living in nursing homes. The intervention group received group-based OEP for 12 weeks, while the control group received routine care. The modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), timed Up and Go test (TUG), four-stage Balance test (FSBT), and 30 seconds sit-to-stand test (30s-SST) were used. After twelve weeks, we found that the intervention group had better outcomes than the control group in mSAFFE, TUG, FSBT and 30s-SST (p<0.05). Also, we compared the pretest-posttest results within the two groups, respectively. We found that, within the intervention group, the outcomes of mSAFFE, TUG, FSBT, and 30s-SST become significantly better after twelve weeks, but within the control group, the outcomes of TUG, FSBT, and 30s-SST become significantly worse. Our findings demonstrated that a group-based OEP was feasible and acceptability among Chinese older adults living in nursing homes and the group-based OEP could improve FOF and physical function among those older adults.

Fear of Falling in Older Adults: A Scoping Review of Recent Literature

Background

Fear of falling (FOF) is prevalent among older adults and associated with adverse health outcomes. Over recent years a substantial body of research has emerged on its epidemiology, associated factors, and consequences. This scoping review summarizes the FOF literature published between April 2015 and March 2020 in order to inform current practice and identify gaps in the literature.

Methods

A total of 439 articles related to FOF in older adults were identified, 56 selected for full-text review, and 46 retained for data extraction and synthesis.

Results

The majority of included studies were cross-sectional. Older age, female sex, previous falls, worse physical performance, and depressive symptoms were the factors most consistently associated with FOF. Studies that measured FOF with a single question reported a significantly lower prevalence of FOF than those using the Falls Efficacy Scale, a continuous measure. FOF was associated with higher likelihoods of future falls, short-term mortality, and functional decline.

Conclusions

Comparisons between studies were limited by inconsistent definition and measurement of FOF, falls, and other characteristics. Consensus on how to measure FOF and which participant characteristics to evaluate would address this issue. Gaps in the literature include clarifying the relationships between FOF and cognitive, psychological, social, and environmental factors.

Enduring life in between a sense of renewal and loss of courage: lifeworld perspectives one year after hip fracture

Purpose: To explore everyday life experiences of being active in aged adults´ with walking impairment one year after hip fracture (HF).Methods: A phenomenological-hermeneutic study design is based on Heidegger´s and Gadamer´s thinking focusing on aged adults being-in-the-world one year after HF. Individual semi-structured interviews were conducted from May to July 2017 in the homes of nine participants, who were part of a longitudinal qualitative study with four interview-rounds for a period of 18 months after the HF event. The analysis was interpretative and secured that the authors´ pre-understanding was put at stake through a five-step process of meaning condensation.Results: One theme, "Enduring life in between a sense of renewal and loss of courage", described aged adults´ experiences of being active in three sub-themes: "Facing loss and losing courage", "Taking up the challenge and maintaining courage ", and "Renewing the energy to be active". Living with being under change and increased vulnerability created a challenge in maintaining courage and reaching for possibilities to unfold their own being in life.Conclusion: This study contributes knowledge on how the aged adults´ experiences of the balance between courage and loss in being active one year after HF are profoundly connected with experiences of well-being.

The association between fear of falling and orthostatic hypotension in older adults

The aim of this study was to determine the relationship between the fear of falling/the degree of fear of falling (FoF) and orthostatic hypotension (OH) in older adults. This cross-sectional study was conducted with 314 older outpatients. If the total score of the Falls Efficacy Scale-International scale was 16-19, 20-27 and ≥ 28, it was assumed that there was low FoF, moderate FoF and high FoF, respectively. OH was evaluated for the 1st (OH1) and 3rd (OH3) minutes, after transitioning from the supine position to standing. Participants were aged 65-93 years (mean age 74.2 ± 8.5 years) and 193 (61.5%) were female. Among the FoF groups, significant differences were found for age, gender, education, marital status, who the patient lived with, the history of falling and hypertension, Timed Up-Go test score and hemoglobin levels (p < 0.005). The prevalence of OH1 and OH3 was found to be significantly higher in those with an FoF score of 20 and above than those below 20 (p < 0.005). After adjustment for potential confounders, participants who reported a high FoF had higher risk for OH1 and OH3 (OR 2.14, 95% CI 1.14-4.0, p = 0.017; and OR 2.72, 95% CI 1.46-5.09, p = 0.002, respectively), but those with moderate FoF had no increased risk of having OH compared to low FoF (p > 0.05). There is a close relationship between high FoF and OH in older adults. Therefore, when evaluating an older patient with OH, FoF should be evaluated, or FoF should also be questioned in older patients with OH.

Intervention Characteristics Associated With a Reduction in Fear of Falling Among Community-Dwelling Older People: A Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND AND OBJECTIVES

Fear of falling (FoF) is associated with decreased physical functioning and an increased fall risk. Interventions generally demonstrate moderate effects and optimized interventions are needed. Intervention characteristics, such as setting or delivery method may vary. We investigated which overarching intervention characteristics are associated with a reduction in FoF in community-dwelling older people.

RESEARCH DESIGN AND METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) in community-dwelling older people without specific diseases was performed. Associations between intervention characteristics and standardized mean differences (SMD) were determined by univariate meta-regression. Sensitivity analyses were performed.

RESULTS

Data on 62 RCTs were extracted, 50 intervention groups were included in the meta-analysis. Most intervention characteristics and intervention types were not associated with the intervention effect. Supervision by a tai chi instructor (SMD: -1.047, 95% confidence interval [CI]: -1.598; -0.496) and delivery in a community setting (SMD: -0.528, 95% CI: -0.894; -0.161) were-compared to interventions without these characteristics-associated with a greater reduction in FoF. Holistic exercise, such as Pilates or yoga (SMD: -0.823, 95% CI: -1.255; -0.392), was also associated with a greater reduction in FoF. Delivery at home (SMD: 0.384, 95% CI: 0.002; 0.766) or with written materials (SMD: 0.452, 95% CI: 0.088; 0.815) and tailoring were less effective in reducing FoF (SMD: 0.687, 95% CI: 0.364; 1.011).

DISCUSSION AND IMPLICATIONS

Holistic exercise, delivery with written materials, the setting and tailoring potentially represent characteristics to take into account when designing and improving interventions for FoF in community-dwelling older people. PROSPERO international prospective register of systematic reviews, registration ID CRD42018080483.

Association of fear of falling with frailty in community-dwelling older adults: A cross-sectional study

This study aimed to describe frailty and fear of falling and examine the cross-sectional association between frailty and fear of falling in community-dwelling older adults in China. We recruited 165 older adults from five selected communities in the five districts of Changchun, Jilin Province. Participants were asked to complete a demographic questionnaire, the Short Falls Efficacy Scale-International, and the Tilburg Frailty Indicator. We found that 60% of our participants were frail and that 81% reported a fear of falling. Using binary logistic regression, we found that the participants with fear of falling were 7.2 times more likely to be frail. These findings suggest that fear of falling should be regularly screened in clinical practice to help identify older adults with greater risks of frailty. Future longitudinal studies of larger sample size are needed to confirm the association. Moreover, frailty prevention programs that include strategies to reduce the fear of falling should be tested among community-dwelling older adults.

The Effectiveness of Community Occupational Therapy Interventions: A Scoping Review

Background: This review aims to evaluate the level of scientific evidence for the effectiveness of Community Occupational Therapy interventions. Methods: A systematic review was used to analyze and synthesize the studies collected. The databases of Cochrane, OTseeker, OTCATS, Web of Science, Scielo and Scopus were used in order to collect articles published between 2007 and 2020. PRISMA recommendations were followed. Results: A total of 12 articles comprised part of the study (7 randomized controlled studies, 4 systematic reviews and 1 meta-analysis). The main areas of practice were geriatric gerontology (22.1%) and mental health (19.7%), which were statistically significant (χ²; p < 0.005) compared to the rest. Regarding the studies analyzed, all of them had scores of >7 on the PEDro and AMSTAR scales. Conclusions: Research on Community Occupational Therapy constitutes a consolidated line of research but the objectives and areas of research were limited. Descriptive qualitative methodology predominated and studies on the effectiveness of Community Occupational Therapy interventions showed a medium–low level of evidence.

Predictive Factors of Fall-Related Activity Avoidance in People With Parkinson Disease-A Longitudinal Study With a 3-Year Follow-up

BACKGROUND AND PURPOSE

Knowledge of predictive factors can foster the development of preventive approaches. This study examined how prevalence and severity of fall-related activity avoidance evolve over a 3-year period in people with Parkinson disease (PD). A specific aim was to identify predictive factors of fall-related activity avoidance (ie, modified Survey of Activities and Fear of Falling in the Elderly [mSAFFE] scores) after 3 years.

METHODS

The sample included 151 people with PD (mean [SD] age: 68 [8.8] years). The mSAFFE score was the dependent variable in multivariable linear regression analyses, with 17 potential predictors. On the basis of a collinearity check, 2 models studying various risk factors were developed. Model 1 included concerns about falling and model 2 walking difficulties.

RESULTS

After 3 years, more participants reported fall-related activity avoidance, that is, 34% versus 50% (P < 0.001). Regression model 1 explained 63% of the variance. The strongest predictive factor was concerns about falling (standardized regression coefficient, β = 0.589), followed by pain (β = 0.161), unsteadiness while turning (β = 0.137), and age (β = 0.136). These variables remained significant when adjusting for mSAFFE baseline scores.In model 2 (explained 50% of the variance), the strongest predictive factor was perceived walking difficulties (β = 0.392), followed by age (β = 0.238), unsteadiness while turning (β = 0.198), and pain (β = 0.184). Unlike the other factors, walking difficulties were not significant when adjusting for mSAFFE baseline scores.

DISCUSSION AND CONCLUSIONS

Fall-related activity avoidance increased over time in people with PD. If fall-related activity avoidance is to be targeted, this study suggests that interventions should address concerns about falling, pain, unsteadiness while turning, and walking difficulties.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A310).

Older Adults' Experiences With the Visual Physio-Feedback Technology and Peer-Led Combined Group and Home-Based Exercises

This study aimed to explore older adults' experience with an in-home Physio-feEdback and Exercise pRogram and explore whether the Physio-feEdback and Exercise pRogram intervention influenced their physical activity adherence. A qualitative study approach was employed, and data were collected using exercise logs, observations, focus groups, and open-ended questions after the program completion. Nineteen participants who engaged in an 8-week Physio-feEdback and Exercise pRogram intervention participated in this study. Thematic analysis was used. Three major concepts of the self-determination theory, including competence, relatedness, and autonomy, were used as guidelines for coding. Results reveal three themes, including: (a) competence-alignment of body and mind and increased awareness about fall risk, (b) relatedness-relationship with peer coach and having fun with friends, and (c) autonomy-integration of exercise into daily activities for staying physically and socially active. Individuals' need for competence and autonomy can be supported by giving physio-feedback, cognitive reframing, and peer-led exercise, which can enhance physical activity and prevent falls.

Older adults' views on barriers and facilitators to participate in a multifactorial falls prevention program: Results from Prevquedas Brasil

OBJECTIVES

To understand the reasons older people engage in a multifactorial fall prevention program and, to identify the barriers and facilitators for adherence.

METHODS

Cross-sectional study, with 218 older adults from the intervention group of a 12-week multifactorial fall prevention program (Prevquedas Brazil). We interviewed participants using a semi-structured questionnaire concerning reasons to engage in, barriers, and facilitators to participating in the program. We compared participants with low (0-5 sessions) and moderate/high (6-12 sessions) adherence regarding barriers and facilitators.

RESULTS

Physical and mental health problems (55 %), and competing demands (45.2 %) were the most frequent barriers reported. Pleasant environment (97.7 %), a sense of receiving proper care (96.7 %), and empathy with the team (96.7 %) were the main facilitators. Seven out of the twelve facilitators distinguished participants with high adherence from those with low adherence. Only the barriers related to the program characteristics and the lack of social support were able to identify participants with low adherence. Open-ended questions revealed that self-determination, commitment, and the desire of being physically active and fit promoted participation. Anticipated health benefits and functional gains, a need to take action due to fall consequences, and encouragement from others were among the reasons to engage in the program.

CONCLUSION

Although barriers should not be neglected, facilitators are critically important for adherence. Health professionals may develop skills to facilitate uptake and optimize older adults' participation. Implementing sustainable fall prevention programs in low and middle-income countries requires overcoming the fragmentation and inflexibility of healthcare services.

Impacts of Motion-Based Technology on Balance, Movement Confidence, and Cognitive Function Among People With Dementia or Mild Cognitive Impairment: Protocol for a Quasi-Experimental Pre- and Posttest Study

Background

While exercise can benefit the health and well-being of people with dementia or mild cognitive impairment, many exercise programs offered to this population are passive, unengaging, and inaccessible, resulting in poor adherence. Motion-based technologies are increasingly being explored to encourage exercise participation among people with dementia or mild cognitive impairment. However, the impacts of using motion-based technologies with people with dementia or mild cognitive impairment on variables including balance, movement confidence, and cognitive function have yet to be determined.

Objective

The purpose of this study is to examine the impacts of a group motion-based technology intervention on balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment.

Methods

In this quasi-experimental pre- and posttest design, we will recruit 24 people with dementia or mild cognitive impairment from 4 adult day programs and invite them to play Xbox Kinect bowling in a group setting, twice weekly for 10 weeks. We will require participants to speak and understand English, be without visual impairment, and be able to stand and walk. At pretest, participants will complete the Mini-Balance Evaluation Systems Test (Mini-BESTest) and the Montreal Cognitive Assessment (MoCA). We will video record participants during weeks 1, 5, and 10 of the intervention to capture behavioral indicators of movement confidence (eg, fluency of motion) through coding. At posttest, the Mini-BESTest and MoCA will be repeated. We will analyze quantitative data collected through the Mini-BESTest and the MoCA using an intent-to-treat analysis, with study site and number of intervention sessions attended as covariates. To analyze the videos, we will extract count and percentage data from the coded recordings.

Results

This study will address the question of whether a group motion-based technology intervention, delivered in an adult day program context, has the potential to impact balance, movement confidence, and cognitive function among people with dementia or mild cognitive impairment. The project was funded in 2019 and enrollment was completed on February 28, 2020. Data analysis is underway and the first results are expected to be submitted for publication in 2021.

Conclusions

This study will assess the feasibility and potential benefits of using motion-based technology to deliver exercise interventions to people with dementia or mild cognitive impairment. This work can also be used as the basis for developing specific software and future exercise programs using motion-based technology for people with dementia or mild cognitive impairment, as well as understanding some of the conditions in which these programs can be delivered.

International Registered Report Identifier (IRRID)

DERR1-10.2196/18209

"Fiercely independent": Experiences of aging in the right place of older women living alone with physical limitations

This study explores the experience of aging among older Canadian women with physical limitations who live by themselves. While aging in place has been a policy priority in rapidly greying Canada, a lack of complementary public supports poses challenges for many older adults and their family members. Employing a qualitative methodology, and drawing from the notion of aging in the right place, we collected personal narratives of 12 women (aged 65 to 92) in two geographic areas in Ontario, including residents of regular houses, apartments, condominiums, assisted living and community housing for seniors. Through thematic analysis, we identified four overarching themes: 1) striving to continue on "at home", 2) living as a "strong independent woman", 3) the help needed to support their "independence", and 4) social activities to maintain self. Our findings illustrate how, despite their mobility limitations, older women can change their residential environment and their behavior by deploying the coping strategies and resources they have developed over time. However, we also found that older women are largely silent about their needs, and that experiences varied depending on life histories, health conditions, and the availability of supports in their wider environment (home care, alternative housing options, accessible transportation, opportunities for social and physical activities). We hope these findings will incite further studies and discussion to help make aging in the right place a real choice for anyone who wishes to do so.

Shifting Maladaptive Fall Risk Appraisal in Older Adults through an in-Home Physio-fEedback and Exercise pRogram (PEER): A Pilot Study

OBJECTIVES

1) examine the preliminary effectiveness of the Physio-feEdback and Exercise pRogram (PEER) for shifting maladaptive to adaptive fall risk appraisal and reducing fall risk, 2) determine the participants' feedback and acceptability of the program.

METHODS

Forty-one older adults were assigned to either PEER intervention or attention control group. The 8-week PEER intervention consists of a visual physio-feedback, cognitive reframing, and combined group and home-based exercise led by a trained peer coach. The attention control group read fall prevention brochures and continued their normal activities. BTrackS Balance Test (BBT), short version of Fall Efficacy Scale International (short FES-I) and CDC fall risk checklist were measured from pre- to post-intervention. The feedback and acceptability were conducted at the program conclusion.

RESULTS

About 11% of participants in the PEER group had positive shifting but none in the attention control group. Up to 32% of the participants in attention control had negative shifting compared to 5.3% in the PEER group. PEER group reported significant decreases in fall risk and high acceptability of the program.

CONCLUSIONS

PEER intervention facilitates a shift from maladaptive to adaptive fall risk appraisal and reduces fall risk.

CLINICAL IMPLICATIONS

Preventive interventions promoting alignment between perceive and physiological fall risk may contribute to reducing falls and increasing exercise adherence.