Psychological correlates of fear of falling: Findings from the German Aging Survey

Cross-sectional study of prevalence and correlates of fear of falling in the older people in residential care in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES)

OBJECTIVE

To report the prevalence and risk factors for the fear of falling (FOF) among older individuals living in residential care facilities in India.

DESIGN

Cross-sectional study.

SETTING

Homes for the aged centres in Hyderabad, India.

PARTICIPANTS

The study included individuals aged ≥60 years from homes for the aged centres. The participants underwent a comprehensive eye examination in make-shift clinics setup in homes. Trained investigators collected the personal and demographic information of the participants and administered the Patient Health Questionnaire-9 and Hearing Handicap Inventory for Elderly questionnaire in the vernacular language. FOF was assessed using the Short Falls Efficacy Scale. The presence of hearing and visual impairment in the same individual was considered dual sensory impairment (DSI). A multiple logistic regression analysis was done to assess the factors associated with FOF.

PRIMARY OUTCOME MEASURE

FOF.

RESULTS

In total, 867 participants were included from 41 homes for the aged centres in the analyses. The mean (±SD) age of the participants was 74.2 (±8.3) years (range 60-96 years). The prevalence of FOF was 56.1% (95% CI 52.7% to 59.4%; n=486). The multivariate analysis showed that those with DSI had eleven times higher odds of reporting FOF than those with no impairment (OR 11.14; 95% CI 3.15 to 41.4.) Similarly, those with moderate depression had seven times higher odds (OR 6.85; 95% CI 3.70 to 12.70), and those with severe depression had eight times higher odds (OR 8.13; 95% CI 3.50 to 18.90) of reporting FOF. A history of falls in the last year was also associated with increased odds for FOF (OR 1.52; 95% CI 1.03 to 2.26).

CONCLUSION

FOF is common among older individuals in residential care in India. Depression, falling in the previous year and DSI were strongly associated with FOF. A cross-disciplinary approach may be required to address FOF among the older people in residential care in India.

Association Between Objective Social Isolation and Unmet Medical Needs: A Nationwide Cross-sectional Study in Korea

OBJECTIVES

The aim of this study was to analyze the relationship between objective social isolation (SI) and unmet medical needs (UMN) in adults aged 19 and older.

METHODS

A cross-sectional analysis was conducted of 208 619 adults aged 19 and older, excluding missing data, using the 2019 Korea Community Health Survey. To analyze the association between objective SI and UMN, the chi-square test and logistic regression analysis were performed.

RESULTS

The prevalence of UMN was 1.14 times higher (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.06 to 1.23) among those with SI than among those without SI, and the OR for groups with 5 SI types was 2.77 (95% CI, 1.86 to 4.12) compared to those with no SI types. In addition, a stratified analysis by age group showed that the association between SI and UMN existed even in groups under 64 years old. However, among those aged 65 and older, SI was associated with an OR of 1.53 (95% CI, 1.37 to 1.71) for UMN compared to non-SI. As the number of SI types increased, the prevalence of UMN also increased, indicating a strong association between SI and UMN in older adults.

CONCLUSIONS

This study found that individuals with SI experienced UMN due to fear and anxiety about interpersonal relationships. Therefore, based on the results of this cross-sectional study, it is necessary to investigate the causal relationship between SI and UMN through future longitudinal data.

The relationship between fall and loneliness among older people in China: the mediating role of personality trait

Aims

We aimed to explore the role of personality traits between fall and loneliness.

Methods

A questionnaire survey was used to investigate falls, the big five personality traits, and loneliness among older people (≥ 60 years old) in China mainland.

Results

A total of 4,289 older people participated in the survey. There are significant differences in age, marital status, education level, residence, solitariness, and fall in relation to loneliness among older people. Falls, especially when they occurred one time increase the loneliness of older people. Agreeableness, conscientiousness, and neuroticism were significant mediating effects between falls and loneliness.

Conclusion

This study implied that agreeableness, conscientiousness, and neuroticism were meditating factors between falls and loneliness. In the future, we should consider the big five personality traits more to understand loneliness and offer older people interventions for reducing their loneliness. The study design was cross-sectional, so the temporal precedence of mediators and causality could not be tested. Because the data were collected retrospectively, current loneliness is likely to have confounding effects on retrospective recall.

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.

Investigating Factors Associated with Fear of Falling in Community-Dwelling Older Adults through Structural Equation Modeling Analysis: A Cross-Sectional Study

The scientific literature mentions the existence of factors associated with fear of falling in older adults. However, the direct and indirect paths of its predictors have not yet been fully explored. This study aimed to analyze the socioeconomic, clinical, and health factors directly and indirectly associated with fear of falling in community-dwelling older adults. This is a cross-sectional study conducted in older adults (n = 410 - 70.11 ± 7.22 years). Clinical and health-condition data were collected, as were data on fear of falling using the Falls Efficacy Scale International-Brazil (FES-I Brazil). It was found that being female and having a higher number of self-reported morbidities, worse physical performance, and a higher number of depressive symptoms were directly associated with greater fear of falling. Regarding indirect associations, physical inactivity, mediated by a greater number of morbidities, worse physical performance, and a greater number of depressive symptoms, was associated with greater fear of falling. In addition, worse self-rated health, mediated by a greater number of depressive symptoms, as well as older age, mediated by worse physical performance, were associated with the outcome. This study provides information on the predictors directly and indirectly associated with fear of falling, expanding current understanding of this relationship.

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

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

A Protection Motivation Theory Approach to Understanding How Fear of Falling Affects Physical Activity Determinants in Older Adults

OBJECTIVES

This study applied an extended Protection Motivation Theory to investigate the relative importance of fear of falling (FoF) among motivational and intentional determinants of physical activity (PA) behavior.

METHODS

Older U.S. adults (N = 667, 65+) were surveyed using online research panels and completed measures of self-efficacy and response efficacy (coping appraisal), perceived vulnerability and perceived severity (threat appraisal), FoF, autonomous motivation, intention, physical health, and past PA level.

RESULTS

Our structural equation model showed that past PA level and health predicted intention via cognitive constructs. PA and health predicted FoF and motivation via threat and coping appraisal. FoF did not directly predict intention.

DISCUSSION

Results from this sample provide support for the predictive effects of threat appraisal on fear. However, findings suggest that FoF may not be of great importance for the formation of PA intention compared with an established habit of being physically active and a subsequently fostered coping appraisal and motivation.

Prospective associations between subjective age and fear of falling in older adults

OBJECTIVE

Subjective age has been implicated in a range of health outcomes but its associations with Fear of Falling (FoF) are unknown. The present study examined the relation between subjective age and FoF in large national sample.

METHODS

Participants were drawn from the National Health and Aging Trends Study (NHATS, 2011-2017). 1,679 participants provided data on FoF, subjective age, demographic factors, depressive symptoms, prior falls, self-rated health and measures of the Short Physical Performance Battery. FoF was assessed again 7 years later.

RESULTS

Regression analyses revealed that an older subjective age was related to a 24% higher likelihood to develop FoF 7 years later. This association was independent of age, sex, educational attainment, race and prior falls. In addition, depressive symptoms, self-rated health, and physical inactivity mediated the associations between subjective age and FoF.

CONCLUSIONS

The present study showed that an older subjective age is related to the development of FoF over time, and further identified psychological and functional pathways that may explain this association. These results confirm the role of subjective age on one of the markers of frailty in the aging population.

Association between activity restriction due to fear of falling and mortality: Results from the Korean longitudinal study of aging

AIM

To analyze the correlation between activity restriction due to fear of falling and mortality among Koreans aged ≥45 years.

METHODS

After excluding missing values, the data of 411 participants from the first to sixth waves of the Korean Longitudinal Study of Aging were analyzed using the χ² -test, log-rank tests and Cox proportional hazards model.

RESULTS

In model 1, which did not include activity restriction due to fear of falling as an independent variable, the death rate increased by 1.024-fold (hazard ratio 1.024, 95% confidence interval 1.000-1.050, P = 0.0498) as the number of falls increased by one. In model 2, which included activity restriction due to fear of falling as an independent variable, participants with experience of activity restriction showed 1.993-fold higher mortality (hazard ratio 1.993, 95% confidence interval 1.112-3.572, P = 0.0205) than those without such experience. In addition, as the number of falls in the group with chronic diseases increased by one, the mortality rate increased by 1.028-fold (hazard ratio 1.028, 95% confidence interval 1.001-1.057, P = 0.043).

CONCLUSIONS

There was a close relationship between activity restriction due to fear of falling and mortality. Therefore, this study can serve as the foundation for policies and institutional measures to reduce the mortality rate of groups with activity restrictions due to fear of falling. Geriatr Gerontol Int 2021; ••: ••-••.

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

Background

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

Methods

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

Results

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

Conclusions

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

Why Do They Fall? The Impact of Insomnia on Gait of Older Adults: A Case-Control Study

STUDY OBJECTIVES

To compare gait and cognitive performance conducted separately as a single- (ST) and simultaneously as a dual-task (DT), ie, when a cognitive task was added, among community-dwelling older adults with and without insomnia.

METHODS

Participants included: 39 (28 females) community-dwelling older adults with insomnia, 34 (21 females) controls without insomnia. Subject groups were matched for age, gender, and education. Sleep quality was evaluated based on two-week actigraphy. Gait speed and cognition were assessed as ST and DT performance. DT costs (DTCs) were calculated for both tasks. Outcomes were compared via independent samples t-tests or Mann-Whitney U-tests.

RESULTS

Older adults with insomnia demonstrated significantly slower gait speed during ST (1 ± 0.29 vs 1.27 ± 0.17 m/s, p<0.001) and DT (0.77 ± 0.26 vs 1.14 ± 0.20 m/s, p<0.001) and fewer correct responses in the cognitive task during ST (21 ± 7 vs 27 ± 11, p=0.009) and DT (19 ± 7 vs 23 ± 9, p=0.015) compared to control group. DTC for the gait task was higher among older adults with insomnia (18.32%, IQR: 9.48-30.93 vs 7.81% IQR: 4.43-14.82, p<0.001). However, no significant difference was observed in DTC for the cognitive task (14.71%, IQR: -0.89-38.84 vs 15%, IQR: -0.89-38.84%, p=0.599).

CONCLUSION

Older adults with insomnia have lower gait speed and poorer cognitive performance during ST and DT and an inefficient pattern of task prioritization during walking, compared to counterparts without insomnia. These findings may explain the higher risk of falls among older adults with insomnia. Geriatric professionals should be aware of potential interrelationships between sleep and gait.

The predictive relationship between factors related to fear of falling and mortality among community-dwelling older adults in Korea: analysis of the Korean longitudinal study of aging from 2006 to 2014

OBJECTIVES

This study was conducted to identify the predictive relationship between factors related to fear of falling (FOF) and mortality among community-dwelling older adults in Korea.

METHOD

Data were obtained from the Korean Longitudinal Study of Aging (KLoSA). Hierarchical Cox proportional hazards regression analyses were conducted to identify factors related to FOF and correlations of these factors with mortality.

RESULTS

During the eight-year follow-up period, 964 participants (23.5%) died. Death was more likely to occur in males (hazard ratio [HR], 2.55; 95% confidence interval [95% CI], 2.17-3.00), those 75 years old or older (HR, 2.76; 95% CI, 2.40-3.17), those without education (HR, 1.27; 95% CI, 1.05-1.52), and those living without a spouse (HR, 1.30; 95% CI, 1.11-1.51). Those afraid of falling (HR, 1.41; 95% CI, 1.17-1.70), limiting their activities due to FOF (HR, 1.40; 95% CI, 1.21-1.62), showing symptoms of depression (HR, 1.34; 95% CI, 1.16-1.54), and having low life satisfaction (HR, 1.34; 95% CI, 1.13-1.59) were also more likely to experience decreased lifespans.

CONCLUSION

These results suggest that early management and prevention of factors related to FOF should be an effective approach to reducing mortality in older adults.

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.

Falls and visual impairment among elderly residents in 'homes for the aged' in India

We evaluated the prevalence of falls and their association with visual impairment (VI) in elderly residents in 'homes for the aged' in Hyderabad, India. Participants aged ≥ 60 years were recruited from 41 homes, and a comprehensive eye examination was conducted. Interviews were conducted to collect personal and demographic information, systemic health status, fear of falling, depression, and history of falls in the last year. VI categories included low vision (presenting visual acuity worse than 6/18 to 3/60) and blindness (presenting visual acuity worse than 3/60). The data of 1,074 participants were analysed. The mean age was 74.4 years (standard deviation:8.7 years); 63.9% were women, 19.4% had no formal education, 28.1% were diabetic and 56.9% were hypertensive. The annual prevalence of falls was 29.1% (95% CI: 26.4-32.0). Multivariable analysis showed those with VI had significantly higher odds of falls (Odds Ratio:1.47; p = 0.043). The prevalence of falls was higher among those with VI due to uncorrected refractive errors. We found a very high prevalence of falls in elderly individuals living in 'homes for the aged' in Hyderabad, India. Addressing VI can result in fewer falls and contribute to healthy aging in India.

Fear of falling and cognitive impairment in elderly with different social support levels: findings from a community survey in Central Vietnam

BACKGROUND

Fear of falling (FoF) in the elderly is one of the major public health concerns in this era of aging of the population. As there is limited evidence on how cognitive function may differ by social support level in relation to FoF among the elderly, this cross-sectional study aims to investigate the prevalence of FoF and the associations between cognitive impairment and FoF by the social support level, after adjustments for potential confounders.

METHODS

Data from the "Health needs assessment of elderly in Thua Thien Hue Province, Vietnam in 2018" survey of 725 elderly aged 60 years or older were used for analysis. FoF was assessed using the Fall Efficacy Scale-International. High FoF was defined as a score above 28. The Multidimensional Scale of Perceived Social Support was used to measure the perception of support. Logistic regression analysis was performed to investigate the association between cognitive function and FoF by social support levels (p < 0.05).

RESULTS

The prevalence of high FoF among the elderly was 40.8%. Female gender, advanced age, a marital status of single or formerly married, living alone, history of injury, history of falls, chronic diseases (arthritis and/or hypertension), limitations of the IADL and BADL, visual difficulty and walking difficulty, low social support, and cognitive impairment were all significantly associated with a high FoF. After adjustments for the age, gender, marital status, history of falls and health-related factors, cognitive impairment remained significantly associated with a high FoF among the elderly with a low to moderate social support level (OR = 2.97, 95% CI 1.49-5.89), but not in those with a high social support level.

CONCLUSIONS

A high FoF was associated with impairment of cognitive function among the elderly who perceived themselves as having low or moderate support levels, even after adjustments for socio demographic and physical functional factors. However, this association was not observed among the elderly who perceived themselves as having high social support levels. Fall prevention programs for the elderly with various levels of social support should be carefully devised, keeping in mind the cognitive function levels of the target recipients.

Impact of falls on depressive symptoms among the oldest old: Results from the AgeQualiDe study

OBJECTIVE

The purpose of this study was to examine the impact of falls on depressive symptoms among the oldest old in Germany longitudinally.

METHODS

Data were used from 2 waves of the multicenter prospective cohort "Study on needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe). This study covers primary care patients ≥85 years (at baseline: n = 547, average age of 88.9 ± 3.0 years; ranging from 85 to 100 years). General practitioner-diagnosed falls were used as explanatory variable. The Geriatric Depression Scale was used as outcome measure.

RESULTS

Linear fixed effects regressions showed that the occurrence of falls is associated with an increase in depressive symptoms (β = .60, P = .02), whereas changes in marital status, ageing, social support, functional decline (instrumental activity of daily living), cognitive impairment, and an increase in chronic diseases did not affect depressive symptoms. In sensitivity analysis, an increase in depressive symptoms was associated with functional impairment (basic activities of daily living; Barthel index; β = -.04, P = .005).

CONCLUSIONS

Based on a large, population-based longitudinal study, this study underlined the impact of falls on depressive symptoms and consequently extended previous knowledge about an association between falls and depressive symptoms in the oldest old. Developing strategies to prevent falls might also help to prevent depressive symptoms.

Impact of Incident Parkinson's Disease on Satisfaction With Life

Aim: The aim of the study was to investigate the effect of the onset of Parkinson's disease (PD) on life satisfaction.

Method: Data from 2008, 2011, and 2014 were used from a population-based prospective cohort (German Ageing Survey; 8,982 observations in FE regression analysis) of community-residing individuals in the second half of life (≥40 years) in Germany. Satisfaction with life was quantified using the established Satisfaction with Life Scale. Physician-diagnosed PD was reported.

Results: In total, 48.9% were female. The mean age was 63.8 years (±11.3 years). Average life satisfaction equaled 3.8 (±0.7). Linear fixed effects regressions revealed that the onset of PD was associated with a considerable decline in life satisfaction (β = −0.37, 95% CI −0.69 to −0.05, p < 0.05). This effect was significantly more pronounced in men. Moreover, a decrease in life satisfaction was associated with younger age, changes from “employed” to “not employed,” worsening self-rated health, the onset of depression, and an increase in the number of physical illnesses.

Conclusions: The onset of PD is associated with a marked reduction of life satisfaction among individuals in the second half of life in the total sample and in men, but not in women. For example, this effect was about twice as large as the effect of depression on life satisfaction. Moreover, the effect of PD on life satisfaction was more pronounced than the effect of a strong decrease in self-rated health (from “very good” to “very bad”) on life satisfaction. Effective treatment of symptoms might contribute to maintaining life satisfaction.