A multiple correspondence analysis of the fear of falling, sociodemographic, physical and mental health factors in older adults

Fear of falling (FoF) is a disabling condition due to different factors. The present study assessed potential FoF predictors, among sociodemographic, physical, and mental health domains, and explored their structural patterns. This cross-sectional study is part of the Physical Activity Promotion & Domestic Accidents Prevention (PAP & DAP) project, and was targeted to a sample of 229 independent older people (M 14.0%, F 86.0%) aged over 60 (mean 70.5 ± 5.96), both normal and overweight (median BMI 25.8 kg/m2, Interquartile Range 5.24). Standardized tools were used to assess the variables: the Short Falls Efficacy Scale International for the FoF; an information questionnaire for the socio-demographic variables, the presence of diseases, and previous falls; the International Physical Activity Questionnaire for the PA level; the Senior Fitness Test for physical fitness data; the Short Form 12 questionnaire for variables in the mental domain; and the Psychological Well-Being Scale 24 for the psychological well-being. Correlation/regression analyses were used to explore relationships between FoF and the considered variables. A Multiple Correspondence Analysis (MCA) was conducted to show graphical patterns projected into space dimensions. A percentage of 59.0 of the sample showed moderate/high concern of falling. The multiple regression model showed the following variables being significant predictors (p < 0.05) of the FoF: BMI (coeff 0.44, SE 0.104), musculoskeletal disease (1.55, 0.681), upper body strength (0.33, 0.117), mobility and balance (0.76, 0.320), perceived physical health (- 0.21, 0.047), and self-acceptance (- 0.52, 0.190). MCA evidenced two dimensions: the first one explained 41.8% of the variance and was described mostly by FoF (square residuals 0.721), gender (0.670), leg strength (0.617), perceived mental health (0.591), musculoskeletal diseases (0.572), and PA level (0.556); the second dimension (12.3% of the variance), was characterized mainly by perceived physical health (0.350), life objectives (0.346), education (0.301), upper body strength (0.278), and living in family/alone (0.260). The pattern elicited by MCA was characterized by older subjects with moderate/high FoF having low education or no occupation, being overweight and inactive, suffering from different diseases, having low physical fitness, and declaring low perceived physical and mental health. These results suggest that interventions aimed at reducing FoF should be addressed to this specific profile of older people.

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.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Construction and validation of a nomogram for predicting fear of falling related activity restrictions in community-dwelling older adults

Fear of falling related activity restrictions are widespread among older adults, leading to several adverse effects. Given these consequences, there is an urgent need for a comprehensive assessment tool that integrates various risk factors to predict the likelihood of older adults experiencing such activity restrictions. This cross-sectional study investigated fear of falling related activity restrictions and its influencing factors, simultaneously constructed and validated a nomogram among older adults residing in the communities in China. The model includes variables like age, gender, self-rated health, past year injurious falls, gait stability, anxiety, and cognitive impairment. It showed an AUC of 0.892. Internal validation had an AUC of 0.893, and external validation had an AUC of 0.939. Calibration curve showed good fit, and decision curve showed high clinical benefits. It's an intuitive tool for medical professionals to identify older adults at high risk of activity restrictions due to fear of falling.

Optimizing a Technology-Based Body and Mind Intervention to Prevent Falls and Reduce Health Disparities in Low-Income Populations: Protocol for a Clustered Randomized Controlled Trial

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51899.

Association between multimorbidity and falls and fear of falling among older adults in eastern China: a cross-sectional study

Background

Growing evidence has reported an association between multimorbidity and falls and fear of falling (FOF) in older adults, however, the results regarding this association from China are limited. Our study aimed to investigate the association between multimorbidity and falls and FOF in older adults in eastern China.

Methods

We conducted a cross-sectional study in Zhejiang Province, Eastern China, which recruited a provincial representative sample of adults aged ≥ 60 years. A structured questionnaire including demographic characteristics, chronic diseases, history of falls in the past 12 months, and FOF, was administered by all participants. The exposure variable was multimorbidity, which was defined as the presence of two or more chronic diseases and medical conditions in the same individual. The outcomes included a history of falls and FOF. Multivariate logistic regression was used to evaluate the association between multimorbidity and falls and FOF in older adults.

Results

In total of 7,774 participants were included in the analysis, among whom 3,898 (50.1%) were female, with a mean ± standard deviation age is 72.9 ± 8.4 years. Multimorbidity was associated with the increased risk of falling in older adults [adjusted odds ratio (OR), 1.99; 95% confidence interval (CI):1.55-2.36]. The ORs for having experienced single fall and repeated falls were 1.85 (95% CI: 1.42-2.42) and 3.45 (95% CI: 1.47-6.97), respectively, with multimorbidity compared with those without chronic diseases. The older adults with multimorbidity were more likely to report FOF compared with those without chronic diseases (adjusted OR, 1.49; 95%CI:1.30-1.70). Moreover, the association between multimorbidity and FOF remained significant in the older adults with a history of fall (OR, 1.57; 95%CI:1.04-2.38).

Conclusion

The association between multimorbidity and falls and FOF is significant in the Chinese population and the effects of multimorbidity on falls and FOF do not vary according to the frequency and history of falls in older adults.

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.

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

Background

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

Methods

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

Results

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

Conclusion

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

A longitudinal study of disability in activities of daily living and activity restriction‐induced fear of falling among Korean older people

AIM

This study examined the effects of the fear of falling (FOF) alone and fear-associated activity restriction (FAR) on future activities of daily living (ADL) disability and analysed predictors of ADL disability among community-dwelling older people with and without FAR.

DESIGN

This prospective study involved secondary data analysis of the Korean Longitudinal Study of Aging.

METHODS

We obtained data from 5074 community-dwelling older adults. Generalized estimating equations were used to identify the predictors of changes in ADL disability between 2008 and 2018.

RESULTS

Compared with FOF alone, FAR was significantly related to changes in ADL disability. Being older, living with others and having poor self-rated health status were associated with future ADL disability in participants without FAR. Weakened grip strength and social engagement were associated with future ADL disability in those with FAR. Nurses must consider the impact of FAR on future ADL decline and implement tailored interventions.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Association of falls and fear of falling with objectively-measured driving habits among older drivers: LongROAD study

OBJECTIVE

Falls in older adults are associated with increased motor vehicle crash risk, possibly mediated by driving behavior. We examined the relationship of falls and fear of falling (FOF) with subsequent objectively measured driving habits.

METHODS

This multi-site, prospective cohort study enrolled 2990 active drivers aged 65-79 (53% female). At enrollment, we assessed falls in the past year and FOF (Short Falls Efficacy Scale-International). Driving outcomes included exposure, avoidance of difficult conditions, and unsafe driving during one-year follow-up, using in-vehicle Global Positioning System devices.

RESULTS

Past-year falls were associated with more hard braking events (HBE). High FOF was associated with driving fewer days, miles, and trips, driving nearer home and more HBE. Differences were attenuated and not significant after accounting for health, function, medications and sociodemographics.

DISCUSSION

Differences in objectively measured driving habits according to past-year fall history and FOF were largely accounted for by differences in health and medications. Rather than directly affecting driving, falls and FOF may serve as markers for crash risk and reduced community mobility due to age-related changes and poor health.

Patterns of participation restriction among older adults at risk of falls and relationship with intrinsic capacity: A latent cluster analysis

Introduction

The concept of participation restriction was first described by the World Health Organization in 2001 as a component of The International Classification of Functioning, Disability and Health Framework. Both falls and fear of falling (FOF) are associated with social isolation, depression, anxiety, poor quality of life and cognitive impairment resulting in participation restriction. Life-space mobility (LSM) is an important indicator for participation restriction which depends on multiple inter-related factors. We aimed to determine participation patterns using latent cluster analysis (LCA) in older adults at risk of falls, its relationship with intrinsic capacity (IC) and its risk prediction.

Methods

Cross-sectional study of 154 community dwelling older adults ≥ 60 years with falls or risk of falls was conducted. Questionnaires were administered on demographics, hearing, LSM, frailty (FRAIL scale), anorexia of aging (SNAQ), cognition (Montreal Cognitive Assessment, MoCA), FOF (Falls Efficacy Scale-International), physical function, and assessment for handgrip strength (HGS), gait speed, 5-times sit to stand (STS), vision and times-up-and-go (TUG) were performed. Six IC domains (vision and hearing, cognition, nutrition, mobility and depression) were measured.

Results

Three pattern of participation cluster were identified, high (n = 63, 40.9%), moderate (n = 83, 53.9%) and low (n = 8, 33 5.2%). Individuals in the high participation cluster were significantly younger, had higher LSM scores and lower FES-I scores, more robust, fewer ADL and IADL limitations, lower prevalence of low HGS, higher gait speed and shorter TUG. In the fully adjusted model compared to the high participation cluster, moderate participation was significantly associated with low MoCA scores (OR 4.2, 95% CI 1.7-10.4, p = 0.02), poor STS (OR 7.1, 95% CI 3.0-17.0, p < 0.001) whereas low participation was associated with anorexia of aging (OR 9.9, 95% CI 1.6-60.9, p = 0.014), poor STS (OR 19.1, 95% CI 2.0-187.5, p = 0.011) and hearing impairment (OR 9.8, 95% CI 1.4-70.8, p = 0.024). Participants with 3 out of 6 IC decline had a probability of greater than 80% to belong to the low/moderate participation class.

Discussion

Physical function, cognition, hearing and nutrition were significantly associated with low and/or moderate participation class. Future studies are needed to evaluate improvement in participation of those with falls or at risk for falls through restoration of IC.

The mediator role of frailty in the effect of fear of falling avoidance behavior on quality of life in older adults admitted to hospital

The aim of this research was to determine the mediator role of frailty in the effect of fear of falling avoidance behavior on quality of life in the older adults. This descriptive and cross-sectional study was conducted with 312 individuals in Istanbul between June-October 2021. The Edmonton Frail Scale (EFS) score was 7.06±3.69, Fear of Falling Avoidance Behavior Questionnaire (FFABQ) score was 17.84±15.3. Quality of Life Scale (SF-12) physical component score was 34.21±25.12 and mental component score was 41.81±17.87. EFS plays a mediating role in the effect of FFABQ on SF-12 and strengthens its negative effect on SF-12. The frailty severity of the participants was moderate, activity limitation and participation restriction due to fear of falling were low, and their quality of life in physical and mental components was low. Avoidance behavior has a direct effect on quality of life and an indirect effect with the role of frailty.

Global evidence on falls and subsequent social isolation in older adults: a scoping review

BACKGROUND

Falls are a leading cause of injury-related hospitalizations among adults aged 65 years and older and may result in social isolation.

OBJECTIVE

To summarise evidence on falls and subsequent social isolation and/or loneliness in older adults through a scoping review.

ELIGIBILITY CRITERIA

Studies were eligible for inclusion if the population had a mean age of 60 years or older, they examined falls and subsequent social isolation, loneliness, fear of falling or risk factors and were primary studies (eg, experimental, quasi-experimental, observational and qualitative).

SOURCES OF EVIDENCE

MEDLINE, CINAHL, Embase, Ageline and grey literature from inception until 11 January 2021.

CHARTING METHODS

A screening and charting form was developed and pilot-tested. Subsequently, two reviewers screened citations and full-text articles, and charted the evidence.

RESULTS

After screening 4993 citations and 304 full-text articles, 39 studies were included in this review. Participants had a history of falling (range: 11% to 100%). Most studies were conducted in Europe (44%) and North America (33%) and were of the cross-sectional study design (66.7%), in the community (79%). Studies utilised 15 different scales. Six studies examined risk factors for social isolation and activity restriction associated with fear of falling. Six studies reported mental health outcomes related to falls and subsequent social isolation.

CONCLUSIONS

Consistency in outcome measurement is recommended, as multiple outcomes were used across the included studies. Further research is warranted in this area, given the ageing population and the importance of falls and social isolation to the health of older adults.

SCOPING REVIEW REGISTRATION NUMBER

10.17605/OSF.IO/2R8HM.

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.

The association between falls and anxiety among elderly Chinese individuals: The mediating roles of functional ability and social participation

BACKGROUND

Elderly individuals who experience falls suffer from higher levels of anxiety because of physical or mental injury. This study examined the association between falls and anxiety among elderly Chinese individuals. It also explored the mediating roles of functional ability and social participation in the link between falls and anxiety.

METHODS

The analytical sample included 8233 elderly people aged 60 and above, and prospective data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Anxiety was evaluated by a 7-item Generalized Anxiety Disorder (GAD-7) scale, and falls were determined by self-report. The association between falls and anxiety was assessed by linear regression. Mediation analysis was used to explore the potential mediating roles of functional ability and social participation on the association between falls and anxiety.

RESULTS

Suffering falls predicted higher anxiety levels among elderly individuals (B = 0.608, 95% CI: 0.471, 0.746). Functional ability and social participation play partial mediating roles in the association between falls and anxiety, and the mediating effects were 0.036 (95% CI: 0.020, 0.058) and 0.005 (95% CI: 0.003, 0.014), respectively. The serial mediating effect of functional ability and social participation on the association between falls and anxiety was 0.003 (95% CI: 0.002, 0.005).

LIMITATIONS

This study is based upon cross-sectional data, which limit inferring causality.

CONCLUSIONS

This study suggests that policy-makers should explore how to encourage elderly individuals who experience falls to restore functional ability and participate in appropriate social activities to alleviate anxiety.

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.

Age Moderates Differences in Performance on the Instrumented Timed Up and Go Test Between People With Dementia and Their Informal Caregivers

BACKGROUND AND PURPOSE

The instrumented Timed Up and Go test (iTUG) affords quantification of the subelements of the Timed Up and Go test to assess fall risk and physical performance. A miniature sensor applied to the back is able to capture accelerations and velocities from which the subelements of the iTUG can be quantified. This study is the first to compare iTUG performance between people with dementia (PWD) and their age-matched caregivers. The aims of this study were to explore how age moderates the differences in performance on the iTUG between PWD and their informal caregivers.

METHODS

Eight-three community-dwelling older PWD and their informal caregivers were recruited for this cross-sectional, observational study. Participants were grouped by age: younger than 70 years, 70 to 79 years, and 80 years and older. Participants wore an inertial sensor while performing the iTUG in their home. The performance of the subelements sit-to-stand, walking, and turning were captured through an algorithm converting accelerations and velocities into performance metrics such as duration and peak velocity. Performance for PWD was compared with caregivers for each age-matched group, and multiple regression models incorporating age, gender, and presence or absence of dementia were computed.

RESULTS

People with dementia took longer to turn in the younger than 70-year group, suggesting this may be an early indicator of functional decline in this age group. People with dementia took longer to complete the whole iTUG compared with caregivers in the 70- to 79-year-old group. In the 80+-year-old group, PWD took longer to complete both walking phases, sit-to-stand, and the full iTUG along with displaying slower turning velocity. Multiple regression models illustrated that gender failed to contribute significantly to the model, but age and presence of dementia explained around 30% of the variance of time to complete walking phases, total iTUG, and turning velocity.

CONCLUSIONS

Differences were evident in performance of the iTUG between PWD and caregivers even after controlling for age. Age moderates the differences observed in performance.

Patterns of occupational engagement among community-dwelling older adults in Singapore: An exploratory mixed method study

Introduction

The aim of this study is to understand the patterns of occupations among community-dwelling older adults in Singapore. The objectives are to describe their occupational engagement using the Activity Card Sort Singapore, understand their occupational preferences and perceived barriers and facilitators to engagement.

Methods

A convergent parallel mixed-method study was conducted over a 5-month period in 2018. Purposive and snowball sampling were used to recruit the participants. Individual 1-h interviews were conducted at participants’ homes. Quantitative data collected include demographic information, Modified Barthel Index scores and activity engagement based on the Activity Card Sort Singapore. Qualitative data was collected using semi-structured interviews.

Results

105 participants were enrolled in the study. Overall, older adults engaged mostly in instrumental and social activities. However, leisure and social activities were most preferred. Gender, educational level and age were found to influence occupational engagement. Overall, six main themes relating to perceived barriers and facilitators to occupational engagement were identified: cognition and physical status, self-efficacy, resources, affect and meaningfulness, social influence and environmental factors.

Conclusion

The findings from this study provided insights into the occupational patterns of community-dwelling older adults in Singapore and their perceived barriers and facilitators to engagement. Recommendations for practice were identified.

Is fear of falling and the associated restrictions in daily activity related to depressive symptoms in older adults?

BACKGROUND

Depression is a risk factor for various conditions, including suicide. Considering the high prevalence of fear of falling in the elderly, its association with depression requires examination. This study investigated the relationship between depressive symptoms and fear of falling and falling-induced daily activity restrictions in Koreans aged 60 years or above.

METHODS

Data from the 2006 to 2018 Korean Longitudinal Study of Ageing were used. Depressive symptoms were measured using the 10-item Centre for Epidemiological Studies Depression (CES-D 10) scale. The general characteristics of the study population were analysed using Chi-square tests. The relationship between the dependent and independent variables were investigated using the generalised estimating equation (GEE) model.

RESULTS

Of the 2933 study participants, 1086 (37.0%) reported fear of falling but no related restrictions in daily activities, and 399 (13.6%) reported fear of falling plus such restrictions. Compared to individuals without fear of falling, participants with fear of falling but no related activity restriction (odds ratio (OR) 2.08, 95% CI 1.94-2.23) and activity limitations (OR 2.51, 95% CI 2.28-2.75) showed higher likelihoods of depressive symptoms in a stepwise manner after adjustment.

CONCLUSION

Fear of falling and its induced daily activity restrictions were associated with a higher likelihood of depressive symptoms in older adults. The findings infer the need to implement preventive and moderating measures to address fear of falling and its related negative health effects.

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.

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.

Risk for physical dependence in community-dwelling older adults: The role of fear of falling, falls and fall-related injuries

BACKGROUND

Falls and fall-related injuries along with fear of falling (FoF) seem to restrict activities of daily living (ADL), resulting in physical dependence. However, it is still unclear how falls and related injuries or FoF by themselves explain general and specific ADL dependence.

OBJECTIVES

To investigate the relationships between falls and related injuries, FoF and physical dependence on ADL in community-dwelling older adults, controlling for age, gender, physical activity and physical fitness as confounders.

METHODS

This cross-sectional descriptive study assessed 588 community-dwelling older adults. Falls and fall-related injuries, ADL dependence on basic, instrumental and advanced activities, FoF, demographic characteristics and health conditions were assessed through a questionnaire. Physical activity was measured through the International Physical Activity Questionnaire. Physical fitness was assessed by the Senior Fitness Test and the Fullerton Advanced Balance Scale. Body composition was measured through bioimpedance.

RESULTS

Severe injuries occurrence increased the likelihood of moderate and high physical dependence by 3 and 6 times, while FoF increased this likelihood by 3 and 7 times, respectively. Also, the occurrence of previous falls, resulting in severe injuries, increased the likelihood of dependence in two instrumental ADL (3 and 4 times), while FoF increased this likelihood in numerous basic, instrumental and advanced ADL (2-3 times). The FoF was shown to explain overall physical functioning dependence, by itself, representing a constraint on the performance of most basic, instrumental and advanced ADL.

CONCLUSION

The FoF showed to be a greater threat to ADL dependence than falls and related injuries. Assessment guidelines for older adults living in the community should include the FoF in clinical evaluation.

IMPLICATIONS FOR PRACTICE

Understand the isolated interplay of FoF and previous falls and injuries on ADL dependence among older adults allows healthcare professionals to perform more accurate clinical evaluations and develop more successful interventions to prevent further dependence.

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.

Gait symmetry in the dual task condition as a predictor of future falls among independent older adults: a 2-year longitudinal study

BACKGROUND

Given the potential consequences of falls among older adults, a major challenge is to identify people at risk before the first event. In this context, gait parameters have been suggested as markers of fall risk.

AIM

To examine, among older people, the prospective relationship between gait patterns assessed in comfortable and challenging walking conditions, and future fall(s).

METHOD

A total of 105 adults older than 65 years, living independently at home and without a recent fall history were included in a 2-year, longitudinal, observational study. All underwent physical and functional assessment. Gait speed, stride length, frequency, symmetry and regularity and Minimum Toe Clearance (MTC) were recorded in comfortable (CW), fast (FW) and dual task walking (DTW) conditions. Gait parameter changes occurring between CW and FW and between CW and DTW were calculated and expressed in percent. DTW cost was calculated as the change of DTW relative to CW. Fall events were recorded using fall diaries. Comparisons according to fall occurrence were performed by means of univariate analysis and multivariate binary logistic regression analysis.

RESULTS

Two-year follow-up was available for 96 participants, of whom 35 (36.5%) fell at least once. Comparative analysis showed that future fallers had shorter FW stride length and higher symmetry DTW cost than non-fallers (p < 0.05). Binary logistic regression analysis showed that each additional percent of stride symmetry cost was associated with an increase in future fall risk (odds ratio 1.018, 95% Confidence Interval (CI) 1.002-1.033; p = 0.027).

DISCUSSION

Our results confirm the association between a symmetry decrease in DTW and future fall(s). Indeed in this study, the mean symmetry DTW cost in fallers is almost 20% higher than in non-fallers, meaning a fall risk that is around 36% higher than among non-fallers.

CONCLUSION

This exploratory study shows the usefulness of considering gait parameters, particularly symmetry in challenging walking conditions, for early identification of future fallers.

Association between the instrumented timed up and go test and cognitive function, fear of falling and quality of life in community dwelling people with dementia

OBJECTIVE

To explore relationships between the instrumented timed up and go test (iTUG) and the following risk factors for falls: cognitive functioning, fear of falling (FoF), and quality of life (QoL) in people with dementia.

METHODS

83 community-dwelling older adults with dementia (mean±sd age 78.00±7.96 years; 60.2% male) completed an interview to capture global cognition (Mini-Addenbrooke's Cognitive Evaluation), FoF (Iconographical Falls Efficacy Scale) and QoL (ICEpopCAPability measure for Older people). Participants completed an iTUG whilst wearing an inertial sensor on their trunk. Linear accelerations and rotational velocities demarcated sub-phases of the iTUG. Relationships were explored through correlations and regression modelling.

RESULTS

Cognition was related to duration of walking sub-phases and total time to complete iTUG (r=0.25-0.28) suggesting gait speed was related to cognition. FoF was most strongly related to turning velocity (r=0.39-0.44), but also to sit-to-stand, gait sub-phases and total time to complete iTUG. Sub-phases explained 27% of the variance in FoF. There were no correlations between iTUG and QoL.

CONCLUSIONS

Cognition and FoF were related to time to complete walking sub-phases but FoF was more closely related to turning velocity and standing acceleration. iTUG may offer unique insights into motor behaviour in people with dementia.

Assessing gait parameters with accelerometer-based methods to identify older adults at risk of falls: a systematic review

PURPOSE

The purpose of this study was to perform a systematic review to assess the utility of accelerometric methods to identify older adults at risk of falls.

METHODS

The Preferred Reporting Item for Systematic review and Meta-Analysis (PRISMA) guidelines were followed during all steps of this systematic review. Cross sectional and longitudinal studies assessing gait parameters in older adults using accelerometric devices, and comparing groups based on the risk of falls or fall history were identified from studies published in the MEDLINE, SCOPUS and Cochrane Database of Systematic Reviews databases between January 1996 and January 2017. Study selection and data extraction were performed independently by two reviewers. The quality of the methodology used in the studies included was assessed using the Newcastle-Ottawa Scale.

RESULTS

In total, 354 references were identified through the database search. After selection, ten studies were included in this systematic review. According to the cross sectional studies, people who fall or are at risk of fall are slower, and walk with shorter steps, lower step frequency, worse stride and step regularity in terms of time, position and acceleration profiles. One longitudinal study suggests considering harmonic ratio of upper trunk acceleration in the vertical plane. Two other longitudinal studies highlight the importance of considering more than one gait parameter, and sophisticated statistical tools to discern older adults at risk for future fall(s).

CONCLUSION

This systematic review essentially highlights the lack of available literature providing strong evidence that gait parameters obtained using acceleration-based methods could be useful to discern older people at risk of fall. Available literature is encouraging, but further high quality studies are needed to highlight the cross-sectional and longitudinal relationships between gait parameters and falls in older adults.

Fear of falling and activities of daily living function: mediation effect of dual-task ability

OBJECTIVE

The aim of the study was to explore the association between fear of falling (FOF), dual-task ability during a mobility task, and the activities of daily living (ADL) in a sample of older adults.

METHODS

Seventy-six older adults (mean age M = 70.87 ± 5.16 years) participated in the study. Data on FOF (using the Falls Self-Efficacy Scale-International), walking ability during both single- and dual-task performances and ADL were collected.

RESULTS

Mediation analysis demonstrated the mediation effect of dual-task ability (β = 0.238, p = 0.011) between FOF and ADL level (β = 0.559, p < 0.001). Moreover, significantly lower performances were observed during dual-task condition [F (2, 73) = 7.386, p < 0.001], and lower ADL levels were also found in older adults with FOF [F (2, 73) = 13.734, p < 0.001].

CONCLUSION

The study underlines the relationship between FOF, dual-task ability and ADL level. These results could be used to develop specific intervention programmes for successful ageing.

Comparison of Factors Associated with Fear of Falling between Older Adults with and without a Fall History

Background: Although fear of falling (FOF) has been studied since FOF has negative consequences for the elderly, there is limited information about the risk factors of FOF, including the environment. The purpose of this study was to describe individual and environmental factors of FOF between those with and without a fall history from an ecological aspect and to examine whether individual and environmental factors differently affect the FOF according to the state of fall history in community-dwelling older adults in Korea. Methods: Data from the 2014 Survey of Living Conditions and Welfare Needs of Korean Older Adults were used. Participants were 7730 older adults. Hierarchical logistic regression analysis was conducted to examine the predictors of FOF. Results: According to the ecological model, female and discomfort with the neighborhood environment were significantly associated with greater odds of reporting FOF in both older adults with fall history and those without. A significant interaction was not observed between any variable of FOF in participants with and without a fall history. Conclusions: An ecological model including individual and environmental factors should be considered when conducting research and designing programs and decision policies related to FOF for older adults with and without a history of falling.

Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both?

Background

Despite the number of studies that have tried to demonstrate that there is an association between previous falls and the fear of falling, the relationship between these two variables remains a matter of controversy.

Objectives

Our objective was to investigate whether the fear of falling is a cause of falls, a consequence, or both in community-dwelling adults aged ≥ 75 years old.

Methods

A descriptive, longitudinal, prospective study was performed. A total of 640 individuals were interviewed between 2009 and 2011. Sociodemographic data, health status, history of falls and fear of falling were assessed at baseline and at 24 months.

Results

The prevalence of falls at baseline was 25% as opposed to 35.2% at 24 months. The prevalence of the fear of falling was 41.5% at baseline. Logistic regression analysis showed a significant association between a history of falls and the fear of falling. Other factors associated with the fear of falling were female gender, comorbidity, depressive symptoms, and disability. In total, 41.7% of the subjects who had reported a fear of falling at baseline had suffered at least one fall 24 months later. Unadjusted Cox regression analysis revealed that the fear of falling was a risk factor for falls. According to the final model adjusted for other covariates, the only reliable predictor was female gender. The Cox model stratified by gender failed to show a crude association between fear of falling and falls.

Conclusion

A previous history of falls in the previous year was a good predictor of the fear of falling; but the fear of falling was a predictor of falls during follow-up only in the unadjusted model, pointing to strong gender turns out as an effect modifier of the association of FOF and subsequent falls. Nursing staff working in elderly care should not only routinely assess patients’ previous history of falls, but also evaluate their fear of falling and its associated factors.

Fear of Falling in People With Multiple Sclerosis: Which Clinical Characteristics Are Important?

BACKGROUND

Fear of falling (FOF) is an important risk indicator for health-related outcomes and quality of life in patients with multiple sclerosis (MS). However, factors associated with FOF in MS are not well investigated.

OBJECTIVES

This study was done to explore predictors of FOF in this population.

METHODS

Seventy relapsing remitting patients with MS were evaluated. Fear of falling was assessed using the Fall Efficacy Scale-International (FES-I). Motor outcomes included: 30-second chair stand test (30s-CST), Berg Balance Scale (BBS), 10-Meter Walk Test (10MWT), and 6-Minute Walk Test (6MWT). Cognitive status was determined using the Montréal Cognitive Assessment (MOCA) and Symbol Digit Modalities Test (SDMT). Affective factors including depression, fatigue, and sleep were also assessed using the Beck Depression Inventory (BDI), Modified Fatigue Impact Scale (MFIS), and Pittsburgh Sleep Quality Index (PSQI), respectively.

RESULTS

Fear of falling was significantly correlated with all motor and affective measures used. However, a stepwise regression found that only BBS from motor measures, MOCA from cognitive measures, and sleep disorders from affective factors were significantly predictive of the FOF.

CONCLUSIONS

Fear of falling in patients with MS is multifactorial and includes motor and nonmotor factors. Thus, therapies that aim to reduce risk of falling in this population should address motor functions, cognitive abilities, and sleep quality.

The Complex Association Between Fear of Falling and Mobility Limitation in Relation to Late-Life Falls: A SHARE-Based Analysis

OBJECTIVE

This study examines fear of falling (FOF) in relation to falls in light of mobility limitation.

METHOD

Data on community-dwelling older Europeans, aged 65+, were drawn from two consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). The analysis regressed fall status in 2013 on reported FOF 2 to 3 years earlier, controlling for previous falls.

RESULTS

FOF predicted subsequent falls when mobility limitation was low to moderate. However, the effect of FOF on fall probability was reversed when mobility limitation was high.

DISCUSSION

The analysis underscores a complex association between FOF and mobility limitation in relation to late-life falls. People who are worried about falling tend to fall more. Those having high mobility limitation but lacking FOF are also more likely to fall. In cases of considerable mobility limitation, FOF may act as a protective buffer. The less worried in this group, however, may be subject to greater falling, and thus require greater attention.

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.