Effects of mild and global cognitive impairment on the prevalence of fear of falling in community-dwelling older adults

Effect of combined physical and cognitive intervention on fear of falling in older adults: A systematic review and meta-analysis

OBJECTIVE

Fear of falling (FOF) is common among older adults. Currently, physical exercise, cognitive intervention, and combined physical and cognitive intervention have been proven to be effective interventions. However, whether combined interventions can provide additional benefits than single interventions remains unclear. Thus, the systematic and meta-analysis was conducted to explore the immediate and retention effects of combined physical and cognitive interventions, in comparison with a single intervention.

MATERIALS AND METHODS

Randomized controlled trials of combined interventions on FOF in older adults were searched using Web of Science, PubMed, Cochrane Library, EMBASE, SCOPUS, CINAHL, and PsycINFO from inception to March 20, 2023. The risk of bias in included studies was evaluated using the Cochrane Collaboration Risk of Bias tool. Two independent researchers extracted the data using predetermined criteria.

RESULTS

31 studies were included in the systematic review and meta-analysis. For the immediate post-intervention effect, the combined intervention was more effective than the blank/placebo/conventional intervention and the single cognitive intervention, while no additional effect was observed compared with the single physical intervention. Moreover, no additional follow-up retention effects were found when comparing the combined intervention with the single intervention.

CONCLUSIONS

Combined interventions had positive immediate effects on FOF in older adults, compared with single cognitive intervention, while combined interventions had a similar effect as a single physical intervention. More well-designed studies are required to explore the additional benefits of combined interventions compared with a single intervention and to investigate the follow-up effects of combined interventions.

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.

Differences in fall-related characteristics across cognitive disorders

Approximately 40-60% of falls in the elderly lead to injuries, resulting in disability and loss of independence. Despite the higher prevalence of falls and morbidity rates in cognitively impaired individuals, most fall risk assessments fail to account for mental status. In addition, successful fall prevention programmes in cognitively normal adults have generally failed in patients with cognitive impairment. Identifying the role of pathological aging on fall characteristics can improve the sensitivity and specificity of fall prevention approaches. This literature review provides a thorough investigation into fall prevalence and fall risk factors, the accuracy of fall risk assessments, and the efficacy of fall prevention strategies in individuals with diverse cognitive profiles. We show that fall-related characteristics differ between cognitive disorders and fall risk assessment tools as well as fall prevention strategies should critically consider each patient's cognitive status to facilitate the identification of fallers at an earlier stage and support clinical decision-making.

[Classification of community-dwelling older people based on their physical, mental, cognitive, and oral functions and comorbidities and its relationship with the fall history]

AIM

To prevent falls among older adults, healthcare professionals need to assess these individuals from multiple perspectives. This study aimed to group community-dwelling older Japanese people based on their physical, mental, cognitive, and oral functions and comorbidities, and compare the history of falling in these groups.

METHODS

Data were obtained from a cross-sectional survey conducted in 2015 among older residents of a ward of Tokyo. For the survey, a questionnaire was distributed to all residents aged ≥65 years without a certificate of long-term care (n = 132,005). Questions were posed concerning respondents' physical, mental, cognitive, and oral functions; comorbidities; and experience with falling in the past year. Cluster and logistic regression analyses were performed.

RESULTS

A total of 70,746 participants (53.4%) were included in the analysis. The mean age was 73.6 years old, and 44.9% were male. Four groups were identified in the cluster analysis: the "good general condition group" (n = 37,797, 52.4%), "poor mental function group" (n = 10,736, 14.7%), "moderate physical function group" (n = 13,461, 19.0%), and "poor general condition group" (n = 9,122, 12.9%). A logistic regression analysis with adjusting for socio-demographic characteristics, health behaviors, and fear of falling showed that the odds ratios for the experience of falling within the past year were 1.44 (95% confidence interval: 1.34-1.53), 1.54 (1.44-1.65), and 2.52 (2.34-2.71) in the poor mental function, moderate physical function, and poor general condition groups, respectively, with the good general condition group as the reference.

CONCLUSIONS

We classified community-dwelling older adults into four groups based on multiple functions and found possible variations in the risk of falling by group. These findings suggest that such classification may be useful for the prevention of falls.

Prevalence, risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis

OBJECTIVES

To identify falls prevalence, falls risk factors and evaluate the effectiveness of falls prevention interventions for community-dwelling people with Mild Cognitive Impairment.

DATA SOURCES

Peer-reviewed articles (inception to 4 August 2022) from PubMed, CINAHL, PsycInfo, EMBASE, Scopus, SportDiscus and the Cochrane library.

REVIEW METHODS

All types of methodological approaches were considered. Inclusion criteria were community-dwelling; diagnosis of Mild Cognitive Impairment; aged 50+ years. Interventions needed to include falls prevention programs aiming to reduce falls and/or risk of falls. Outcomes of interest included number and/or rate of falls, falls prevalence and falls risk factors. For controlled trials, any control group was included. Quality assessment was completed using Cochrane's Risk of Bias Tool for randomized controlled trials and the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields for all other studies. Where statistical data pooling was not possible, narrative synthesis was used to present data in tables and figures.

RESULTS

Forty-seven studies were included. Prevalence of falls was 43% when data were gathered prospectively for 12 months. Confirmed falls risk factors included slow gait, dual-tasking, postural control and non-amnesic Mild Cognitive Impairment. Few studies evaluated interventions to reduce falls. Six meta-analyses were conducted, no significant reduction in falls was found.

CONCLUSIONS

Until further high-quality, adequately powered studies are available to guide practice, best practice guidelines recommend balance training as a core component of falls prevention programs for older people generally, as well as people with Mild Cognitive Impairment.

Transient versus stable nature of fear of falling over 24 months in community-older persons with falls- data of the EU SCOPE project on Kidney function

BACKGROUND

Fear of falling (FoF) is an important risk factor for falls among older people. The objectives of our investigations were: a.) to present characteristics of older community-dwelling (CD) fallers with persistent or transient FoF (P-FoF or T-FoF) over 12 months, and b.) to investigate clinical predictors of P-FoF and T-FoF and c.) to explore differences between P-FoF and T-FoF.

METHODS

Our series consisted of 389 older people reporting a fall or injurious fall at baseline and during 24 months follow-up participating in a multicenter prospective study. T-FoF was defined as participants reported "not at all" at baseline and "somewhat/fairly/very concerned" at follow-up, or "not at all" at follow-up, and "somewhat/fairly/very concerned" at baseline, and P-FoF was defined as participants answered "somewhat/fairly/very concerned" in both assessments at baseline and at follow-up. The association between risk factors and T-FoF or P-FoF was investigated by logistic regression analysis.

RESULTS

The mean age of fallers in our sample was 79.0 years (SD 6.0), and 54.2% were females. Out of 389 older adults with a fall history at baseline, 83 participants (21.3%) did not report any FoF over time, P-FoF and T-FoF were observed in 42.7% and 35.9% of participants, respectively. After adjusting for potential confounders (e.g. age, gender), osteoporosis (OR = 2.04, 95%CI = 1.03-4.05) and impaired physical performance (OR = 2.38, 95%CI = 1.12-5.03) were significant predictors of T-FoF vs No-FoF. Osteoporosis (OR = 2.68, 95%CI = 1.31-5.48), depressive symptoms (OR = 3.54, 95%CI = 1.23-10.1) and living alone (OR = 2.44, 95%CI = 1.17-5.06) were significantly associated with P-FoF vs No-FoF. When comparing T-FoF and P-FoF, female gender (OR = 1.95, 95%CI = 1.16-3.27), BMI (OR = 1.08, 95%CI = 1.02-1.14), overall comorbidity (OR = 1.07, 95%CI = 1.02-1.13) and depression (OR = 2.55, 95%CI = 1.33-4.88) were significant predictors of P-FoF.

CONCLUSIONS

T-FoF and P-FoF may be predicted by different sets of risk factors among older fallers. Thus, fallers should be screened for FoF especially when carrying specific risk factors, including female gender, osteoporosis, depression, living alone, impaired physical performance, BMI, comorbidity. These findings may be helpful in designing tailored intervention to blunt the risks related to consequence of FoF among older people experiencing falls.

TRIAL REGISTRATION

The SCOPE study was registered prospectively at clinicaltrials.gov (NCT02691546; 25/02/2016).

Psychometric Properties of the Turkish Version of the Fear of Falling Questionnaire-Revised (FFQ-R) in Nursing Home Residents with Mild Cognitive Decline

BACKGROUND

The aim of the study was to investigate the validity and reliability of the Turkish version of the Fear of Falling Questionnaire-Revised (FFQ-R) in older adults with mild cognitive impairment (MCI) living in a nursing home.

METHODS

The study was conducted with 107 (69 women) older adults. The participants were evaluated with the FFQ-R, the Falls Efficacy Scale (FES), the Mini-Mental State Examination (MMSE), the Barthel Index and Montgomery-Åsberg Depression Rating Scale (MADRS)". FFQ-R was refilled one month later for retesting.

RESULTS

Cronbach's alpha value of the FFQ-R was 0.971. The global internal consistency was excellent (>0.80). Intraclass correlation coefficient of the FFQ-R was 0.962 (95% CI: 0.92-0.98), indicating excellent test-retest reliability. The Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) values of the FFQ-R was 0.80 and 2.21, respectively. The correlation between the total score of FFQ-R and the FES was excellent (r = 0.963, p < .001). The relationship between FFQ-R and MMSE was excellent (r = -0.821, p < .001). Besides, there was a moderate correlation between the FFQ-R with Barthel Index (r = -0.648, p < .001) and FFR-Q with MADRS (r = 0.568, p < .001).

CONCLUSION

Turkish version of the FFQ-R is a valid and reliable tool to assess the fear of falling in nursing home residents.

Factors Associated with Fear of Falling in Individuals with Different Types of Mild Cognitive Impairment

Mild cognitive impairment (MCI) is considered an intermediate state between normal aging and early dementia. Fear of falling (FOF) could be considered a risk indicator for falls and quality of life in individuals with MCI. Our objective was to explore factors associated with FOF in those with MCI due to Alzheimer’s disease (AD-MCI) and mild cognitive impairment in Parkinson’s disease (PD-MCI). Seventy-one participants were separated into two groups, AD-MCI (n = 37) and PD-MCI (n = 34), based on the disease diagnosis. FOF was assessed using the Activities-specific Balance Confidence scale. The neuropsychological assessment and gait assessment were also measured. FOF was significantly correlated with global cognitive function, attention and working memory, executive function, Tinetti assessment scale scores, gait speed, and stride length in the AD-MCI group. Moreover, attention and working memory were the most important factors contributing to FOF. In the PD-MCI group, FOF was significantly correlated with gait speed, and time up and go subtask performance. Furthermore, turn-to-walk was the most important factor contributing to FOF. We noted that FOF in different types of MCI was determined by different factors. Therapies that aim to lower FOF in AD-MCI and PD-MCI populations may address attention and working memory and turn-to-walk, respectively.

Fear of Falling, Cognition, and Physical Function in Community-Dwelling Older Adult

BACKGROUND

Fear of falling (FOF) might be associated with physical and cognitive function, but there is a lack of understanding of the specific relationship between the three variables.

OBJECTIVES

To accurately investigate the association of FOF with cognitive and physical function in community-dwelling older adults.

METHODS

A total of 669 older adults (> 60 years) participated in this study. A self-report questionnaire collected information about demographic characteristics, lifestyle, and behavioral habits. FOF was evaluated through the Shortened Version of the Falls Efficacy Scale International. Global cognitive function and the subdomains of cognitive function (including memory, visual-spatial, language, attention, and executive function) were assessed using the Montreal Cognitive Assessment (MoCA) scale, the Auditory Verbal Learning Test (AVLT), the Clock-Drawing Test (CDT), the Verbal Fluency Test, and the Trail Making Test. Subjective memory complaints were assessed using the Subjective Memory Complaints Questionnaire (SMCQ). Physical function was evaluated by measuring muscle strength and balance ability, and muscle strength was indicated by hand grip strength. In contrast, balance was assessed using the Timed Up and Go (TUG) Test.

RESULTS

After adjustment for potential confounding factors, the linear or ordinal regression analysis showed that the values of hand grip strength, MoCA, AVLT, and CDT were significantly and negatively correlated with the score of FOF. On the other hand, SMCQ and TUG Test values showed significant positive correlations with FOF scores. Moreover, compared with other cognitive or physical measures, the CDT and TUG Test values showed a greater association with the FOF scores.

DISCUSSION

Low subjective or objective cognitive ability and low physical function, especially low visuospatial and balance ability, were positively associated with the risk of FOF in a community-dwelling older population.

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.

Mobility Performance in Community-Dwelling Older Adults: Potential Digital Biomarkers of Concern about Falling

INTRODUCTION

Concern about falling is a prevalent worry among community-dwelling older adults and may contribute to a decline in physical and mental health. This study aimed to examine the association between mobility performance and concern about falling.

METHODS

Older adults aged 65 years and older, with Mini-Mental State Examination score ≥24, and ambulatory (with or without the assistive device) were included. Concern about falling was evaluated with Falls Efficacy Scale-International (FES-I) scores. Participants with high concern about falling were identified using the cutoff of FES-I ≥23. Participants' motor capacity was assessed in standardized walking tests under single- and dual-task conditions. Participants' mobility performance was measured based on a 48-h trunk accelerometry signal from a wearable pendant sensor.

RESULTS

No significant differences were observed at participant characteristics across groups with different levels of concern about falling (low: N = 64, age = 76.3 ± 7.2 years, female = 46%; high: N = 59, age = 79.3 ± 9.1 years, female = 47%), after propensity matching with BMI, age, depression, and cognition. With adjustment of motor capacity (stride velocity and stride length under single- and dual-task walking conditions), participants with high concern about falling had significantly poorer mobility performance than those with low concern about falling, including lower walking quantity (walking bouts, steps and time per day, and walking bout average, walking bout variability, and longest walking bout, p ≤ 0.013), and poorer daily-life gait (stride velocity and gait variability, p ≤ 0.023), and poorer walking quality (frontal gait symmetry, and trunk acceleration and velocity intensity, p ≤ 0.041). The selected mobility performance metrics (daily steps and frontal gait symmetry) could significantly contribute to identifying older adults with high concern about falling (p ≤ 0.042), having better model performance (p = 0.036) than only walking quantity (daily steps) with adjustment of confounding effects from the motor capacity (stride length under dual-task walking condition).

CONCLUSION

There is an association between mobility performance and concern about falling in older adults. Mobility performance metrics can serve as predictors to identify older adults with high concern about falling, potentially providing digital biomarkers for clinicians to remotely track older adults' change of concern about falling via applications of remote patient monitoring.

A comparison of the prevalence of Fear of Falling between older patients with Lewy body dementia, Alzheimer's disease, and without dementia

BACKGROUND

The development of cognitive impairment and Fear of Falling (FoF) are strongly linked, but prevalence of FoF is not known in patients with different types of dementia. This study aims to evaluate and compare the prevalence and severity of FoF in patients' with dementia with Lewy bodies (DLB), Alzheimer disease (AD), and non-dementia.

METHODS

46 participants with DLB, 86 participants with AD and participants without dementia (controls), underwent Comprehensive Geriatric Assessment (CGA). The Falls Efficacy Scale-International (FES-I) was used to determine and classify FoF. An overall score on the FES-I of 16-19, 20-27 and ≥28, was accepted as low, moderate, and high concern about FoF, respectively.

RESULTS

Prevalence of high FoF was 86.9% in DLB, 36.0% in AD and 37.4% in controls. All CGA parameters were worse in the DLB and AD group than non-dementia group (p < 0.001). The prevalence of high FoF/FES-scores was significantly higher in the DLB group than in the AD and non-dementia group (p < 0.001), but was similar in AD and non-dementia groups (p > 0.05). The significant relationship between DLB and FoF was maintained when adjusted for age, CGA parameters, and orthostatic hypotension (OR: 2.55, CI: 1.03-6.25, p = 0.041 comparison to AD; OR: 4.79, CI: 2.10-10.92, p < 0.001 comparison to non-dementia).

CONCLUSION

Eight out of ten elderly patients with DLB have high FoF, which is much higher than those with AD and without dementia. Therefore, clinicians should be aware of FoF and its related consequences in the management of DLB in older adults.

Association of fear of falling with cognitive function and physical activity in older community-dwelling adults

PURPOSE

This study addressed a two-part question. First, is cognitive decline associated with fear of falling (FoF)? Second, if this association is observed, is there also an association between FoF and physical activity (PA) independent of cognitive decline?

METHODS

Participants in the study were community-dwelling Japanese residents between 65 and 85 years of age (N = 458, mean age = 72.4 ± 4.6, male = 53.7%). Step counts were recorded, as was objectively measured PA, divided into (1) low-intensity PA and (2) moderate- and vigorous-intensity PA. Three groups were determined based on FoF: low, moderate, and high. Neuropsychological tests were also conducted.

RESULTS

Participants with high FoF had slower processing speed. low-intensity PA was associated with only high FoF, but after controlling for processing speed, the significance of this association was attenuated. Shorter time of moderate- and vigorous-intensity PA was associated with high FoF, even in the full model controlling for other factors. All FoF levels were associated with lower step counts.

CONCLUSION

older community-dwelling adults with high FoF were found to have had declined cognitive speed/ Second, both moderate and high FoF were associated with moderate- and vigorous-intensity PA and step counts in older community-dwelling adults, with the high FoF group performing shorter time of moderate- and vigorous-intensity PA and fewer steps.

Mismatch of Subjective and Objective Risk of Falling in Patients with Dementia

BACKGROUND

Match or mismatch of objective physiological and subjectively perceived fall risk may have serious consequences in patients with dementia (PwD) while research is lacking.

OBJECTIVE

To analyze mismatch of objective and subjective fall risk and associated factors in PwD.

METHOD

Cohort study in a geriatric rehabilitation center. Objective and subjective risk of falling were operationalized by Tinetti's Performance Oriented Mobility Assessment and the Falls Efficacy Scale-International. Four sub-groups according to objective and subjective fall risk were classified. Subgroups were compared for differences in clinical, cognitive, psychological, and behavioral variables.

RESULTS

In geriatric rehab patients with mild to moderate dementia (n = 173), two-thirds showed a mismatch of subjective versus objective risk of falling, independently associated with previous falls. Underestimation of objective fall risk (37.6%) was determined by lower activity avoidance (OR 0.39), less concerns about falling due to previous falls (OR 0.25), and higher quality of life (OR 1.10), while overestimation (28.9%) was determined by higher rate of support seeking strategies (OR 50.3), activity avoidance (OR 15.2), better executive (OR 21.0) and memory functions (OR 21.5), and lower quality of life (OR.75) in multivariate logistic regression.

CONCLUSION

The majority of patients showed a mismatch between objective and subjective falls risk. Underestimation as well as overestimation of fall risk was associated with specific profiles based on cognitive- and psychological status, falls and fall-related behavioral consequences which should be included in the comprehensive assessment of fall risk, and planning of individualized fall prevention programs for this population.

Fear of Falling and Mortality among Older Adults in Korea: Analysis of the Korean Longitudinal Study of Aging

Background

The fear of falling (FOF) has been reported in a high percentage of elderly people. An excessive FOF is a major concern among the elderly because it can lead to permanent disability. However, the impact of FOF on mortality has been insufficiently studied. The aim of this study was to investigate the impact of FOF on mortality among the elderly in Korea.

Methods

This was a prospective study carried out using the database of the Korean Longitudinal Study of Aging, a nationwide study of community-dwelling adults in Korea. Study participants included 3,421 adults, aged 65 years or older, without either severe cognitive impairment (Korean version of Mini-Mental Status Examination ≥10), or previous history of cancer. We used Cox proportional hazards models to investigate the association between FOF and all-cause mortality.

Results

This study included 1,474 men and 1,947 women. Cox regression showed that participants with FOF had an increased risk of mortality (mild: hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.01−1.54; moderate: HR, 1.59; 95% CI, 1.23−2.05) after adjusting for confounding variables. In a subgroup analysis, FOF was still a significant risk factor of mortality for patients with no previous history of falling after adjusting for other risk factors, as in the full model, except for history of falling (HR, 1.65; 95% CI, 1.27−2.13).

Conclusion

We found that FOF was a significant risk factor for mortality in the elderly in Korea. Further studies on the effects and mechanism of FOF on mortality are needed.

Fear of falling in community-dwelling older adults diagnosed with cancer: A report from the International Mobility in Aging Study (IMIAS)

BACKGROUND

The incidence of fear of falling (FOF) is high among people with cancer. However, factors that are associated with FOF in people with cancer has not yet been investigated. Therefore, the objective of this study was to identify the associated factors with FOF in people with cancer.

METHOD

This is a secondary analysis of the International Mobility in Aging Study (IMIAS) study. A total of 175 people self-identified as patients with cancer (mean age: 69.3 years, women: 50.2%) and 177 healthy age-matched group. FOF measured using the Falls Efficacy Scale-International (FES-I) was the primary outcome. Potential variables/factors for consistency known to be associated with FOF (cognitive status, depression, physical performance, the number of falls in the last year, visual acuity and grip strength) were assessed. Simple linear regression was used to identify factors associated with FOF. Variables with p-value <0.05 were then included in a multiple linear regression adjusted for the study confounders (study site, sex, and age).

RESULTS

For people with cancer, FES-I was significantly associated with the Leganes Cognitive Test, The Short Physical Performance Battery (SPPB) total scores and the number of falls reported in the past 12 months (P-value <0.05). For the healthy group, FOF was only associated with depression and SPPEB.

CONCLUSION

FOF is multifactorial in people with cancer and it is associated with cognitive status, physical performance and number of falls in the last year. Healthcare providers for patients with cancer should evaluate all potential factors associated with FOF and manage it.

Fear of falling: A manifestation of executive dysfunction?

OBJECTIVE

Fear of falling (FoF) may be an early marker of decline in global cognitive functioning, but associations with specific domains of cognitive functioning are unclear. The aim was to examine associations between FoF and 4-year decline in memory, processing speed, and executive functioning in adults aged 50 years and older.

METHODS

Data were from 5174 participants (mean age = 62.6 ± 8.9 years, range = 50-91, 54.5% female) in The Irish Longitudinal Study on Ageing, a population-based study.

MEASUREMENTS

FoF was self-reported in 2009 to 2011. Immediate and delayed recall, Colour Trails 1 and 2, choice reaction time, sustained attention to response task, and verbal fluency were measured in 2009 to 2011 and 2014 to 2015. Prospective associations between FoF and domains of cognitive functioning were examined using linear mixed modelling. Adjustment was made for demographic and health factors. Interactions with age were examined.

RESULTS

In 2009 to 2011, 20.6% of participants reported FoF. No statistically significant interaction of FoF with age was found for any of the associations (P ≥ .06). Participants with FoF had greater decline on delayed recall (B = -0.19; 95% CI, -0.32 to -0.06), verbal fluency (B = -0.52; 95% CI, -0.88 to -0.18); and the ln-transformed scores for the Colour Trails 1 test (B = -0.04; 95% CI, -0.07 to -0.01) and the Colour Trails 2 test (B = -0.04; 95% CI, -0.06 to -0.02) than participants without FoF. No statistically significant associations were found for any of the other outcomes.

CONCLUSIONS

FoF may be an indicator of decline in domains of cognitive functioning, particularly those related to executive function and processing speed. However, studies with longer follow-up and/or higher average age are required to confirm this.

FACTORS ASSOCIATED WITH LOW CONCERN ABOUT FALLING IN PHYSICALLY ACTIVE OLDER PEOPLE

ABSTRACT Introduction: Fear of falling is one of the main consequences of falls in the elderly; therefore, it is important to investigate the factors associated with the reduction of this fear. Objective: The objective of this study consisted of verifying the associated factors that best explain the low concern about falling in physically active older people. Methods: A total of 162 elderly people with a mean age of 69.95 (SD = 6.69) participated in the study. The diagnostic data sheet, the Falls Efficacy Scale-International, the Senior Fitness Test and anthropometric measurements were used to obtain data. Binary Logistic Regression was used in the data analysis to estimate the Odds Ratio (OR) and 95% confidence intervals (95% CI). The p <0.05 Omnibus Test was used to assess the quality of the adjusted model, and the Hosmer-Lemeshow test was applied to verify the explanatory power of the model. Results: In the crude analysis, normal weight elderly subjects (OR = 2.86, 95% CI = 1.32-6.20) with good levels of lower limb strength (OR = 2.64, 95% CI = 1.38-5.06), are more likely to have low fear of falling. In the adjusted analysis, the model was able to explain 75% of endpoint occurrence. Conclusion: It is concluded that among the variables analyzed, age, BMI and lower limb strength best explain the low concern about falling in the elderly. Level of Evidence III; Study of nonconsecutive patients; without consistently applied reference “gold” standard.

Fear of falling in sensory impaired nursing home residents

Objectives: Fear of falling (FOF) causes excess disability in nursing home (NH) residents and is associated with vision and hearing impairment. We explored factors associated with FOF in 225 NH residents with vision, hearing or dual sensory impairment.Methods: We explored age, gender, cognition, depression, social engagement, illness burden, falls, physical function, mobility, falls self-efficacy and outcome expectancy as predictors of FOF using univariate logistic regression modeling, followed by multivariate analysis by group (visual, hearing, dual, total sample).Results: Fifty-one percent of residents had FOF. Residents who had FOF reported better cognition, lower falls self-efficacy, and higher outcome expectancy in the total sample and in most impairment groups. Falls outcome expectancy predictedFOF in the total sample and in the visual and hearing sensory impairment groups.Conclusion: When addressing FOF in NH residents it is important to address sensory status along with fears about falling to promote function.

Can clinical and physical-functional factors predict falls in cognitively impaired older adults?

Abstract Objective: to investigate the frequency of falls and clinical and physical-functional factors associated with falls, and the accuracy of such factors to identify the risk of falling in cognitively impaired older adults. Method: a cross-sectional study with cognitively impaired older adults was carried out using the Mini-Mental State Examination. The dependent variable was a history of falls in the previous six months. The independent variables were self-reported mental confusion, hearing and visual impairment, physical fatigue, muscle weakness, dizziness, body imbalance, insecurity when walking, diagnosed depression, hospitalizations, continuous use medications (form from study used), muscle mass (calf circumference) and handgrip strength (dynamometry), functional capacity (Pfeffer) and mobility (SAM-Br). Descriptive statistics were applied. The groups were compared using the Mann Whitney U test, the risk factors were identified by univariate and multivariate logistic regression, and the area under the ROC curve (AUC) was calculated for the associated factors. Results: 216 cognitively impaired older adults were included in the analysis, 41.7% of whom were fallers. Multivariate regression analyzes indicated that complaints of visual impairment (OR=2.8; p=0.015) and body imbalance (OR=2.7; p=0.004), and greater medication use (OR=1.1; p=0.038) were associated with a history of falls. The AUC found poor accuracy for quantity of medications as a screening tool for fallers (AUC=0.6 [0.5; 0.7]; p=0.028). Conclusion: cognitively impaired older adults had a high frequency of falls. Complaints of visual impairment, body imbalance and polypharmacy were predictors of falls. The early assessment of these factors can contribute to the identification of cognitively-impaired older adults at risk of falling in clinical practice and research.

Fear of falling and its predictors among community-living older adults in Korea

OBJECTIVES

To explore the prevalence and predicting factors of fear of falling (FOF) among community-living older adults in Korea.

METHODS

Secondary data analysis of the 2011 Korean National Elderly Living Conditions and Welfare Desire Survey was used. Logistic regression analysis was conducted to examine the predictors of FOF.

RESULTS

In total, 75.6% of older adults with normal cognition have FOF. Factors associated with an increased risk of FOF in older adults are previous experience with falling (OR = 3.734, 95% CI = 2.996-4.655), limitations in the performance of exercise involving lower extremities (OR = 2.428, 95% CI = 2.063-2.858), being female (OR = 2.335, 95% CI = 2.023-2.694), having more than three chronic diseases (OR = 1.994, 95% CI = 1.625-2.446), limitations in instrumental activities of daily living (IADLs) (OR = 1.745, 95% CI = 1.230-2.477), limitations in the performance of exercise involving upper extremities (OR = 1.646, 95% CI = 1.357-1.997), living without a spouse (OR = 1.626, 95% CI = 1.357-1.948), having poor self-rated health (OR = 1.571, 95% CI = 1.356-1.821), limitations in muscle strength (OR = 1.455, 95% CI = 1.150-1.841), age (≥75 years) (OR = 1.320, 95% CI = 1.150-1.516), lower levels of education (0-6 years) (OR = 1.231, 95% CI = 1.075-1.409), and life satisfaction (OR = 1.104, 95% CI = 1.065-1.114).

CONCLUSION

A multidimensional construct of general characteristics, physical, and psychosocial variables act as risk factors for FOF. Preventive intervention should be developed to decrease the FOF among Korean older adults.

The Association Between Excessive Daytime Sleepiness and Gait Parameters in Community-Dwelling Older Adults: Cross-Sectional Findings From the Obu Study of Health Promotion for the Elderly

OBJECTIVE

This study examined the association between excessive daytime sleepiness (EDS) and gait characteristics (e.g., speed, variability) in community-dwelling older adults.

METHOD

This cross-sectional study included 3,901 individuals aged ≥65 years. Participants answered questions about EDS, sleep duration, and other sleep-related symptoms. Gait speed, stride length, and the variability in stride length were assessed by using a stopwatch and a WalkWay device.

RESULTS

EDS was significantly associated with slower gait speed among younger subjects (<75 years, p = .021) and with both slower gait speed ( p = .045) and greater variability in stride length among older subjects (≥75 years, p = .048) in a multivariate analysis adjusted for age, sex, body mass index, medication, number of comorbidities, and education.

DISCUSSION

EDS associates with gait ability, particularly in older old adults. Further prospective studies are needed to determine the causal association between gait ability and sleep disturbances, including EDS.

Falls and Fall Prevention in Older Adults With Early-Stage Dementia: An Integrative Review

Older adults with mild cognitive impairment (MCI) and early-stage dementia have an increased risk of falling, with risks to their health and quality of life. The purpose of the current integrative review was to evaluate evidence on fall risk and fall prevention in this population. Studies were included if they examined falls or fall risk factors in older adults with MCI or early-stage dementia, or reported interventions in this population; 40 studies met criteria. Evidence supports the increased risk of falls in individuals even in the early stages of dementia or MCI, and changes in gait, balance, and fear of falling that may be related to this increased fall risk. Interventions included exercise and multifactorial interventions that demonstrated some potential to reduce falls in this population. Few studies had strong designs to provide evidence for recommendations. Further study in this area is warranted. [Res Gerontol Nurs. 2017; 10(03):139-148.].

Factors Associated with Fear of Falling among Community-Dwelling Older Adults in the Shih-Pai Study in Taiwan

Background

Fear of falling is an important risk indicator for adverse health related outcomes in older adults. However, factors associated with fear of falling among community-dwelling older adults are not well-explored.

Objectives

To explore the quality of life and associated factors in fear of falling among older people in the Shih-Pai area in Taiwan.

Methods

This community-based survey recruited three thousand eight hundred and twenty-four older adults aged ≥ 65 years. The measurements included a structured questionnaire, including quality of life by using Short-Form 36, and information of fear of falling, fall history, demographics, medical conditions, insomnia, sleep quality, depression and subjective health through face-to-face interviews.

Results

A total of 53.4% of participants reported a fear of falling. The rate of fear of falling was higher in female subjects. Subjects with fear of falling had lower Short Form-36 scores both for men and women. Falls in the previous year, older age, insomnia, depression and worse subjective health were correlates of fear of falling for both sexes. Male-specific associations with fear of falling were the accessibility of medical help in an emergency, diabetes mellitus and stroke. In parallel, cardiovascular diseases were a female-specific correlate for fear of falling.

Conclusions

Fear of falling is prevalent among community-dwelling older adults. It is seems that there are gender differences in fear of falling with respect to the prevalence and associated factors in older adults. Gender differences should be considered when planning prevention and intervention strategies for fear of falling among older people.

Heterogeneity of Characteristics among Housing Adaptation Clients in Sweden--Relationship to Participation and Self-Rated Health

The aim of the paper was to explore the heterogeneity among housing adaptation clients. Cluster analysis was performed using baseline data from applicants in three Swedish municipalities. The analysis identified six main groups: “adults at risk of disability”, “young old with disabilities”, “well-functioning older adults”, “frail older adults”, “frail older with moderate cognitive impairments” and “resilient oldest old”. The clusters differed significantly in terms of participation frequency and satisfaction in and outside the home as well as in terms of self-rated health. The identification of clusters in a heterogeneous sample served the purpose of finding groups with different characteristics, including participation and self-rated health which could be used to facilitate targeted home-based interventions. The findings indicate that housing adaptions should take person/environment/activity specific characteristics into consideration so that they may fully serve the purpose of facilitating independent living, as well as enhancing participation and health.

Fear of falling in vision impairment

Falls are the leading cause of injury-related morbidity and mortality among older adults. In addition to the resulting physical injury and potential disability after a fall, there are also important psychological consequences, including depression, anxiety, activity restriction, and fear of falling. Fear of falling affects 20 to 43% of community-dwelling older adults and is not limited to those who have previously experienced a fall. About half of older adults who experience fear of falling subsequently restrict their physical and everyday activities, which can lead to functional decline, depression, increased falls risk, and reduced quality of life. Although there is clear evidence that older adults with visual impairment have higher falls risk, only a limited number of studies have investigated fear of falling in older adults with visual impairment and the findings have been mixed. Recent studies suggest increased levels of fear of falling among older adults with various eye conditions, including glaucoma and age-related macular degeneration, whereas other studies have failed to find differences. Interventions, which are still in their infancy in the general population, are also largely unexplored in those with visual impairment. The major aims of this review were to provide an overview of the literature on fear of falling, its measurement, and risk factors among older populations, with specific focus on older adults with visual impairment, and to identify directions for future research in this area.

Fear of falling and falls in older adults with mild cognitive impairment and Alzheimer's disease

Cognitive impairment and fear of falling are risk factors for falls in older adults. Recurrent falls are more prevalent in older adults with cognitive impairment. We examined the number of previous falls, self-reported fear of falling, and the Falls Efficacy Scale-International (FES-I) in 104 older adults [26 with mild Alzheimer's disease (AD), 42 with mild cognitive impairment (MCI) and 36 cognitively healthy]. Older adults with AD and MCI had a higher number of falls (1.1 ± 1.2 and 1.5 ± 1.5, respectively) compared to the control group (0.3 ± 0.5, P < .001). Older adults with MCI more often reported fear of falling (74%) than patients with AD (31%) (P ≤ .002) and scored higher on the FES-I (29.7 and 23.8, respectively, P ≤ .01). The prevalence of falls in older adults with MCI and AD is higher than in subjects cognitively healthy. Older adults with MCI and AD differ in terms of reported fear of falling and falls self-efficacy.