Predictors of Incident Fear of Falling in Community-Dwelling Older Adults

Embodied navigation: the influence of lived experience on physical activity and sedentary behavior among older adults

PURPOSE

The impact of a sedentary lifestyle on health and well-being is well recognized. However, there is limited understanding of how a lifetime of physical activity and sedentary behaviour influences an active lifestyle in older adults. The aim of this study was to describe how lived experience of physical activity and sedentary behaviour impacts daily activities among older adults, from a life course perspective.

METHODS

Qualitative content analysis was used; individual telephone interviews were conducted with fourteen older adults aged 71 to 92 years. The participants received initial support from community care and lived in ordinary housing in southern Sweden.

RESULTS

The interviews yielded one theme, "Navigating with an embodied activity compass," and two sub-themes: "Being guided by the past" and "Unveiling pathways through body awareness."

CONCLUSIONS

Our study highlights how older adults' lived experiences of physical activity, with their connections to body awareness and acceptance, impact daily physical activity. These findings offer new knowledge for clinical practitioners balancing recommendations of sedentary behaviour and physical activity, to promote healthy daily physical activity among older adults. Future research and policies should consider the lived experiences of older adults when addressing public health matters related to sedentary behaviour and physical activity.

Implications for fall efficacy strategies on center of pressure and center of gravity sway distances in adults with chronic low back pain

BACKGROUND

Although chronic low back pain (LBP) is a complex condition often associated with altered motor control and compensatory postural adjustments, existing literature provides inconsistent reports on the underlying control mechanisms for maintaining balance.

PURPOSE

This study aimed to compare differences in sway distances between the center of pressure (COP) and the center of gravity (COG), while considering limb dominance, in adults with and without LBP.

METHODS

There were 26 subjects with LBP and 39 control subjects who performed three repeated unilateral standing tasks on a force platform. Outcome measures included the sway distances between COP and COG in the anteroposterior (AP) and mediolateral (ML) directions, as well as the results of the fall efficacy scale (FES).

RESULTS

A significant group interaction was demonstrated on limb dominance and direction for the sway distance (F = 5.46, p = 0.02). Specifically, the third trial in the ML direction while standing on the dominant limb indicated a significant difference in COP-COG sway distance (t = -2.30, p = 0.01). When FES scores were used as a covariate, a significant three-way interaction (dominance x direction x trial) was found (F = 4.06, p = 0.04).

CONCLUSION

Although no significant group interaction was observed for dominance, direction, and trial, the LBP group demonstrated an ability to leverage fall efficacy following repeated trials to reduce ML balance deficits. Clinicians should consider neuromuscular control and limb dominance when developing fall efficacy strategies for postural adaptations in adults with LBP.

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.

Falls prevention in older people and the role of nursing

Falls among older individuals pose a significant public health challenge globally, impacting both individual wellbeing and healthcare systems. This article examines the importance of falls prevention in older people and the pivotal role of nursing in this domain. It presents statistics indicating the high prevalence of falls among older adults, highlighting their substantial impact on morbidity, mortality and healthcare costs. Furthermore, it discusses the multifactorial nature of fall risk factors, including age-related changes, chronic health conditions, medication use, impaired mobility, sensory deficits and environmental hazards. Nursing interventions encompass comprehensive assessments, personalised care plans, patient education and advocacy efforts aimed at reducing fall risks and enhancing safety. By addressing intrinsic and extrinsic factors contributing to falls, nurses contribute significantly to improving the quality of life for older adults and reducing the economic burden associated with fall-related injuries.

Factors associated with fear of falling and fall-related injuries among people who use wheelchairs and motorized mobility scooters: a cross-sectional study

PURPOSE

To identify the factors associated with the fear of falling (FOF) and fall-related injuries (FRI) among full-time wheelchair and motorized mobility scooter (WC/S) users with various health conditions.

METHODS

This cross-sectional study included participants (≥18 years old) who used WC/S for at least one year for ≥ 75% of mobility and had a history of ≥ 1 fall in the past three years. Logistic regression models identified factors associated with FOF (yes/no) and FRI (yes/no) during the past year. Data on demographics, prior falls, mental health, environmental accessibility, and WC/S usage were used as independent variables.

RESULTS

Among 156 participants, 96% reported at least one fall within the past year, among whom 94.6% reported FOF, and 74% reported FRI within the same period. FOF was associated with fall incidence in the past year (OR = 17.75, p = 0.001). FRI was associated with higher levels of anxiety (OR = 1.15, p = 0.003) and fewer hours of WC/S use per week (OR = 0.98, p = 0.012).

CONCLUSION

This study highlights the high prevalence of FOF and FRI among WC/S users who had falls. The findings emphasized the relation between prior fall experiences and FOF and underscored the significance of addressing anxiety symptoms and WC/S usage in relation to FRI.

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.

A study on the effects of visual condition on postural stability in adults with and without chronic low back pain

This study was conducted to compare postural stability during repeated unilateral standing tasks between adults with and without chronic low back pain (LBP) while considering visual input. The study involved 26 participants with LBP and 39 control participants. Each participant performed three trials of standing tasks on the dominant limb using a stable platform. The Falls Efficacy Scale was utilized to assess fall-related self-efficacy and fear of falling due to potential physical frailty. The center of pressure (COP) sway excursion was analyzed at 10 mm and 20 mm thresholds for the time-in-boundary (TIB). The results indicated a significant fear of falling difference in the LBP group compared to the control group (t = 3.27, p = 0.001). The LBP group demonstrated a significant interaction between visual condition and TIB (F = 8.45, p = 0.01), particularly in the LBP group, which demonstrated a notable decrease in TIB at 10 mm (54.02 % compared to the control group's 70.40 %) and 20 mm (70.93 % compared to the control group's 85.92 %) thresholds during the second trial and at 10 mm (59.73 % compared to the control group's 73.84 %) during the third trial in the eyes open condition. Overall, visual condition demonstrated significant interactions on thresholds (F = 15.80, p = 0.001, η2p = 0.21) as well as trials  ×  thresholds (F = 4.21, p = 0.04, η2p = 0.07). These findings indicate a potential adaptation in postural control among the LBP group with visual feedback. Further research is warranted to explore group differences when considering visual conditions and sway excursion thresholds.

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.

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.

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.

Fear of falling in community-dwelling older adults: What their gait acceleration pattern reveals

BACKGROUND

Fear of Falling (FOF) is common among community-dwelling older adults and is associated with increased fall-risk, reduced activity, and gait modifications.

OBJECTIVE

In this cross-sectional study, we examined the relationships between FOF and gait quality.

METHODS

Older adults (N=232; age 77±6; 65 % females) reported FOF by a single yes/no question. Gait quality was quantified as (1) harmonic ratio (smoothness) and other time-frequency spatiotemporal variables from triaxial accelerometry (Vertical-V, Mediolateral-ML, Anterior-Posterior -AP) during six-minute walk; (2) gait speed, step-time CoV (variability), and walk-ratio (step-length/cadence) on a 4-m instrumented walkway. Mann Whitney U-tests and Random forest classifier compared gait between those with and without FOF. Selected gait variables were used to build Support Vector Machine (SVM) classifier and performance was evaluated using AUC-ROC.

RESULTS

Individuals with FOF had slower gait speed (103.66 ± 17.09 vs. 110.07 ± 14.83 cm/s), greater step time CoV (4.17 ± 1.66 vs. 3.72 ± 1.24 %), smaller walk-ratio (0.53 ± 0.08 vs. 0.56 ± 0.07 cm/steps/minute), smaller standard deviation V (0.15 ± 0.06 vs. 0.18 ± 0.09 m/s2), and smaller harmonic-ratio V (2.14 ± 0.73 vs. 2.38 ± 0.58), all p<.01. Linear SVM yielded an AUC-ROC of 67 % on test dataset, coefficient values being gait speed (-0.19), standard deviation V (-0.23), walk-ratio (-0.36), and smoothness V (-0.38) describing associations with presence of FOF.

CONCLUSION

Older adults with FOF have reduced gait speed, acceleration adaptability, walk-ratio, and smoothness. Disrupted gait patterns during fear of falling could provide insights into psychosocial distress in older adults. Longitudinal studies are warranted.

Normalized stability time analysis within the boundaries between adults with and without fear of falling

BACKGROUND

The unilateral stance test, measured by the center of pressure (COP), has been widely used to identify balance deficits. However, there is a critical gap in understanding the specific COP thresholds on postural stability in adults with a fear of falling (FOF).

AIMS

To investigate the normalized stability time, which was defined as the ratio of time spent within stability boundaries to the total test duration, under different visual conditions and specific thresholds between adults with and without FOF.

METHODS

Twenty-one older adults with FOF and 22 control subjects completed the unilateral limb standing test in eyes-open and eyes-closed conditions. Normalized stability times were computed based on five pre-determined COP sway range thresholds: 10 mm, 15 mm, 20 mm, 25 mm, and 30 mm.

RESULTS

Receiver operating characteristic analysis determined the diagnostic accuracy of FOF. There were significant differences in the effects of both visual conditions (F = 46.88, p = 0.001) and threshold settings (F = 119.38, p = 0.001) on stability time between groups. The FOF group significantly reduced normalized stability time at the 10 mm COP threshold under eyes-closed conditions (t = - 1.95, p = 0.03).

DISCUSSION

The findings highlight the heightened sensitivity of the 10 mm COP threshold in identifying group variances in postural stability when eyes are closed. Moreover, the FOF group displayed a marked reduction in stability duration based on visual scenarios and normalized thresholds.

CONCLUSION

The study highlights the need to account for both COP boundaries and visual conditions in adults with FOF. When assessing postural control during unilateral stances, clinicians must also give attention to non-visual cues.

Relationship between fear of falling and fall risk among older patients with stroke: a structural equation modeling

BACKGROUND

With reduced balance and mobility, older patients with stroke are more susceptible to fear of falling (FOF). A maladaptive form of FOF can cause excessive activity restriction, poor balance, and recurrent falls, forming a self-reinforcing vicious cycle. This study applied and adapted the FOF model to investigate the interaction between FOF and fall risk in older stroke patients.

METHODS

A cross-sectional study was conducted among 302 older stroke patients aged 60 and over. All participants were invited to complete the FOF, fall risk, physical activity, and balance tests, which were measured by the Falls Efficacy Scale International (FES-I), Self-Rated Fall Risk Questionnaire (FRQ), the long-form International Physical Activity Questionnaire (IPAQ-LF) and the Four-Stage Balance Test (FSBT) respectively. Data were analyzed using structural equation modeling.

RESULTS

The mean age of the respondents was 68.62 ± 7.62 years; 8.94% reported a high level of FOF, and 18.21% reported a moderate level of FOF. The structural equation model showed that FOF was directly associated with fall risk (β=-0.38, p < 0.001), and was indirectly associated with fall risk via physical activity (β=-0.075, p < 0.05) and balance ability (β=-0.123, p < 0.05). Depression (β=-0.47, p < 0.001), fall history (β=-0.13, p < 0.05), and female sex (β=-0.16, p < 0.05) affected FOF, while anxiety was not associated with FOF.

CONCLUSIONS

The increased risk of falling in older stroke patients results from a maladaptive FOF affected by depression, fall history, poor balance ability, and limited physical activity. Our results suggest that greater attention should be paid to FOF during stroke recovery and fall prevention. A multifaced intervention program encompassing physiological and psychological factors should be designed to address FOF and prevent falls.

Effectiveness of virtual reality-based balance and gait in older adults with fear of movement: A systematic review and meta-analysis

OBJECTIVE

To summarize the current evidence from randomized controlled trials (RCTs) regarding the effectiveness of Virtual Reality (VR) training and functional mobility in older adults with fear of movement. TYPE: Systematic review and meta-analysis of randomized clinical trials.

METHODOLOGY

An electronic search was performed using PubMed, Embase, Medline, SPORTDiscus, Scopus, and CINAHL. A data search from January 2015 to December 2022 and a manual electronic literature search were conducted to identify published RCTs. The effectiveness of VR-based balance training for balance and gait was evaluated in older adults with a fear of movement, which was measured by the Timed Up and Go (TUG) test and the Falls Efficacy Scale (FES). Three reviewers independently performed the study selection, and the quality assessment of the included studies was performed using the Physiotherapy Evidence Database (PEDro) scale. The reporting was based on the new Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines.

SYNTHESIS

The search product produced 345 results, from which 23 full text articles were studied. Seven RCTs of good methodological quality, including 265 participants, were included in the review. Overall, the studies reported that VR had a significant improvement on the TUG (Cohen's d = -0.91 [-1.38; -0.44], p = 0.001), while the FES was not significantly different (Cohen's d = -0.54 [-1.80; 0.71] p = 0.40). The average for PEDro scores (6.14) was good, and the risk of bias revealed that more than one-third of the studies correctly described the random sequence generation and allocation concealment procedures.

CONCLUSION

VR-based training is effective on balance or gait training based on the TUG; however, there were mixed results to improve FES scores following VR intervention. These inconsistent results might be limited due to variations in the studies, including heterogeneous training paradigms, sensitive outcome measures, small sample sizes, and short intervention durations, which limit the validity of our findings. Future investigations should compare different VR protocols to help establish better guidelines for clinicians.

Investigating the emotional content of older adults engaging in a fall prevention exercise program integrated with dance movement therapy: a preliminary study

Fall prevention interventions for older adults have primarily focused on the physical aspects, overlooking the emotional aspects inherent in falls. This qualitative study presents a novel fall prevention intervention that integrates physical therapy exercise (PTE) based on the Otago Exercise Program with Dance Movement Therapy (DMT) to address the emotional experience during PTE. The aim of this study is to explore the emotional content expressed by older adults during balance-focused exercises and the unique emotional content expressions following the PTE + DMT intervention compared to the PTE intervention. Eleven older adults (aged 81-91 years) from a day center were randomly assigned to either the PTE + DMT group (n = 6) or the PTE group (n = 5). Interpretative phenomenological analysis of the instructors' observations and process diary identified three themes that emerged during the sessions: (1) self-image and self-worth, (2) the individual in relation to others, and (3) past memories. These themes highlight both similarities and differences between the groups. These findings provide valuable insights into the emotional experiences encountered by older adults, particularly in the context of falls prevention practices. Recognizing, understanding, and facilitating the expression of these experiences can enhance the effectiveness of fall prevention interventions and contribute to the overall health of older adults.

Frequency, Characteristics, and Risk Factors for Falls at an Inpatient Cancer Rehabilitation Unit

PURPOSE

Falls in the hospital can lead to adverse events, including injuries. Studies have shown that patients with cancer and those undergoing inpatient rehabilitation (IPR) are at higher risk for falls. Therefore, we measured the frequency, degree of harm, and characteristics of patients who fell in an inpatient cancer rehabilitation unit.

METHODS

A retrospective review was conducted on inpatient cancer rehabilitation patients admitted from January 2012 to February 2016. Fall frequency, degree of harm, fall circumstances, cancer type, patient's fall risk score on the basis of the MD Anderson Cancer Center Adult Inpatient Fall Risk Assessment Tool (MAIFRAT), length of stay, and risk factors were evaluated for patients.

RESULTS

There were 72 out of 1,571 unique individual falls (4.6%), with a falls incidence of 3.76 falls per 1,000 patient-days. Most fallers (86%) suffered no harm. Risk factors for falls included presence of patient-controlled analgesia pump (P = .03), pump such as insulin or wound vacuum-assisted closure (P < .01), nasogastric, gastric, or chest tube (P = .05), and higher MAIFRAT score (P < .01). The fallers were younger (62 v 66; P = .04), had a longer IPR stay (13 v 9; P = .03), and had a lower Charlson comorbidity index (6 v 8; P < .01).

CONCLUSION

The frequency and degree of harm for falls in the IPR unit were less than previous studies, which suggests that mobilization for these patients with cancer is safe. The presence of certain medical devices may contribute to fall risk, and more research is needed to better prevent falls in this higher-risk subgroup.

Elective Foot and Ankle Procedures in the Patients Greater than 65 Years of Age: Worth the Mobility Gains

Chronic, non-traumatic pathologies of the foot and ankle can be mobility-limiting for patients of all ages. The objective of this study was to compare postoperative changes in LifeSpace Mobility Assessment (LSA) scores of adult and elderly patients following elective foot and ankle surgery. A prospective study of 184 patients undergoing elective ankle, hindfoot, and midfoot procedures conducted by one surgeon between 2015 and 2019 was undertaken. Patient-reported LSA scores were collected at preoperative, 6-month, and 12-month follow-up. Patient data was compared using an independent sample t-test for continuous, normally distributed data and a chi-squared or Fischer's exact test for categorical data. Alpha and beta were .05 and .8. Patients were divided based on age. 140 patients were observed in the younger (<65) group, 44 patients were observed in the elderly (≥65) group. The average LSA score of elderly patients at the preoperative visit was 58.3 (SD 38.0) vs 79.3 (SD 38.8) in the younger cohort (P = .041). Both patient cohorts saw decreased mobility at 3-month postoperative visits but surpassed preoperative mobility scores by 6 months and 1 year postop. No difference in average mobility score was observed between young (85.6, SD 36.1) and elderly (90.1, SD 34.3) cohorts at 1-year follow up. Given the increased rates of perioperative comorbidities and the heightened risks of intraoperative complications, physicians may be more inclined to manage elderly patients with longer periods of conservative treatment for similar pathologies. However, these results imply that elderly patients experience similar improvements after surgery to younger cohorts and should not be excluded from surgical consideration. Our results, in tandem with literature showing the deleterious effects of decreased mobility in the elderly, suggest that the discussion to pursue or hold surgical correction of chronic foot and ankle disease in patients over age 65 must consider the mobility benefits of surgery.

Fear of Falling as a Behavioral Symptom in Neurocognitive Impaired Patients: Evidence from an Underrepresented Population

BACKGROUND

Fear of falling (FoF) is a condition associated with falls, multi-morbidity, and functional impairment. To date it remains unknow which clinical, somatic, socio-demographic, behavioral, and emotional factors are associated with FoF and how these factors interact in people with Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD).

OBJECTIVE

Identify the association of FoF with clinical, socio-demographic, and neuropsychiatric factors in patients with AD and bvFTD.

METHODS

We evaluated 98 participants, 58 with AD and 40 with bvFTD at mild or moderate stages and assess FoF using the Falls Efficacy Scale-International. Additionally, we analyzed cognitive, physical performance variables, functional impairment, and affective and behavioral symptoms associated with FoF using standardized scales and a regression model analysis.

RESULTS

The prevalence of FoF in AD and bvFTD was 51% and 40%, respectively. In the AD group, physical performance [F (3, 53) = 4.318, p = 0.009], the behavioral symptoms model [F (19, 38) = 3.314, p = 0.001], and the anxiety model [F (1, 56) = 13.4, p≤0.01] showed statistically significant values. In addition, the presence of hallucinations assessed with the Neuropsychiatric Inventory and social behavior assessed with the Mild Behavioral Impairment Checklist were significant. In contrast, in the bvFTD group, a homologous group of models was evaluated but we did not find any significant results.

CONCLUSION

FoF in people with AD was related to physical performance, neuropsychiatric symptoms such as apathy and hallucinations, and affective symptoms such as anxiety. However, this pattern was not seen in the bvFTD group, and therefore further studies are required.

The association of fear of falling and physical and mental Health-Related Quality of Life (HRQoL) among community-dwelling older persons; a cross-sectional study of Urban Health Centres Europe (UHCE)

BACKGROUND

The share of people over 80 years in the European Union is estimated to increase two-and-a-half-fold from 2000 to 2100. A substantial share of older persons experiences fear of falling. This fear is partly associated with a fall in the recent past. Because of the associations between fear of falling, avoiding physical activity, and the potential impact of those on health, an association between fear of falling and low health-related quality of life, is suggested. This study examined the association of fear of falling with physical and mental Health-Related Quality of Life (HRQoL) among community-dwelling older persons in five European countries.

METHODS

A cross-sectional study was conducted using baseline data of community-dwelling persons of 70 years and older participating in the Urban Health Centers Europe project in five European countries: United Kingdom, Greece, Croatia, the Netherlands and Spain. This study assessed fear of falling with the Short Falls Efficacy Scale-International and HRQoL with the 12-Item Short-Form Health Survey. The association between low, moderate or high fear of falling and HRQoL was examined using adjusted multivariable linear regression models.

RESULTS

Data of 2189 persons were analyzed (mean age 79.6 years; 60.6% females). Among the participants, 1096 (50.1%) experienced low fear of falling; 648 (29.6%) moderate fear of falling and 445 (20.3%) high fear of falling. Compared to those who reported low fear of falling in multivariate analysis, participants who reported moderate or high fear of falling experienced lower physical HRQoL (β = -6.10, P < 0.001 and β = -13.15, P < 0.001, respectively). In addition, participants who reported moderate or high fear of falling also experienced lower mental HRQoL than those who reported low fear of falling (β = -2.31, P < 0.001 and β = -8.80, P < 0.001, respectively).

CONCLUSIONS

This study observed a negative association between fear of falling and physical and mental HRQoL in a population of older European persons. These findings emphasize the relevance for health professionals to assess and address fear of falling. In addition, attention should be given to programs that promote physical activity, reduce fear of falling, and maintain or increase physical strength among older adults; this may contribute to physical and mental HRQoL.

Feasibility and Effectiveness of a Novel Intervention Integrating Physical Therapy Exercise and Dance Movement Therapy on Fall Risk in Community-Dwelling Older Women: A Randomized Pilot Study

This pilot study presents a novel fall prevention intervention that integrates physical therapy exercise (PTE) and dance movement therapy (DMT) to address both physical and emotional fall risk factors, as well as factors influencing adherence to treatment. The aim of this study was to examine the feasibility and effectiveness of the intervention in a sample of eight older women (median = 86 [81.25-90.75] years) from a day center for senior citizens. The intervention, based on the Otago Exercise Program and DMT techniques, aimed to address the emotional experience during physical exercise. Participants were randomly assigned to either a PTE+DMT intervention group (n = 5) or a PTE control group (n = 3). A pre-post intervention battery of physical and emotional fall risk assessments, therapist-patient bond, and home exercise adherence was conducted. Non-parametric tests results showed significant improvement in the PTE+DMT group in measures of balance and fear of falling compared to the PTE group. However, no other significant differences were found between the groups in terms of falls-related psychological concerns, self-perceived health status, therapist-patient bond, and home exercise adherence. These findings demonstrate the feasibility and potential benefits of an intervention that integrates both physical and emotional aspects to reduce fall risk in older adults, and provide a basis for further studies and modifications in the research protocol.

Association between fear of falling and self-care behaviours of older people with hypertension

AIM

This study investigated the association between fear of falling and self-care behaviours of older people with hypertension.

DESIGN

A cross-sectional study.

METHODS

This study was conducted in 2019 on 301 older people with hypertension above the age of 60 years in Tehran, Iran. Data were collected using a demographic questionnaire, the Persian Falls Efficacy Scale-International, and a hypertension-related self-care behaviour questionnaire.

RESULTS

Analyses revealed that gender, educational level and history of falling were significant factors associated with fear of falling; and marital status, educational level and income source were significant factors associated with self-care behaviours (p < 0.05). Partial correlations controlling for education revealed a significant positive correlation showing that high fear of falling is associated with worse health promotion self-care behaviours and significant inverse correlations with psycho-emotional, social and daily self-care behaviours (p < 0.05), meaning that high fear of falling is associated with better self-care for these dimensions.

PATIENT OR PUBLIC CONTRIBUTION

This study involved patients in order to evaluate the validity and reliability of the questionnaires. The study was conducted on older people with hypertension referred to hypertension clinics in hospitals.

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.

Gait Characteristics Associated with Fear of Falling in Hospitalized People with Parkinson's Disease

BACKGROUND

Fear of falling (FOF) is common in Parkinson's disease (PD) and associated with distinct gait changes. Here, we aimed to answer, how quantitative gait assessment can improve our understanding of FOF-related gait in hospitalized geriatric patients with PD.

METHODS

In this cross-sectional study of 79 patients with advanced PD, FOF was assessed with the Falls Efficacy Scale International (FES-I), and spatiotemporal gait parameters were recorded with a mobile gait analysis system with inertial measurement units at each foot while normal walking. In addition, demographic parameters, disease-specific motor (MDS-revised version of the Unified Parkinson's Disease Rating Scale, Hoehn & Yahr), and non-motor (Non-motor Symptoms Questionnaire, Montreal Cognitive Assessment) scores were assessed.

RESULTS

According to the FES-I, 22.5% reported low, 28.7% moderate, and 47.5% high concerns about falling. Most concerns were reported when walking on a slippery surface, on an uneven surface, or up or down a slope. In the final regression model, previous falls, more depressive symptoms, use of walking aids, presence of freezing of gait, and lower walking speed explained 42% of the FES-I variance.

CONCLUSION

Our study suggests that FOF is closely related to gait changes in hospitalized PD patients. Therefore, FOF needs special attention in the rehabilitation of these patients, and targeting distinct gait parameters under varying walking conditions might be a promising part of a multimodal treatment program in PD patients with FOF. The effect of these targeted interventions should be investigated in future trials.

Prevalence and risk factors for abnormal tandem gait in patients with essential tremor syndrome: A cross-sectional study in Southwest China

Objectives

Patients with essential tremor (ET) syndrome have more prevalent and more serious gait and balance impairments than healthy controls. In this cross-sectional study, we explored whether balance impairments are associated with falls as well as more pronounced non-motor symptoms in patients with ET syndrome.

Methods

We assessed the tandem gait (TG) test, as well as falls or near-falls that occurred over the previous year. Non-motor symptoms-including cognitive deficits, psychological and sleep disorders-were evaluated. In univariate analyses, statistical significance was corrected for multiple comparisons using the Benjamini-Hochberg method. Multiple logistic regression was utilized to evaluate the risk factors of poor TG performance in patients with ET syndrome.

Results

A total of 358 patients with ET syndrome were divided into the abnormal TG (a-TG) and normal TG (n-TG) groups based on their performances in the TG test. We revealed that 47.2% of patients with ET syndrome had a-TG. The patients with a-TG were older, were more likely female, and were more likely present with cranial tremors and falls or near-falls (all adjusted P < 0.01). The patients with a-TG had significantly lower Mini-Mental Status Examination scores, as well as significantly higher Hamilton Depression/Anxiety Rating Scale and Pittsburgh Sleep Quality Index scores. Multiple logistic regression analysis demonstrated that female sex (OR 1.913, 95% CI: 1.180-3.103), age (OR 1.050, 95% CI: 1.032-1.068), cranial tremor scores (OR 1.299, 95% CI: 1.095-1.542), a history of falls or near-falls (OR 2.952, 95% CI: 1.558-5.594), and the presence of depressive symptoms (OR 1.679, 95% CI: 1.034-2.726) were associated with the occurrence of a-TG in patients with ET syndrome.

Conclusion

TG abnormalities may be a predictor of fall risk in patients with ET syndrome and are associated with non-motor symptoms, especially depression.

Longitudinal Relationship between Mobility Device Use, Falls and Fear of Falling (FOF) Differed by Frailty Status among Community-Dwelling Older Adults

OBJECTIVES

This study examined the longitudinal relationship between mobility device use, falls and fear of falling (FOF) among community-dwelling older adults by frailty status over a one-year follow-up.

DESIGN

A longitudinal cohort study.

SETTING

Communities in the United States.

PARTICIPANTS

Community-dwelling older adults from the National Health and Aging Trends Study, a nationally representative survey of Medicare Beneficiaries in the United States (N=5,896).

MEASUREMENTS

Based on yes or no response to the corresponding items for the variables, fall-related outcomes were determined separately including falls and FOF. Falls were assessed by asking participants whether they had a fall and if they had fallen down more than one time. FOF was measured by asking participants whether they worried about falling and if this worry ever limited activities. Mobility device use was determined by asking whether participants used any type of mobility devices and the number of devices used, including cane, walker, wheelchair and scooter. Frailty was assessed using the frailty phenotype. Multinomial logistic regression models were conducted to examine the association between mobility device use and fall-related outcomes among older adults by frailty status.

RESULTS

At Year 1, 28.6% of participants reported using mobility devices. Among robust participants, using one mobility device had 3.58 times higher risks of FOF with fear-related activity restriction (FAR) than non-device users (95% CI: 1.10-11.65). Cane-only robust users had 5.94 and 2.18 times higher risks of FOF with and without FAR (95% CI: 1.80-19.57; 95% CI: 1.12-4.22) than non-device users. Among pre-frail participants, using one mobility device was associated with recurrent falls and FOF with FAR (RRR=2.02, 95% CI: 1.30-3.14; RRR=2.13, 95% CI: 1.25-3.63). Using ≥2 devices was associated with one fall (RRR=2.08, 95% CI: 1.30-3.33), recurrent falls (RRR=2.92, 95% CI: 1.62-5.25) and FOF with FAR (RRR=2.84, 95% CI: 1.34-6.02). Pre-frail cane-only users were more likely to have one fall (RRR=1.57, 95% CI: 1.06-2.32), recurrent falls (RRR=2.36, 95% CI: 1.48-3.77) and FOF with FAR (RRR=2.08, 95% CI: 1.12-3.87) than non-device users. The number of mobility device used and the use of canes failed to be significantly associated with fall-related outcomes among frail participants.

CONCLUSION

The number of mobility devices used and the only use of canes were associated with fall-related outcomes among robust and pre-frail individuals. Further research is needed to develop targeted strategies for preventing falls and FOF among older adults with mobility device use, particularly for those in the early stages of frailty.

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.

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.

Symptoms of anxiety and depression predicting fall-related outcomes among older Americans: a longitudinal study

Background

Anxiety and depressive symptoms are associated with fear of falling and fear of falling-related activity restrictions. However, it remains unknown whether anxiety or depressive symptoms alone could predict fear of falling and activity restrictions in older adults. We sought to determine if anxiety and depressive symptoms alone could be an independent predictor of fear of falling and activity restrictions in community-dwelling older adults.

Methods

This longitudinal analysis used waves 5 (time 1, [T1]) and 6 (time 2, [T2], 1 year from T1) data (N = 6376) from the National Health and Aging Trends Study. The Generalized Anxiety Disorder Scale 2 and Patient Health Questionnaire 2 were used to assess anxiety and depressive symptoms, respectively. Interview questions included demographics, health-related data, and fall worry levels (no fear of falling, fear of falling but no activity restrictions, and activity restrictions). Using multinomial logistic regression models, we examined whether anxiety and depressive symptoms (T1) predicted fear of falling and activity restrictions (T2).

Results

In wave 5 (T1, mean age: 78 years, 58.1% female), 10 and 13% of participants reported anxiety and depressive symptoms. About 19% of participants experienced fear of falling but not activity restrictions, and 10% of participants developed activity restrictions in wave 6 (T2), respectively. Participants with anxiety symptoms at T1 had a 1.33 times higher risk of fear of falling (95% CI = 1.02–1.72) and 1.41 times higher risk of activity restrictions (95% CI = 1.04–1.90) at T2. However, having depressive symptoms did not show any significance after adjusting for anxiety symptoms.

Conclusions

Anxiety symptoms seemed to be an independent risk factor for future fear of falling and activity restrictions, while depressive symptoms were not. To prevent future fear of falling and activity restrictions, we should pay special attention to older individuals with anxiety symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03406-8.

Cognitive, psychological and social factors associated with older adults' mobility: a scoping review of self-report and performance-based measures

Although many factors have been associated with mobility among older adults, there is paucity of research that explores the complexity of factors that influence mobility. This review aims to synthesise the available evidence for factors comprising the cognitive, psychological, and social mobility determinants and their associations with mobility self-reported and performance-based outcomes in older adults (60 years). We followed Arksey and O'Malley's five stages of a scoping review and searched PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature and Sociological Abstract databases. Reviewers in pairs independently conducted title, abstract, full-text screening and data extraction. We reported associations by analyses rather than articles because articles reported multiple associations for factors and several mobility outcomes. Associations were categorised as significantly positive, negative, or not significant. We included 183 peer-reviewed articles published in 27 countries, most of which were cross-sectional studies and conducted among community-dwelling older adults. The 183 articles reported 630 analyses, of which 381 (60.5%) were significantly associated with mobility outcomes in the expected direction. For example, older adults with higher cognitive functioning such as better executive functioning had better mobility outcomes (e.g., faster gait speed), and those with poor psychological outcomes, such as depressive symptoms, or social outcomes such as reduced social network, had poorer mobility outcomes (e.g., slower gait speed) compared to their counterparts. Studies exploring the association between cognitive factors, personality (a psychological factor) and self-reported mobility outcomes (e.g., walking for transportation or driving), and social factors and performance-based mobility outcomes in older adults are limited. Understanding the additive relationships between cognitive, psychological, and social factors highlights the complexity of older adults' mobility across different forms of mobility, including independence, use of assistive devices, transportation, and driving.

Relationship between Associated Neuropsychological Factors and Fall Risk Factors in Community-Dwelling Elderly

This study examined whether neuropsychological factors could affect fall risk factors in the community-dwelling elderly via correlation analysis. A total of 393 older adults (76.69 ± 6.01) participated in this study. Cognitive function, depression, fall efficacy, balance confidence, balance, gait, and muscle strength were evaluated, and the correlation between psychological factors and fall risk factors was analyzed. Additionally, a multiple regression analysis was conducted to determine whether or not there was a significant effect between psychological factors and fall risk factors. Analysis showed that the psychological factors examined were all significantly correlated with the fall risk factors. A correlation analysis between cognitive function and fall risk factors showed that the correlation coefficient of the 6-Meter Walk Test was highest; for depression and fall risk factors, the correlation coefficient of gait speed was highest; for fall efficacy and fall risk factors, the correlation coefficient of the 6-Meter Walk Test was highest; and for confidence in balancing and fall risk factors, the correlation coefficient of the 6-Meter Walk Test was highest. This study suggests that psychological factors affect fall risk factors in the community-dwelling elderly, and a multifaceted approach that includes psychological factors would be helpful in providing interventions for falls.

Does poor sleep quality and excessive daytime sleepiness influence fear of falling among older adults? A cross-sectional study

Poor sleep is a risk factor for falling among older adults. This study aimed to investigate whether poor sleep quality and excessive daytime sleepiness in older people was associated with fear of falling. Participants aged 60 years or older were interviewed, with those who did not have preserved cognitive skills being excluded. Data on age, gender, body mass index, alcohol consumption, mental status, depression, excessive daytime sleepiness, sleep quality, comorbidities and fear of falling were collected. Univariate and multivariate linear regression were conducted. The logistic regression assessed the association between daytime sleepiness and fear of falling. The odds of an older adult being afraid of falling was 3 times higher among those with excessive daytime sleepiness, in comparison to those with no excessive daytime sleepiness. The higher the daytime sleepiness, the greater the fear of falling. Health professionals should be aware of older patients' sleepiness because it can increase fear of falling and influence their treatment.

Coexistent physical and cognitive decline and the development of fear of falling among Korean older adults

OBJECTIVES

Although hand grip strength and cognitive function are associated with fear of falling (FOF), little is known about whether coexisting physical and cognitive decline is jointly related to FOF. This study examines whether grip strength and cognitive function interact to shape FOF and FOF-related activity restriction (FAR) among Korean older adults.

METHODS/DESIGN

This study used seven waves of the Korean Longitudinal Study of Ageing (N = 3373 older adults aged 65 or over). Grip strength was assessed by a handgrip dynamometer, and cognitive function by Korean Mini-mental State Examination (K-MMSE). Fixed effects models were estimated to account for time-invariant confounders such as genetic predispositions, innate ability, and health endowments. This study estimated a joint model that included interaction effects between grip strength and cognitive function.

RESULTS

Declines in grip strength and cognitive function were independently associated with FOF. Fixed effects estimates suggested that, despite some attenuation, controlling for individual heterogeneity does not confound the associations. The interaction model showed that coexistence of low grip strength and cognitive decline leads to a greater risk of FOF and FAR than having a single condition. Similar patterns were found for FAR.

CONCLUSIONS

This study provides evidence that coexistent cognitive and physical decline are a significant risk factor for FOF and FAR. Given the well-established adverse effects of FOF on older adults' health and well-being, results of this study lend support to interventions to target old adults with coexistent cognitive and physical decline to remove excessive concerns about FOF.

Harnessing robot experimentation to optimize the regulatory framing of emerging robot technologies

From exoskeletons to lightweight robotic suits, wearable robots are changing dynamically and rapidly, challenging the timeliness of laws and regulatory standards that were not prepared for robots that would help wheelchair users walk again. In this context, equipping regulators with technical knowledge on technologies could solve information asymmetries among developers and policymakers and avoid the problem of regulatory disconnection. This article introduces pushing robot development for lawmaking (PROPELLING), an financial support to third parties from the Horizon 2020 EUROBENCH project that explores how robot testing facilities could generate policy-relevant knowledge and support optimized regulations for robot technologies. With ISO 13482:2014 as a case study, PROPELLING investigates how robot testbeds could be used as data generators to improve the regulation for lower-limb exoskeletons. Specifically, the article discusses how robot testbeds could help regulators tackle hazards like fear of falling, instability in collisions, or define the safe scenarios for avoiding any adverse consequences generated by abrupt protective stops. The article’s central point is that testbeds offer a promising setting to bring policymakers closer to research and development to make policies more attuned to societal needs. In this way, these approximations can be harnessed to unravel an optimal regulatory framework for emerging technologies, such as robots and artificial intelligence, based on science and evidence.

Falls-efficacy as a multiple dimension construct: the role of post-traumatic symptoms

OBJECTIVE

The purpose of this study was to provide the basis for a new theoretical understanding of the psychological response to falls. We tested a hypothesised model of multiple dimensions of falls-efficacy (FE) in older adults. The model involved two main components of posttraumatic stress disorder (PTSD) - fear and dysphoria - that were hypothesised to be directly associated with FE. The model proposed three pathways related to FE: 'at the moment FE' related to fear, 'constant FE' related to dysphoria and 'elaborated FE' related to fear of falls (FoF).

METHODS

In this cross-sectional study a convenience sample of 119 older adults hospitalised in Poland due to fall-related injuries completed a survey involving fear of falls, FE and PTSD assessment.

RESULTS

All three hypothesised pathways related to FE were supported, which accounted for 61% of the variance in falls efficacy. Very strong relationships were found between FE and dysphoria (.447, 95% CI [.303, .632], p = .006), FE and fear (.261, 95% CI [.109, .416], p = .009), and FE and FoF (-.286, 95% CI [-.396, -.183], p = .006).

CONCLUSION

FE is not a unidimensional concept but acts differently depending on what influences it. Dysphoria appears to be central to the fall-related constructs of FE and FoF and responsible for their maladaptivity. FoF, which is often misinterpreted as FE, was found to be less prominent in the analyses. Thus, fear of falls may not always be negative, as it is commonly believed, but adaptive and protective.

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.

SARC-F and the Risk of Falling in Middle-Aged and Older Community-Dwelling Postmenopausal Women

(1) Background: The objective of the present study was to determine the ability of the SARC-F questionnaire to identify individuals at risk of falling among middle-aged and older community-dwelling postmenopausal women. (2) Methods: An analytical cross-sectional study was conducted on 157 women (70.80 ± 8.37 years). The SARC-F questionnaire was used to screen for risk of sarcopenia. Fear of falling and balance confidence, as measured by the Falls Efficacy Scale-International (FES-I) and the Activities-Specific balance Scale-16 items (ABC-16) respectively, were used to assess risk of falling. Anxiety and depression (Hospital Anxiety and Depression Scale), fatigue (Fatigue Severity Scale), body mass index, waist-to-hip ratio, and sleep duration were also determined. (3) Results: Logistic regression showed that higher risk of falling as assessed by FES-I was associated with higher SARC-F scores (OR = 1.656), anxiety levels (OR = 1.147), and age (OR = 1.060), while increased SARC-F scores (OR = 1.612), fatigue (OR = 1.044), and shorter sleep duration (OR = 0.75) were related to ABC-16 scores. In addition, a SARC-F cutoff of 1.50 (83.33% sensitivity and 59.13% specificity) and 3.50 (44.44% sensitivity and 89.26% specificity) were shown to be able to discriminate participants at risk of falling according to the FES-I and the ABC-16, respectively. (4) Conclusions: our results show that SARC-F is an independent predictor of the risk of falling among middle-aged and older community-dwelling postmenopausal women.

Let's Walk It: Mobility and the Perceived Quality of Life in Older Adults

European policy and the research and development landscape put forward a number of arguments in favor of implementing “Active Assisted Living” (AAL) for older adults: it will improve older adults’ quality of life, allow them to age in place, and keep costs for an ageing society down by exploiting new technology markets. The idea is that older adults who are supported by AAL and make use of assistive technologies will enjoy more freedom, autonomy, and mobility and also improved social integration and better communication. Yet, despite a history of more than 10 years of European research and development, the use of AAL applications is not as widespread as expected. To examine older adults’ attitudes to assistive technologies, we conducted a study in Vienna (Austria) between 2018 and 2020 questioning 245 older adults aged 61–93 years (M = 74.27 SD = 6.654) who lived at their private homes and had different support needs (ranging from “no support” to “everyday visit of social and/or care organizations”). The three goals of the study encompassed: (1) examination of their quality of life, (2) their attitudes and use of assistive technologies, and (3) the way they perceive their own and others’ life-course and getting older. AAL as a concept links “ageing in place” and “quality of life”. However, “mobility” is also of major importance here. In this paper, we aim to investigate the relation between the independent variables “Quality of life” and “Mobility” and their possible associations with the following dependent variables: cohabitation, social integration, self-rated health, sportive activities, locomotion, home well-being and safety, physical limitations, falls, and self-perception of their own ageing (compared to others). We calculated multivariate models regressing on these explaining and confounding variables. We found a positive correlation between mobility and quality of life. In detail, our results show a significant positive association between QOL and mobility regarding self-rated health and self-perception. Experiencing vertigo, walking difficulties, and balance problems significantly and negatively influence self-rated health and self-perception compared to others. Our findings can also be read as a clear message that there is a need to improve both health and the culture of ageing and to facilitate positive attitudes toward ageing as an efficient way to enhance the Quality of life of older adults.

Unexplained falls in the elderly

Falls are a geriatric syndrome affecting mortality, morbidity, and institutionalization. Falls are also the leading cause of unintentional injury and a common emergency department presentation. Physical and psychological issues may develop after falling, leading to increase in dependency and disability and their relative costs. The pathogenesis of falls is multi-factorial, being indeed the result of the interaction between increased individual susceptibility, high risk activities and environmental hazards. The patient should be evaluated for gait, standing balance, mobility, muscle weakness, cognitive status, osteoporosis risk, sensorial impairment, urinary incontinence, functional status, and for possible residential environmental hazards. It is also mandatory to obtain a full report of the circumstances and a careful therapeutic recognition. However not all falls are explainable. Indeed, retrograde amnesia and the frequent absence of a witness complicate history collection of falls in older adults. In this case, "the management of unexplained falls should be the same as that for unexplained syncope" as stated by the latest version of the European Society of Cardiology guidelines on syncope. In this context, the investigation of the cardiovascular autonomic nervous system and the use of implantable loop recorder have an increasing role. The present paper addresses the diagnostic approach to falls in older adults through a comprehensive multifactorial risk assessment and examines evidence and gaps on fall prevention strategies.

History of Falls, Dementia, Lower Education Levels, Mobility Limitations, and Aging Are Risk Factors for Falls among the Community-Dwelling Elderly: A Cohort Study

Background: Falling is a serious issue among elderly community dwellers, often resulting in disability. We aimed to investigate the risk factors for falls among elderly community dwellers. Methods: We recruited 232 participants from multiple community learning and care centers, who provided their information through questionnaires. They were divided into two groups, according to their falling events after a 1-year follow-up. Univariate and multivariate logistic regressions were used for statistical analysis. Results: A total of 64 participants reported a fall at the 1-year follow-up. The falling group comprised older and single people with lower education levels, higher rates of dementia, a history of falls, lower scores on the Mini-Mental State Examination, and more disability functions when compared to the non-falling group (all p < 0.05). The regression model showed that a history of falls (OR: 62.011; p < 0.0001), lower education levels (OR: 4.088; p = 0.039), mild dementia (OR: 20.729; p = 0.028), older age (OR: 1.176; p < 0.0001), walking for 300 m (OR: 4.153; p = 0.030), and running for 30 m (OR: 3.402; p = 0.015) were 1-year risk factors for falls. Conclusion: A history of falling, low education levels, aging, mild dementia, and certain mobility limitations were strong risk factors for future falling accidents in elderly Taiwanese community dwellers.

Examining the relationship between elderly patients' fear of falling after spinal surgery and pain, kinesiophobia, anxiety, depression and the associated factors

This study aimed to examine the relationship between fear of falling in elderly patients who underwent spinal surgery and pain, kinesiophobia, anxiety, depression, and associated factors. The study was a descriptive, cross-sectional design. The research sample consisted of 211 elderly patients who had undergone spinal surgery. The average age of the patients was 66.68 ± 5.57. Of the sample, 83.4% were afraid of falling, and 21.3% were severely afraid of falling. In the study, age (β = 0.115, p = 0.005), being a woman (β = -0.182, p < 0.001), pain (β = 0.269, p < 0.001), risk of falling (β = 0.084, p = 0.49), Hospital Anxiety and Depression Scale-Anxiety (HADS-A) (β = 0.135, p = 0.044), Hospital Anxiety and Depression Scale Anxiety-Depression (HADS-D) (β = 0.382, p < 0.001), and kinesiophobia (β = 0.722, p < 0.001) were statistically significant predictors of fear of falling. This study provided important information about the variables that surgical nurses should pay attention to while evaluating the fear of falling in elderly patients who underwent spinal surgery.

Incidence and risk factors related to fear of falling during the first mobilisation after total knee arthroplasty among older patients with knee osteoarthritis: A cross-sectional study

BACKGROUND

The factors that lead to the fear of falling among older people after total knee arthroplasty (TKA) are poorly understood. The present study aims to examine the fear of falling among such patients and to determine the factors that are associated with that fear.

METHODS

A total of 285 patients aged ≥65 with knee osteoarthritis who underwent TKA at an orthopaedic hospital between November 2019 and May 2020 completed surveys about their own first mobilisation after TKA. They were asked to indicate whether they were afraid of falling by asking a single question, and what their pain level was on a visual analogue scale. They also completed the General Anxiety Disorder scale, the Geriatric Depression Scale-Short Form and the Social Support Rating Scale. Multivariate logistic regression was used to identify risk factors for fear of falling during the first mobilisation after TKA. This study was reported in compliance with the STROBE checklist for cross-sectional studies (see Supplementary File S1).

RESULTS

Just over half (56.5%) of participants reported being afraid of falling. Multivariate logistic regression identified three independent risk factors that explained a total of 31% of the variance in the fear of falling: female sex (odds ratio (OR) = 4.21, 95% confidence interval (CI) = 2.35-7.55), higher body mass index (OR =3.93, 95% CI =1.53-10.10) and higher anxiety (OR = 1.56, 95% CI = 1.37-1.78).

CONCLUSIONS

Many older patients fear falling when they begin to move after TKA, particularly women and those with higher body mass index or anxiety. These subgroups may merit special attention from healthcare professionals to mitigate their fears and optimise recovery after TKA.

Fear of falling is as important as multiple previous falls in terms of limiting daily activities: a longitudinal study

Background

Fear of falling and previous falls are both risk factors that affect daily activities of older adults. However, it remains unclear whether they independently limit daily activities accounting for each other.

Methods

We used the data from Round 1 (Year 1) to Round 5 (Year 5) of the National Health and Aging Trends Study. We included a total of 864 community-dwelling participants who provided data on previous falls, fear of falling and limited activities from Year 1 to Year 5 and had no limited daily activities at Year 1 in this study. Previous falls and fear of falling were ascertained by asking participants how many falls they had in the past year and whether they had worried about falling in the last month. Limited daily activities included any difficulties with mobility (e.g., going outside), self-care (e.g., eating), and household activities (e.g., laundering). Generalized estimation equation models were used to examine whether previous falls and fear of falling independently predicted development of limited daily activities adjusting covariates.

Results

Participants were mainly between 65 and 79 years old (83 %), male (57 %), and non-Hispanic White (79 %). Among participants who had multiple falls in Year 1, 19.1-31 %, 21.4-52.4 %, and 11.9-35.7 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 5, respectively. Among those who had fear of falling in Year 1, 22.5-41.3 %, 30.0-55.0 %, and 18.8-36.3 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 4, respectively. Fear of falling independently predicted limitations in mobility (Incidence rate ratio [IRR]: 1.79, 95 % CI: 1.44, 2.24), self-care (IRR: 1.25, 95 % CI: 1.08, 1.44) and household activities (IRR: 1.39, 95 % CI: 1.08, 1.78) after adjusting for previous falls and covariates. Multiple previous falls independently predicted limitations in mobility (IRR: 1.72, 1.30, 2.27), self-care (IRR: 1.40, 95 % CI: 1.19, 1.66) and household activities (IRR: 1.36, 95 % CI: 1.01, 1.83) after adjusting fear of falling and covariates.

Conclusions

Fear of falling seems to be as important as multiple previous falls in terms of limiting older adults’ daily activities.

Associations between Daily Movement Distribution, Bone Structure, Falls, and Fractures in Older Adults: A Compositional Data Analysis Study

With aging, bone density is reduced, increasing the risk of suffering osteoporosis and fractures. Increasing physical activity (PA) may have preventive effects. However, until now, no studies have considered movement behaviors with compositional data or its association to bone mass and structure measured by peripheral computed tomography (pQCT). Thus, the aim of our study was to investigate these associations and to describe movement behavior distribution in older adults with previous falls and fractures and other related risk parameters, taking into account many nutritional and metabolic confounders. In the current study, 70 participants above 65 years old (51 females) from the city of Zaragoza were evaluated for the EXERNET-Elder 3.0 project. Bone mass and structure were assessed with pQCT, and PA patterns were objectively measured by accelerometry. Prevalence of fear of falling, risk of falling, and history of falls and fractures were asked through the questionnaire. Analyses were performed using a compositional data approach. Whole-movement distribution patterns were associated with cortical thickness. In regard to other movement behaviors, moderate-to-vigorous PA (MVPA) showed positive association with cortical thickness and total true bone mineral density (BMD) at 38% (all p < 0.05). In addition, less light PA (LPA) and MVPA were observed in those participants with previous fractures and fear of falling, whereas those at risk of falling and those with previous falls showed higher levels of PA. Our results showed positive associations between higher levels of MVPA and volumetric bone. The different movement patterns observed in the groups with a history of having suffered falls or fractures and other risk outcomes suggest that different exercise interventions should be designed in these populations in order to improve bone and prevent the risk of osteoporosis and subsequent fractures.

[Prevalence of fear of falling and related factors in community-dwelling older people]

Objetivo

El objetivo general del estudio es conocer la prevalencia de la preocupación a caer en personas mayores, independientes para la deambulación, que viven en la comunidad, según la versión reducida del FES-I y los factores asociados que influyen en esta preocupación.

Diseño

Estudio descriptivo transversal.

Emplazamiento

Centro de Salud El Greco (Getafe), Gerencia Asistencial de Atención Primaria de Madrid.

Participantes

Ciento ochenta y nueve pacientes ≥ 70 años independientes o con dependencia funcional leve-moderada (índice de Barthel ≥ 60) e independientes para la deambulación (camina 45 min sin ayuda o con bastón). El estudio se ofreció a 328 personas: 217 aceptaron y rechazaron 111.

Mediciones principales

La variable dependiente, miedo a caerse (MC), fue evaluada mediante el cuestionario Short FES-I, considerando como punto de corte para el cribado positivo del MC una puntuación ≥ 11. Como variables independientes se consideraron: índice de Barthel, escala Downton, prueba de fragilidad Short Physical Performance Battery (SPPB), caídas en el último año, lesiones asociadas a las caídas, tiempo desde la última caída, déficit sensorial, uso de dispositivos de la marcha, comorbilidad y tratamiento farmacológico.

Resultados

La prevalencia del MC fue del 42,9% (IC 95%: 35,5-50,2). Los factores asociados al MC en el análisis multivariante final fueron: sexo femenino, vivir solo, alto riesgo de caídas, presencia de fragilidad, uso de hipotensores y lesiones asociadas a caídas previas.

Conclusiones

La prevalencia del miedo a caer en personas mayores es elevada. Los profesionales de atención primaria deben sistematizar el cribado de este problema de salud, priorizando especialmente en las personas que presentan los siguientes factores de riesgo: ser mujer, vivir solo, tener una puntuación baja en el SPPB (como indicador de fragilidad) o presentar un elevado riesgo de caídas.

Prevalence and Associates of Fear of Falling among Community-Dwelling Older Adults

OBJECTIVES

We aimed to study the prevalence of fear of falling (FOF), and its association with physical performance, functionality, frailty, sarcopenia, and a variety of geriatric syndromes including cognitive impairment, depression, quality of life and hearing.

DESIGN

Retrospective, cross-sectional study.

SETTING

Community-dwelling older adults applied to the geriatric outpatient clinic of a university hospital.

PARTICIPANTS

A total of 1021community-dwelling older adults >= 60 years of age applying to the geriatric outpatient clinic of a university hospital.

MEASUREMENTS

We screened for falls and FOF by single close-ended questions. We performed screening and assessment of probable sarcopenia by SARC-F test and handgrip strength evaluation according to EWGSOP2. We used timed up and go test (TUG), usual gait speed (UGS) for physical performance, and Katz- activities of daily living (ADL) and Lawton-Brody instrumental activities of daily living (IADL) for functional evaluation. We screened anxiety with the Generalized Anxiety Disorder-7 scale.

RESULTS

The prevalence of FOF was 44.6% and falls, 37.7%. Prevalence of FOF in sarcopenia screening positive participants was 30.1%; in probable sarcopenic (35/20 kg) participants, 43.9%; in those with undernutrition, 45.7%; in fallers, 51.1%; in females, 80.4%; and in prefrail/frail was 74.7% Multivariate regression analyses revealed that female sex (OR=4.1, 95%CI= 2.0-8.4, p<0.001), anxiety (OR=2.7, 95%CI= 1.1-6.5, p=0.03) and ADL limitation (OR=2.5, 95%CI= 1.03-6.3, p=0.04) were independent associates of FOF.

CONCLUSION

FOF accompanied by fall experience or not is prevalent in community-dwelling older adults. It is associated with anxiety and ADL limitations apart from the female sex.

Comparison of postural control in older adults under different dual-task conditions: A cross-sectional study

BACKGROUND

and purpose: Performing a cognitive task while maintaining postural stability, known as "dual-task" condition, can increase the cognitive demand and reduce the postural control capacity. The inability to allocate attention to postural control under dual-task conditions may lead to balance impairments, particularly in older adults. The present study aimed to compare the effects of different dual-task conditions of backward counting (BC) and visual attention (VA) on older adults' postural balance performance.

METHODS

Twenty asymptomatic volunteers (mean age: 70.4 ± 4.1 years) were recruited. Participants stood on a foam surface placed over a force plate, and displacement and sway velocity of their center of pressure (COP) in anterior-posterior (AP) and medial-lateral (ML) directions were recorded under three conditions: BC dual-task, VA dual-task (control of center of mass with a laser pointer), and quiet stance as the control task (CT).

RESULTS

Repeated measures ANOVA showed a significant difference in AP and ML sway velocities between conditions with p-values of 0.039 and 0.042, respectively. The LSD post-hoc test revealed that the BC task significantly increased AP sway velocity compared to the CT (p = 0.013), and the VA task significantly increased ML sway velocity compared to the CT (p = 0.034) and the BC tasks (p = 0.026). There were no statistically significant differences between conditions for ML (p = 0.058) and AP (p = 0.350) displacements and total sway velocity (p = 0.051).

CONCLUSION

Older adults' postural stability can be impaired under dual-task conditions and the present study revealed that various dual tasks increase postural sway in different directions.

Mediating factors on the association between fear of falling and health-related quality of life in community-dwelling German older people: a cross-sectional study

Background

Previous research has shown that not only falls, but also fear of falling (FoF) influences health-related quality of life (HrQoL) negatively. The EQ-5D (consisting of an index and a visual analogue scale [EQ-VAS]) is a frequently used instrument to determine HrQoL in clinical studies and economic evaluations, but no previous study compared the association between FoF and the EQ-5D index with the association between FoF and the EQ-VAS. Moreover, factors that influence the association between FoF and HrQoL are rarely examined. Thus, this study aimed to examine the association between FoF and HrQoL and to examine factors that mediate the association.

Methods

FoF (Short Falls Efficacy Scale International) and HrQoL (EQ-5D descriptive system, EQ-5D index, and EQ-VAS) were assessed in a sample of community-dwelling older persons (≥70 years) participating in the baseline assessment of a randomized controlled trial (N = 309). Linear and logistic regression analyses were performed, adjusting for sociodemographic variables, frequency of falls, number of chronic conditions, functional mobility (Timed up-and-go test), and subjective functional capacity (LLFDI function and disability scales). Multiple regression models were used to test the mediating effects.

Results

Moderate or high FoF was prevalent in 66% of the sample. After adjusting for covariates, FoF was negatively associated with the EQ-5D index, but not with the descriptive system or the EQ-VAS. Subjective functional capacity partly mediated the association between FoF and the EQ-5D index and completely mediated the association between FoF and the EQ-VAS.

Conclusion

FoF was negatively associated with the EQ-5D index. As subjective functional capacity mediated the association between FoF and HrQoL, future interventions should account for subjective functional capacity in their design.

What are the psychosocial consequences when fear of falling starts or ends? Evidence from an asymmetric fixed effects analysis based on longitudinal data from the general population

OBJECTIVES

The purpose of this study was to identify whether the onset and the end of fear of falling (FOF) are associated with psychosocial consequences (in terms of depressive symptoms, loneliness, social isolation, autonomy, and subjective well-being).

METHODS/DESIGN

Longitudinal data for this study were taken from the nationally representative German Ageing Survey which included community-dwelling individuals ≥40 years (wave 5 and wave 6). Psychosocial outcome measures were assessed using widely established and well-validated scales. The presence of FOF was used as the main explanatory variable. It was adjusted for age, family status, labor force participation, self-rated health, physical functioning, as well as the number of chronic conditions.

RESULTS

Linear fixed effects regressions revealed that FOF was associated with adverse psychosocial outcomes (increased depressive symptoms, lower life satisfaction, lower positive affect, higher negative affect, and lower perceived autonomy). Asymmetric fixed effects regressions analysis showed that the onset of FOF was associated with reduced life satisfaction as well as reduced autonomy, whereas the end of FOF was associated with reduced depressive symptoms, decreased loneliness scores, as well as decreased negative affect.

CONCLUSIONS

The study findings suggest that future studies should analyze the consequences of FOF differently (onset and end of FOF) which has practical important implications. More specifically, while strategies to avoid the onset of FOF may help to maintain satisfaction with life and autonomy, strategies to end FOF may contribute to avoid increased loneliness, feelings of negative affect, as well as increased depressive symptoms. J Am Geriatr Soc 68:-, 2020.