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Abel B, Bongartz M, Rapp K, Roigk P, Peiter J, Metz B, Finger B, Büchele G, Wensing M, Roth C, Schmidberger O, König HH, Gottschalk S, Dams J, Deuster O, Immel D, Micol W, Bauer JM, Benzinger P. Multimodal home-based rehabilitation intervention after discharge from inpatient geriatric rehabilitation (GeRas): study protocol for a multicenter randomized controlled trial. BMC Geriatr 2024; 24:69. [PMID: 38233746 PMCID: PMC10795216 DOI: 10.1186/s12877-023-04634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Geriatric rehabilitation aims to maintain the functional reserves of older adults in order to optimize social participation and prevent disability. After discharge from inpatient geriatric rehabilitation, patients are at high risk for decreased physical capacity, increased vulnerability, and limitations in mobility. As a result, ageing in place becomes uncertain for a plethora of patients after discharge from geriatric rehabilitation and effective strategies to prevent physical decline are required. Collaboration between different health-care providers is essential to improve continuity of care after discharge from inpatient geriatric rehabilitation. The aim of this study is to evaluate the effectiveness of a multi-professional home-based intervention program (GeRas) to improve functional capacity and social participation in older persons after discharge from inpatient geriatric rehabilitation. METHODS The study is a multicenter, three-arm, randomized controlled trial with a three-month intervention period. Two hundred and seventy community-dwelling older people receiving inpatient geriatric rehabilitation will be randomized with a 1:1:1 ratio to one of the parallel intervention groups (conventional IG or tablet IG) or the control group (CG). The participants of both IGs will receive a home-based physical exercise program supervised by physical therapists, a nutritional recommendation by a physician, and social counseling by social workers of the health insurance company. The collaboration between the health-care providers and management of participants will be realized within a cloud environment based on a telemedicine platform and supported by multi-professional case conferences. The CG will receive usual care, two short handouts on general health-related topics, and facultative lifestyle counseling with general recommendations for a healthy diet and active ageing. The primary outcomes will be the physical capacity measured by the Short Physical Performance Battery and social participation assessed by the modified Reintegration to Normal Living Index, three months after discharge. DISCUSSION The GeRas program is designed to improve the collaboration between health-care providers in the transition from inpatient geriatric rehabilitation to outpatient settings. Compared to usual care, it is expected to improve physical capacity and participation in geriatric patients after discharge from inpatient geriatric rehabilitation. TRIAL REGISTRATION German Clinical Trials Register (DRKS00029559). Registered on October 05, 2022.
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Grants
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- German Innovation Fund (‘New Forms of Care’) coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- Universitätsklinikum Heidelberg (8914)
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Affiliation(s)
- Bastian Abel
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Martin Bongartz
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Patrick Roigk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Janine Peiter
- Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Brigitte Metz
- Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Benjamin Finger
- Department of Telemedicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Schmidberger
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Deuster
- Interdisciplinary Center for Clinical Trials (IZKS) at the University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Désirée Immel
- AOK Baden-Württemberg, Statutory Health Insurance Company, Stuttgart, Germany
| | - William Micol
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Petra Benzinger
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany.
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Ellmers TJ, Wilson MR, Kal EC, Young WR. The perceived control model of falling: developing a unified framework to understand and assess maladaptive fear of falling. Age Ageing 2023; 52:afad093. [PMID: 37466642 PMCID: PMC10355179 DOI: 10.1093/ageing/afad093] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND fear of falling is common in older adults and can have a profound influence on a variety of behaviours that increase fall risk. However, fear of falling can also have potentially positive outcomes for certain individuals. Without progressing our understanding of mechanisms underlying these contrasting outcomes, it is difficult to clinically manage fear of falling. METHODS this paper first summarises recent findings on the topic of fear of falling, balance and fall risk-including work highlighting the protective effects of fear. Specific focus is placed on describing how fear of falling influences perceptual, cognitive and motor process in ways that might either increase or reduce fall risk. Finally, it reports the development and validation of a new clinical tool that can be used to assess the maladaptive components of fear of falling. RESULTS we present a new conceptual framework-the Perceived Control Model of Falling-that describes specific mechanisms through which fear of falling can influence fall risk. The key conceptual advance is the identification of perceived control over situations that threaten one's balance as the crucial factor mediating the relationship between fear and increased fall risk. The new 4-item scale that we develop-the Updated Perceived Control over Falling Scale (UP-COF)-is a valid and reliable tool to clinically assess perceived control. CONCLUSION this new conceptualisation and tool (UP-COF) allows clinicians to identify individuals for whom fear of falling is likely to increase fall risk, and target specific underlying maladaptive processes such as low perceived control.
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Affiliation(s)
| | - Mark R Wilson
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, UK
| | - Elmar C Kal
- Centre for Cognitive Neuroscience, Brunel University London, London, UK
| | - William R Young
- Centre for Cognitive Neuroscience, Brunel University London, London, UK
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, UK
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Castelblanco Toro SM, Jurado Delgado J, Meneses Bernal JF, Santacruz Escudero JM, Santamaria-García H. Fear of Falling as a Behavioral Symptom in Neurocognitive Impaired Patients: Evidence from an Underrepresented Population. J Alzheimers Dis 2023:JAD230266. [PMID: 37393502 DOI: 10.3233/jad-230266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
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.
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Affiliation(s)
- Sandra Milena Castelblanco Toro
- Institute of Aging of the Faculty of Medicine of the Pontificia Universidad Javeriana, Bogotá, Colombia
- Psychiatry Department, Pontificia Universidad Javeriana, Bogotá, Colombia
- Intellectus Memory and Cognition Center, San Ignacio University Hospital, Bogotá, DC, Colombia
| | - Janeth Jurado Delgado
- Universidad del Valle (Univalle), Clínica alta complejidad Santa Bárbara, Palmira, Colombia
| | | | - José Manuel Santacruz Escudero
- Institute of Aging of the Faculty of Medicine of the Pontificia Universidad Javeriana, Bogotá, Colombia
- Intellectus Memory and Cognition Center, San Ignacio University Hospital, Bogotá, DC, Colombia
| | - Hernando Santamaria-García
- Psychiatry Department, Pontificia Universidad Javeriana, Bogotá, Colombia
- Intellectus Memory and Cognition Center, San Ignacio University Hospital, Bogotá, DC, Colombia
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4
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Nugent K, Payne MW, Viana R, Unger J, Hunter SW. A concern for falling impacts quality of life for people with a lower limb amputation. Int J Rehabil Res 2022; 45:253-259. [PMID: 35754349 DOI: 10.1097/mrr.0000000000000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this web-based survey study was to comprehensively evaluate subdomains of concern for falling and its association with quality of life (QoL) among people with lower-limb amputations (PLLA). Forty-eight adults (mean 61.8 ± 11.6 years) with a major (i.e. transtibial or transfemoral) amputation participated. Individuals were currently using a prosthesis for ambulation, completed a prosthetic rehabilitation program, had functional use of English and had access to an internet-connected device (e.g. laptop). Five standardized scales assessed a concern for falling: Modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Activities-specific Balance Confidence (ABC) Scale, Prosthetic Limb Users Survey - Mobility (PLUS-M), Consequences of Falling Scale and Perceived Ability to Manage Falls Scale. QoL was evaluated using the WHO QoL-100 questionnaire. Spearman correlation analysis evaluated the relationship between the five concerns for falling scales. Five independent linear regression modeling evaluated the association of each concern for falling measure on QoL. Strong statistically significant correlations were found between mSAFFE and PLUS-M (rs = -0.87; P < 0.05). Three scales were significantly associated with QoL: mSAFFE [-1.16 (95% CI, -2.04 to -0.29)], ABC [0.36 (95% CI, 0.11-0.61)] and PLUS-M [0.50 (95% CI, 0.05-0.95)]. This is the first study to evaluate multiple concerns for falling subdomains among PLLA. Concern for falling should be addressed in prosthetic rehabilitation to improve community re-integration and QoL.
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Affiliation(s)
- Kristin Nugent
- University of Western Ontario, Faculty of Health Sciences, School of Physical Therapy
| | - Michael W Payne
- Department of Physical Medicine and Rehabilitation, Parkwood Research Institute and.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, Schulich School of Medicine and Dentistry
| | - Ricardo Viana
- Department of Physical Medicine and Rehabilitation, Parkwood Research Institute and.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, Schulich School of Medicine and Dentistry
| | - Janelle Unger
- University of Western Ontario, Faculty of Health Sciences, School of Physical Therapy.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, Schulich School of Medicine and Dentistry
| | - Susan W Hunter
- University of Western Ontario, Faculty of Health Sciences, School of Physical Therapy.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, Schulich School of Medicine and Dentistry
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5
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Landers MR, Nilsson MH. A theoretical framework for addressing fear of falling avoidance behavior in Parkinson's disease. Physiother Theory Pract 2022; 39:895-911. [PMID: 35180834 DOI: 10.1080/09593985.2022.2029655] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Postural instability in Parkinson's disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent downstream consequences is fear of falling (FOF), which is both common and problematic in PD. It can lead to a vicious cycle of FOF avoidance behavior that results in more sedentary behavior, physical deconditioning, and weakening of already impaired balance systems. This, in turn, may make the person with PD more susceptible to a future fall even with benign daily tasks. While FOF activity avoidance can be adaptive (appropriate), it can also be maladaptive (inappropriate or exaggerated). When this adaptive and maladaptive FOF avoidance behavior is contextualized to gait/balance performance, it provides a theoretical framework that can be used by clinicians to match patterns of behavior to a concordant treatment approach. In the theoretical framework proposed in this perspective, four different patterns related to FOF avoidance behavior and gait/balance performance are suggested: appropriate avoiders, appropriate non-avoiders, inappropriate avoiders, and inappropriate non-avoiders. For each of the four FOF avoidance behavior patterns, this paper also provides suggested treatment focuses, approaches and recommendations.
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Affiliation(s)
- Merrill R Landers
- Department of Physical Therapy, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Maria H Nilsson
- Department of Health Sciences, Lund University, Lund, Sweden.,Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Nugent K, Payne MW, Viana R, Hunter SW. The reliability of four standardized concern for falling scales among adults with a major lower extremity amputation. PM R 2022; 15:437-444. [PMID: 35150095 DOI: 10.1002/pmrj.12785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION More than 52.4% of people with a lower extremity amputation (PLEA) will fall at least once each year. Previously established standardized scales which evaluate a concern for falling (CFF) were primarily developed among community dwelling older adults. The reliability of commonly used scales to evaluate a CFF among PLEA is needed. OBJECTIVE To evaluate test-retest relative and absolute reliability, and agreement of the Modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Falls Efficacy Scale - International (FES-I), Consequences of Falling (COF) Scale, Perceived Control Over Falling (PCOF) Scale, and Perceived Ability to Manage Falls (PAMF) Scale among PLEA. DESIGN Web-based cross-sectional repeated measures study. SETTING Rehabilitation hospital. PARTICIPANTS Regularly scheduled appointments (N = 22, mean age ± SD, 63.5 ± 12.9 years) with a transtibial or transfemoral level amputation, completed a prosthetic rehabilitation program, and at minimum of one year using a prosthesis for ambulation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Initial and re-test scores on the mSAFFE, FES-I, COF, PAMF, and PCOF. RESULTS Intraclass correlation coefficients (ICC) demonstrated excellent relative reliability of the mSAFFE [ICC = 0.92 (95% CI: 0.82-0.97)], good relative reliability of the FES-I [ICC = 0.87 (95% CI: 0.70-0.94)], and fair relative reliability of the COF [ICC = 0.78 (95% CI: 0.53-0.90)] and PAMF [ICC = 0.73 (95% CI: 0.46-0.88)] scales. The ICC value of the PCOF scale could not be validly calculated and was not further analyzed. Calculated SE of measurement values for the mSAFFE, FES-I, COF, and PAMF scales were small in magnitude and Bland-Altman graphs demonstrated good agreement of initial and re-test scores for all scales. CONCLUSION This study provides initial evidence on the suitability and reliable use of the mSAFFE, FES-I, COF, and PAMF scales within this population. Further evaluation of the validity of these scales is needed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kristin Nugent
- Faculty of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
| | - Michael W Payne
- Schulich School of Medicine & Dentistry, Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada
| | - Ricardo Viana
- Schulich School of Medicine & Dentistry, Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada
| | - Susan W Hunter
- Faculty of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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Brodowski H, Strutz N, Mueller-Werdan U, Kiselev J. Categorizing fear of falling using the survey of activities and fear of falling in the elderly questionnaire in a cohort of hospitalized older adults: A cross-sectional design. Int J Nurs Stud 2021; 126:104152. [PMID: 34923318 DOI: 10.1016/j.ijnurstu.2021.104152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fear of falling is commonly assessed using the Activities-specific Balance Confidence Scale which is an instrument to measure balance confidence, based on the assumption that fear of falling is due to the absence of balance confidence. The "Survey of Activities and Fear of Falling in the Elderly" measures the concept of fear of falling more directly on a scale of 0.0 and 3.0 points. However, there are no valid cut-off points that might help practitioners to interpret "Survey of Activities and Fear of Falling in the Elderly" scores. The aim of this study was to identify such cut-off points and distinguish between low, moderate and high fear of falling, in relation to balance confidence. METHOD In this cross-sectional study different cut-off point schemes for classifying fear of falling scores as low, moderate or high were compared with F-values in ANOVA using the cut-off point scheme as an independent variable and the balance confidence scores as a dependent variable. The analysis was performed using data from a cohort of 98 hospitalized older adults. RESULTS Using the Activities-specific Balance Confidence Scale as a reference tool, values of 0.6 and 1.4 were identified as optimal cut-off points for low, moderate and high fear of falling. CONCLUSIONS This study was the first to systematically classify fear of falling using the "Survey of Activities and Fear of Falling in the Elderly". This classification can assist health practitioners to interpret fear of falling score and guide clinical decision making. Registration: The study is registered with the German Clinical Trials Register (DRKS00010773, date of registration 2016/05/07, date of recruitment 2016/11/07).
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Affiliation(s)
- Hanna Brodowski
- Institute of Health Sciences, Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Luebeck, Germany; Geriatrics Research Group, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Nicole Strutz
- Geriatrics Research Group, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Ursula Mueller-Werdan
- Geriatrics Research Group, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Joern Kiselev
- Geriatrics Research Group, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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8
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Landers MR, Jacobson KM, Matsunami NE, McCarl HE, Regis MT, Longhurst JK. A vicious cycle of fear of falling avoidance behavior in Parkinson's disease: A path analysis. Clin Park Relat Disord 2021; 4:100089. [PMID: 34316667 PMCID: PMC8299987 DOI: 10.1016/j.prdoa.2021.100089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/12/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Postural instability (PI) in Parkinson's disease (PD) is associated with several negative downstream consequences. OBJECTIVE The purpose was to explore the validity of a theoretical model of these downstream consequences arranged in a vicious cycle wherein PI leads to decreased balance confidence, which in turn leads to increased fear of falling (FOF) avoidance behavior, which in turn leads to decreased physical conditioning, which then feeds back and negatively affects PI. METHODS A path analysis of cross-sectional data from 55 participants with PD was conducted. The four constructs in the model connected in succession were: 1. PI (principal components analysis (PCA) composite of the Unified Parkinson's Disease Rating Scale PI and Gait Difficulty score, Timed Up and Go test, and Berg Balance Scale); 2. balance confidence (Activities-Specific Balance Confidence Scale); 3. FOF avoidance behavior (PCA composite of the FOF Avoidance Behavior Questionnaire and average number of steps per day); and, 4. physical conditioning (2-Minute Step Test). RESULTS The path model was an excellent fit to the data, χ2 (7) = 7.910, p = .341, CFI = 0.985, TLI = 0.968, RMSEA = 0.049 (90% CI: 0.000 to 0.179). The moderate to strong and uniformly significant parameter estimates were -0.519, -0.651, -0.653, and -0.570, respectively (ps < 0.01). CONCLUSIONS PI directly and inversely predicted balance confidence, which in turn directly and inversely predicted FOF avoidance behavior. Furthermore, FOF avoidance behavior directly and inversely predicted physical conditioning, which directly and inversely predicted PI, thereby closing the cycle. These findings highlight the downstream consequences of PI in PD and support the notion of a vicious cycle of FOF avoidance behavior.
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Affiliation(s)
| | | | | | | | | | - Jason K. Longhurst
- University of Nevada, Las Vegas, United States
- Cleveland Clinic Lou Ruvo Center for Brain Health
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Oddsson LIE, Bisson T, Cohen HS, Jacobs L, Khoshnoodi M, Kung D, Lipsitz LA, Manor B, McCracken P, Rumsey Y, Wrisley DM, Koehler-McNicholas SR. The Effects of a Wearable Sensory Prosthesis on Gait and Balance Function After 10 Weeks of Use in Persons With Peripheral Neuropathy and High Fall Risk - The walk2Wellness Trial. Front Aging Neurosci 2020; 12:592751. [PMID: 33240077 PMCID: PMC7680959 DOI: 10.3389/fnagi.2020.592751] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sensory peripheral neuropathy (PN) is associated with gait, balance problems and high fall risk. The walk2Wellness trial investigates effects of long-term, home-based daily use of a wearable sensory prosthesis on gait function, balance, quality of life and fall rates in PN patients. The device (Walkasins®, RxFunction Inc., MN, United States) partially substitutes lost nerve function related to plantar sensation providing directional tactile cues reflecting plantar pressure measurements during standing and walking. We tested the null hypothesis that the Functional Gait Assessment (FGA) score would remain unchanged after 10 weeks of use. METHODS Participants had PN with lost plantar sensation, gait and balance problems, an FGA score < 23 (high fall risk), and ability to sense tactile stimuli above the ankle. Clinical outcomes included FGA, Gait Speed, Timed Up&Go (TUG) and 4-Stage Balance Test. Patient-reported outcomes included Activities-Specific Balance Confidence (ABC) scale, Vestibular Disorders Activities of Daily Living Scale, PROMIS participation and satisfaction scores, pain rating, and falls. Evaluations were performed at baseline and after 2, 6, and 10 weeks. Subjects were not made aware of changes in outcomes. No additional balance interventions were allowed. RESULTS Forty-five participants of 52 enrolled across four sites completed in-clinic assessments. FGA scores improved from 15.0 to 19.1 (p < 0.0001), normal and fast gait speed from 0.86 m/s to 0.95 m/s (p < 0.0001) and 1.24 m/s to 1.33 m/s (p = 0.002), respectively, and TUG from 13.8 s to 12.5 s (p = 0.012). Four-Stage Balance Test did not improve. Several patient-reported outcomes were normal at baseline and remained largely unchanged. Interestingly, subjects with baseline ABC scores lower than 67% (high fall risk cut-off) increased their ABC scores (49.9% to 59.3%, p = 0.01), whereas subjects with ABC scores above 67% showed a decrease (76.6% to 71.8%, p = 0.019). Subjects who reported falls in the prior 6 months (n = 25) showed a decrease in the number of fall-risk factors (5.1 to 4.3, p = 0.023) and a decrease in fall rate (13.8 to 7.4 falls/1000 days, p = 0.014). Four pre-study non-fallers (n = 20) fell during the 10 weeks. CONCLUSION A wearable sensory prosthesis presents a new way to treat gait and balance problems and manage falls in high fall-risk patients with PN. TRIAL REGISTRATION ClinicalTrials.gov (#NCT03538756).
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Affiliation(s)
- Lars I. E. Oddsson
- RxFunction Inc., Eden Prairie, MN, United States
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States
- Recaniti School for Community Health Professions, Ben Gurion University of the Negev, Beersheba, Israel
| | - Teresa Bisson
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States
- M Health Fairview, Minneapolis, MN, United States
| | | | - Laura Jacobs
- RxFunction Inc., Eden Prairie, MN, United States
| | - Mohammad Khoshnoodi
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Doris Kung
- Baylor College of Medicine, Houston, TX, United States
| | - Lewis A. Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, United States
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | | | | | | | - Sara R. Koehler-McNicholas
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States
- Minneapolis VA Health Care System, Minneapolis, MN, United States
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Pfeiffer K, Kampe K, Klenk J, Rapp K, Kohler M, Albrecht D, Büchele G, Hautzinger M, Taraldsen K, Becker C. Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation. Age Ageing 2020; 49:771-778. [PMID: 32832985 DOI: 10.1093/ageing/afaa050] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/08/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND fear of falling and reduced fall-related self-efficacy are frequent consequences of falls and associated with poorer rehabilitation outcomes. To address these psychological consequences, geriatric inpatient rehabilitation was augmented with a cognitive behavioural intervention ("Step by Step") and evaluated in a RCT. METHODS one hundred fifteen hip and pelvic fracture patients (age = 82.5 years, 70% female) admitted to geriatric inpatient rehabilitation were randomly allocated to the intervention or control group. The intervention consisted of eight additional individual sessions during inpatient rehabilitation, one home visit and four telephone calls delivered over 2 months after discharge. Both groups received geriatric inpatient rehabilitation. Primary outcomes were fall-related self-efficacy (short falls efficacy scale-international) and physical activity as measured by daily walking duration (activPAL3™ sensor) after admission to rehabilitation, before discharge and 1-month post-intervention. RESULTS in covariance analyses, patients in the intervention group showed a significant improvement in fall-related self-efficacy (P = 0.025, d = -0.42), but no difference in total daily walking duration (P = 0.688, d = 0.07) 1-month post-intervention compared to the control condition. Further significant effects in favour of the intervention group were found in the secondary outcomes "perceived ability to manage falls" (P = 0.031, d = 0.41), "physical performance" (short physical performance battery) (P = 0.002, d = 0.58) and a lower "number of falls" (P = 0.029, d = -0.45). CONCLUSIONS the intervention improved psychological and physical performance measures but did not increase daily walking duration. For the inpatient part of the intervention further research on the required minimum intensity needed to be effective is of interest. Duration and components used to improve physical activity after discharge should be reconsidered.
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Affiliation(s)
- Klaus Pfeiffer
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Karin Kampe
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany
| | - Jochen Klenk
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB Hochschule Berlin, Studienzentrum Stuttgart, Stuttgart, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michaela Kohler
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Diana Albrecht
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Martin Hautzinger
- Department of Psychology, Eberhard Karls University, Tubingen, Germany
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Clemens Becker
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
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11
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German version of the outcome expectations for exercise scale-2 : Psychometric properties in geriatric patients after hip or pelvic fractures with fear of falling. Z Gerontol Geriatr 2020; 54:582-589. [PMID: 32623492 DOI: 10.1007/s00391-020-01753-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Physical exercise is associated with many health benefits. Especially for older adults it is challenging to achieve an appropriate adherence to exercise programs. The outcome expectations for exercise scale 2 (OEE-2) is a 13-item self-report questionnaire to assess negative and positive exercise outcome expectations in older adults. The aim of this study was to translate the OEE‑2 into German and to assess the psychometric properties of this version. METHODS The OEE‑2 was translated from English into German including a forward and backward translation process. Psychometric properties were assessed in 115 patients with hip/pelvic fractures (76% female, mean age 82.5 years) and fear of falling during geriatric inpatient rehabilitation. RESULTS Principal component analyses could confirm a two-factor solution (positive/negative OEE) that explained 58% of the total variance, with an overall internal reliability of α = 0.89. Cronbach's α for the 9‑item positive OEE subscale was 0.89, for the 4‑item negative OEE subscale 0.79. The two subscales were correlated with rs = 0.49. Correlations of the OEE total score were highest with the perceived ability to manage falls, prefracture leisure time activities and prior training history (rs = 0.35-0.41). CONCLUSION These results revealed good internal reliability and construct validity of the German version of the OEE‑2. The instrument is valid for measuring physical exercise outcome expectations in older, German-speaking patients with hip or pelvic fractures and fear of falling.
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12
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Eckert T, Kampe K, Kohler M, Albrecht D, Büchele G, Hauer K, Schäufele M, Becker C, Pfeiffer K. Correlates of fear of falling and falls efficacy in geriatric patients recovering from hip/pelvic fracture. Clin Rehabil 2019; 34:416-425. [PMID: 31789060 DOI: 10.1177/0269215519891233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To gain a better understanding about the nature of fear of falling, this study analyzed associations between psychological and physical aspects related to fear of falling and falls efficacy in hip/pelvic fracture patients. DESIGN Baseline data of a randomized controlled trial. SETTING Geriatric inpatient rehabilitation hospital. SUBJECTS In all, 115 geriatric patients with hip/pelvic fracture (mean age: 82.5 years) reporting fear of falling within first week of inpatient rehabilitation. INTERVENTIONS None. MAIN MEASURES Falls efficacy (Short Falls Efficacy Scale-International; Perceived Ability to Manage Falls), fear of falling (one-item question), fall-related post-traumatic stress symptoms (six items based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria), physical performance (Short Physical Performance Battery) and psychological inflexibility (Acceptance and Action Questionnaire-II) were assessed. RESULTS Path analyses demonstrated that low falls efficacy (Short Falls Efficacy Scale International) was significantly related to poor physical performance (β* = -.277, P ⩽ .001), but not to psychological inflexibility and fall-related post-traumatic stress symptoms (P ⩾ .05.). Fear of falling was directly associated with fall-related post-traumatic stress symptoms (β*= .270, P = .007) and indirectly with psychological inflexibility (β*= .110, P = .022). Low perceived ability to manage falls was significantly related to previous falls (β* = -.348, P ⩽ .001), psychological inflexibility (β* = -.216, P = .022) and female gender (β* = -.239, P ⩽ .01). CONCLUSION Falls efficacy and fear of falling constitute distinct constructs. Falls efficacy measured with the Short Falls Efficacy Scale International reflects the appraisal of poor physical performance. Fear of falling measured by the single-item question constitutes a fall-specific psychological construct associated with psychological inflexibility and fall-related post-traumatic stress symptoms.
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Affiliation(s)
- Tobias Eckert
- Agaplesion Bethanien Hospital Heidelberg, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
| | - Karin Kampe
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michaela Kohler
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Diana Albrecht
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Klaus Hauer
- Agaplesion Bethanien Hospital Heidelberg, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
| | - Martina Schäufele
- Department of Social Work, Mannheim University of Applied Sciences, Mannheim, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
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13
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Abstract
Objectives: Fear of falling is common amongst older adults with and without a prior experience of falling. It is related to decreased quality of life, isolation, and institutionalisation. It also poses a risk for future falls when activity is avoided because of fear of falling and muscle deconditioning occurs. Relatively little is known about the psychological factors underpinning fear of falling. This study explored the relationship between emotion regulation and fear of falling in community dwelling older adults. Method: A sample of 117 older adults (>65 years) were recruited from community based exercise classes, falls reduction classes, NHS and charity organisations. Self-reported measures included the Falls Efficacy Scale-International (FES-I), the Fear of Falling Behaviour Questionnaire (FFABQ), the Difficulties in Emotion Regulation Scale (DERS) and the Hospital and Anxiety Depression Scale (HADS). Results: A significant positive correlation was found between emotion regulation and fear of falling, as well as between emotional regulation and fear-related avoidance behaviour. A regression model found that after controlling for depression and age, emotion regulation was no longer significantly related to fear of falling. Conclusions: Fear of falling is associated with emotion regulation difficulties in community dwelling older adults. However, this link no longer exists once depression is controlled for. The key clinical implication is the importance of the assessment of depression in older adults with a fear of falling. Future research should use a longitudinal design to further unpick the causal relationships between these variables.
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Affiliation(s)
- Lianne Scarlett
- Section of Clinical Psychology, School of Health in Social Science, University of Edinburgh , Edinburgh , UK
| | | | - Stella W Y Chan
- Section of Clinical Psychology, School of Health in Social Science, University of Edinburgh , Edinburgh , UK
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14
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Ghaffari-Rafi A, Horak RD, Miles DT, Eum KS, Jahanmir J. Case Report on Fear of Falling Syndrome: A Debilitating but Curable Gait Disorder. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1587-1591. [PMID: 31659147 PMCID: PMC6839539 DOI: 10.12659/ajcr.918879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient: Male, 70 Final Diagnosis: Fear of falling syndrome Symptoms: Inability to get up from a chair and ambulate independently Medication: — Clinical Procedure: Lumbar puncture Specialty: Neurology
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Affiliation(s)
- Arash Ghaffari-Rafi
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Richard D Horak
- Department of Radiology, Tripler Army Medical Center, Honolulu, HI, USA
| | - Daniel T Miles
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA
| | - Ki Suk Eum
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA
| | - Jay Jahanmir
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.,Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA
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15
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Elboim-Gabyzon M, Agmon M, Azaiza F. Psychometric properties of the Arabic version of the Activities-Specific Balance Confidence (ABC) scale in ambulatory, community-dwelling, elderly people. Clin Interv Aging 2019; 14:1075-1084. [PMID: 31354251 PMCID: PMC6590840 DOI: 10.2147/cia.s194777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/09/2019] [Indexed: 01/22/2023] Open
Abstract
Background: Fear of falling (FOF) is common among elderly individuals and can appear independently of a previous fall. FOF can start a vicious cycle by leading to a sedentary lifestyle and further FOF, with negative physical and mental consequences. The Activities-Specific Balance Confidence (ABC) scale is a popular, theoretically based, reliable and valid tool designed to assess FOF in ambulatory, community-dwelling, elderly people. A balance confidence measurement tool for Arabic-speaking ambulatory, community-dwelling, elderly individuals is lacking. The objective of the present study was to translate and culturally adapt the ABC to Arabic and to determine its psychometric properties in ambulatory, community-dwelling elderly people. Materials and methods: This two-stage exploratory study included a forward and backward translation process and the administration of the Arabic ABC (A-ABC) via face-to-face interviews. In addition, performance-based clinical measures of balance were assessed, and two self-report physical function and disability questionnaires were administered. The study included 60 volunteers (34 women), with a mean age of 74.1±6.23 years, recruited from the Arab population of northern Israel. To determined test–retest reliability, the questionnaire was re-administered to 40 of the 60 participants twice at a 6–8-day interval. Results: One of the 16 A-ABC scale items was modified to adjust for local climate. The main results included high internal consistency (Cronbach’s α=0.97), good to excellent structural coherence (corrected item-total correlation: 0.77–0.92); excellent test–retest reliability (ICC=0.98, confidence interval =0.08−3.05); low standard error of measure and low smallest real difference (3.5% and 9.64%, respectively); strong-to-moderate correlations with performance-based clinical measures of balance and self-report physical function and disability questionnaires; and a ceiling effect. A significant difference between genders and between fallers and non-fallers was demonstrated. Conclusions: The A-ABC demonstrated excellent psychometric properties in elderly, Arabic-speaking, independently living individuals and can be used as a balance confidence measurement tool in research and clinical settings.
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Affiliation(s)
- Michal Elboim-Gabyzon
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Maayan Agmon
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Faisal Azaiza
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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16
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Abstract
BACKGROUND A load carrying task was identified as a major factor leading to slip and fall injuries such as overexertion and bodily reaction. Holding a load in front of the body while walking would shift the whole body center-of-mass to the front, loading additional rotational torque at the foot-ground contact. OBJECTIVES The present study evaluated if carrying a load would increase the likelihood of slip initiation and the slip severity. METHODS Eleven young and 10 older adults participated in the present study. A dry surface or a slippery surface was introduced while walking. Slip distance, peak sliding heel velocity, heel contact velocity, and required coefficient of friction were measured to test the study hypotheses. RESULTS The results showed that significant main effects were found in slip distance, and peak sliding heel velocity and no main effect were found in heel contact velocity and required coefficient of friction. CONCLUSION In conclusion, younger adults were found to slip longer and faster on the slippery surface while carrying a load. On the contrary, the older adults employed a safety-centered gait adaptation while carrying, to maintain slip initiation and severity characteristics at the same level as normal walking. Furthermore, light load carriage at 10% of body weight was suggested as a safe task for the elderly.
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Affiliation(s)
- Jung-Suk Seo
- Department of Physical Education, College of Education, WonKwang University, Iksan-si, Jeollabuk-do, Korea
| | - Sukwon Kim
- Department of Physical Education, College of Education, Chonbuk National University, Jeonju-si, Jeollabuk-do, Korea
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17
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Schoene D, Heller C, Aung YN, Sieber CC, Kemmler W, Freiberger E. A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls? Clin Interv Aging 2019; 14:701-719. [PMID: 31190764 PMCID: PMC6514257 DOI: 10.2147/cia.s197857] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/17/2019] [Indexed: 11/03/2022] Open
Abstract
Maintaining or improving quality of life (QoL) is a key outcome of clinical interventions in older people. Fear of falling (FoF) is associated with activity restriction as well as with poorer physical and cognitive functions and may be an important contributor to a diminished QoL. The objectives of this systematic review were to determine i) the effect of FoF on QoL in older people, ii) whether the association between these two constructs depends on the use of specific conceptualizations and measurement instruments, and iii) the role of fall events as mediating factor in this relationship. Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Library) were searched from their inceptions to February 2018. Thirty mostly cross-sectional studies in nearly 30.000 people (weighted mean age 75.6 years (SD =6.1); 73% women) were included. FoF was associated with QoL in most studies, and this association appeared to be independent of the conceptualization of FoF. Moreover, this relationship was independent of falls people experienced which seemed to have a lower impact. FoF should be considered not only as by-product of falls and targeted interventions in parts different from those to reduce falls are likely required. Studies are needed showing that reducing FoF will lead to increased QoL.
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Affiliation(s)
- Daniel Schoene
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany.,Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Claudia Heller
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - Yan N Aung
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany.,Department of General Internal and Geriatric Medicine, Hospital of the Order of St. John of God Regensburg, Regensburg, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
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18
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Lee S, Lee C, Ory MG, Won J, Towne SD, Wang S, Forjuoh SN. Fear of Outdoor Falling Among Community-Dwelling Middle-Aged and Older Adults: The Role of Neighborhood Environments. THE GERONTOLOGIST 2019; 58:1065-1074. [PMID: 28958081 DOI: 10.1093/geront/gnx123] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/03/2017] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Fear of falling is a substantial barrier to walking and has been associated with increased fall risks. This study examines neighborhood environmental risk factors related to fear of outdoor falling in middle-aged and older adults. Research Design and Methods A total of 394 participants aged 50 years or older living independently in the community were recruited between 2013 and 2014 from an integrated health care network serving Central Texas. Fear of outdoor falling and perceived neighborhood environmental variables were assessed using self-reported questionnaires. Logistic regression identified perceived neighborhood environmental variables associated with fear of outdoor falling. Results Sixty-nine (17.9%) of 385 participants reported having a fear of outdoor falling. Compared to those who did not report a fear of outdoor falling, those who reported having a fear of outdoor falling were more likely to be adults aged 65 years or older (odds ratio [OR] = 2.974, 95% confidence interval [CI] = 1.247-7.094), be female (OR = 4.423, 95% CI = 1.830-10.689), have difficulty with walking for a quarter of a mile (OR = 2.761, 95% CI = 1.124-6.782), and have had a fall in the past year (OR = 4.720, 95% CI = 1.472-15.137). Among the neighborhood environmental characteristics examined, low traffic speed on streets (OR = 0.420, 95% CI = 0.188-0.935), drainage ditches (OR = 2.383, 95% CI = 1.136-5.000), and broken sidewalks (OR = 3.800, 95% CI = 1.742-8.288) were associated with the odds of having a fear of outdoor falling. Discussion and Implications In addition to the individual factors, findings from this study suggest the importance of addressing the environmental risk factors in identifying and reducing fear of outdoor falling among middle-aged and older adults.
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Affiliation(s)
- Sungmin Lee
- Department of Landscape Architecture & Urban Planning, College of Architecture, Texas A&M University, College Station
| | - Chanam Lee
- Department of Landscape Architecture & Urban Planning, College of Architecture, Texas A&M University, College Station
| | - Marcia G Ory
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M Health Science Center, College Station
| | - Jaewoong Won
- Department of Landscape Architecture & Urban Planning, College of Architecture, Texas A&M University, College Station
| | - Samuel D Towne
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M Health Science Center, College Station
| | - Suojin Wang
- Department of Statistics, College of Science, Texas A&M University, College Station
| | - Samuel N Forjuoh
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M Health Science Center, College Station.,Department of Family & Community Medicine, Baylor Scott & White Health, College of Medicine, Texas A&M Health Science Center, Temple
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19
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Adachi S, Yuki K, Awano-Tanabe S, Ono T, Shiba D, Murata H, Asaoka R, Tsubota K. Factors associated with developing a fear of falling in subjects with primary open-angle glaucoma. BMC Ophthalmol 2018; 18:39. [PMID: 29433472 PMCID: PMC5810054 DOI: 10.1186/s12886-018-0706-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background To investigate the relationship between clinical risk factors, including visual field (VF) defects and visual acuity, and a fear of falling, among patients with primary open-angle glaucoma (POAG). Methods All participants answered the following question at a baseline ophthalmic examination: Are you afraid of falling? The same question was then answered every 12 months for 3 years. A binocular integrated visual field was calculated by merging a patient’s monocular Humphrey field analyzer VFs, using the ‘best sensitivity’ method. The means of total deviation values in the whole, superior peripheral, superior central, inferior central, and inferior peripheral VFs were calculated. The relationship between these mean VF measurements, and various clinical factors, against patients’ baseline fear of falling and future fear of falling was analyzed using multiple logistic regression. Results Among 392 POAG subjects, 342 patients (87.2%) responded to the fear of falling question at least twice in the 3 years study period. The optimal regression model for patients’ baseline fear of falling included age, gender, mean of total deviation values in the inferior peripheral VF and number of previous falls. The optimal regression equation for future fear of falling included age, gender, mean of total deviation values in the inferior peripheral VF and number of previous falls. Conclusion Defects in the inferior peripheral VF area are significantly related to the development of a fear of falling.
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Affiliation(s)
- Sayaka Adachi
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Kenya Yuki
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Sachiko Awano-Tanabe
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Takeshi Ono
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Daisuke Shiba
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Murata
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ryo Asaoka
- Department of Ophthalmology, the University of Tokyo, Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, Japan
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20
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A Comparative Study of the Effects of Pilates and Latin Dance on Static and Dynamic Balance in Older Adults. J Aging Phys Act 2017; 25:412-419. [DOI: 10.1123/japa.2016-0164] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Payette MC, Bélanger C, Benyebdri F, Filiatrault J, Bherer L, Bertrand JA, Nadeau A, Bruneau MA, Clerc D, Saint-Martin M, Cruz-Santiago D, Ménard C, Nguyen P, Vu TTM, Comte F, Bobeuf F, Grenier S. The Association between Generalized Anxiety Disorder, Subthreshold Anxiety Symptoms and Fear of Falling among Older Adults: Preliminary Results from a Pilot Study. Clin Gerontol 2017; 40:197-206. [PMID: 28452660 DOI: 10.1080/07317115.2017.1296523] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE A relationship between generalized anxiety disorder (GAD) and fear of falling (FOF) has long been proposed but never specifically studied. This study aimed at analyzing the relationship between FOF and GAD or anxiety symptoms, while controlling for major depressive episodes (MDE), depressive symptoms, fall risk, and sociodemographic variables. METHODS Twenty-five older adults participated in this pilot study. Assessments included the following: Anxiety Disorder Interview Schedule, Geriatric Anxiety Inventory, Geriatric Depression Scale, Falls-Efficacy Scale-International. A multidisciplinary team evaluated fall risk. RESULTS FOF was significantly correlated with GAD, MDE, anxiety and depressive symptoms, and fall risk, but not with sociodemographic variables. Multiple regression analyses indicated that GAD and anxiety symptoms were significantly and independently associated with FOF. CONCLUSION Although the results of this pilot study should be replicated with larger samples, they suggest that FOF is associated with GAD and anxiety symptoms even when considering physical factors that increase the risk of falling. CLINICAL IMPLICATIONS Treatment of FOF in patients with GAD may present a particular challenge because of the central role of intolerance of uncertainty, which may prevent patients from regaining confidence despite the reduction of fall risk. Clinicians should screen for GAD and anxiety symptoms in patients with FOF to improve detection and treatment.
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Affiliation(s)
- Marie-Christine Payette
- a Université du Québec à Montréal , Quebec , Canada.,b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada
| | - Claude Bélanger
- a Université du Québec à Montréal , Quebec , Canada.,c McGill University , Montreal , Quebec , Canada
| | - Fethia Benyebdri
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada
| | - Johanne Filiatrault
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada.,d Université de Montréal , Montreal , Quebec , Canada
| | - Louis Bherer
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada.,e PERFORM Centre , Concordia University , Montreal , Quebec , Canada.,f Concordia University , Montreal , Quebec , Canada
| | - Josie-Anne Bertrand
- g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada.,h Rotman Research Institute , Baycrest Center , Toronto , Ontario , Canada
| | - Alexandra Nadeau
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada.,d Université de Montréal , Montreal , Quebec , Canada
| | - Marie-Andrée Bruneau
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada.,d Université de Montréal , Montreal , Quebec , Canada.,g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada
| | - Doris Clerc
- d Université de Montréal , Montreal , Quebec , Canada.,g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada
| | - Monique Saint-Martin
- i Centre hospitalier de l'Université de Montréal (CHUM) , Montreal , Quebec , Canada
| | - Diana Cruz-Santiago
- d Université de Montréal , Montreal , Quebec , Canada.,g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada
| | - Caroline Ménard
- d Université de Montréal , Montreal , Quebec , Canada.,g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada
| | - Philippe Nguyen
- d Université de Montréal , Montreal , Quebec , Canada.,g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada
| | - T T Minh Vu
- d Université de Montréal , Montreal , Quebec , Canada.,g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada.,i Centre hospitalier de l'Université de Montréal (CHUM) , Montreal , Quebec , Canada
| | - Francis Comte
- g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada
| | - Florian Bobeuf
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada.,f Concordia University , Montreal , Quebec , Canada
| | - Sébastien Grenier
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada.,d Université de Montréal , Montreal , Quebec , Canada
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Increasing fall risk awareness using wearables: A fall risk awareness protocol. J Biomed Inform 2016; 63:184-194. [DOI: 10.1016/j.jbi.2016.08.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 08/12/2016] [Accepted: 08/14/2016] [Indexed: 11/19/2022]
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Yuen HK, Carter RE. A Predictive Model for the Intention to Implement Home Modifications: A Pilot Study. J Appl Gerontol 2016. [DOI: 10.1177/0733464805280751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study was conducted to explore determinants related to older adults' intention to implement home modifications that can prevent falls. Eighty-seven community-dwelling older adults aged 60 or older completed a questionnaire examining potential determinants to predict an intention to implement home modifications. Multiple logistic regression suggests that the odds ratios (OR) for the participants' intention to implement home modifications were higher for those (a) who have higher levels of belief that home modifications are beneficial (adjusted OR = 2.41, p = .015), (b) who believe that environmental adaptation can help prevent future falls (adjustedOR= 4.61, p = .036), and (c) who have taken past action concerning changes in home environment (adjusted OR = 4.79, p = .029). Findings serve as a preliminary step toward developing a comprehensive predictive model to identify determinants in predicting the degree of adherence to recommended home modifications for fall prevention among older adults.
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Payette MC, Bélanger C, Léveillé V, Grenier S. Fall-Related Psychological Concerns and Anxiety among Community-Dwelling Older Adults: Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0152848. [PMID: 27043139 PMCID: PMC4820267 DOI: 10.1371/journal.pone.0152848] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/20/2016] [Indexed: 12/30/2022] Open
Abstract
Fear of falling and other fall-related psychological concerns (FRPCs), such as falls-efficacy and balance confidence, are highly prevalent among community-dwelling older adults. Anxiety and FRPCs have frequently, but inconsistently, been found to be associated in the literature. The purpose of this study is to clarify those inconsistencies with a systematic review and meta-analysis and to evaluate if the strength of this relationship varies based on the different FRPC constructs used (e.g., fear of falling, falls-efficacy or balance confidence). A systematic review was conducted through multiple databases (e.g., MEDLINE, PsycINFO) to include all articles published before June 10th 2015 that measured anxiety and FRPCs in community-dwelling older adults. Active researchers in the field were also contacted in an effort to include unpublished studies. The systematic review led to the inclusion of twenty relevant articles (n = 4738). A random-effect meta-analysis revealed that the mean effect size for fear of falling and anxiety is r = 0.32 (95% CI: 0.22-0.40), Z = 6.49, p < 0.001 and the mean effect size for falls-efficacy or balance confidence and anxiety is r = 0.31 (95% CI: 0.23-0.40), Z = 6.72, p < 0.001. A Q-test for heterogeneity revealed that the two effect sizes are not significantly different (Q(19) = 0.13, p = n.s.). This study is the first meta-analysis on the relationship between anxiety and FRPCs among community-dwelling older adults. It demonstrates the importance of considering anxiety when treating older adults with FRPCs.
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Affiliation(s)
- Marie-Christine Payette
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Laboratoire d'Étude sur l'Anxiété et la Dépression gÉRiatrique (LEADER), Montreal, Quebec, Canada
| | - Claude Bélanger
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Vanessa Léveillé
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Laboratoire d'Étude sur l'Anxiété et la Dépression gÉRiatrique (LEADER), Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Sébastien Grenier
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
- Laboratoire d'Étude sur l'Anxiété et la Dépression gÉRiatrique (LEADER), Montreal, Quebec, Canada
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
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Chang HT, Chen HC, Chou P. Factors Associated with Fear of Falling among Community-Dwelling Older Adults in the Shih-Pai Study in Taiwan. PLoS One 2016; 11:e0150612. [PMID: 26933882 PMCID: PMC4775068 DOI: 10.1371/journal.pone.0150612] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/16/2016] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Levy F, Leboucher P, Rautureau G, Komano O, Millet B, Jouvent R. Fear of falling: efficacy of virtual reality associated with serious games in elderly people. Neuropsychiatr Dis Treat 2016; 12:877-81. [PMID: 27143889 PMCID: PMC4841394 DOI: 10.2147/ndt.s97809] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Fear of falling is defined as an ongoing concern about falling that is not explained by physical examination. Focusing on the psychological dimension of this pathology (phobic reaction to walking), we looked at how virtual reality associated with serious games can be used to treat this pathology. METHODS Participants with fear of falling were randomly assigned to either a treatment group or a waiting list. The therapy consisted of 12 weekly sessions of virtual reality exposure therapy associated with serious games. RESULTS Sixteen participants were included. The mean age of the treatment group was 72 years and that of the control group was 69 years. Participants' scores on the fear of falling measure improved after treatment with virtual reality associated with serious games, leading to a significant difference between the two groups. CONCLUSION Virtual reality exposure therapy associated with serious games can be used in the treatment of fear of falling. The two techniques are complementary (top-down and bottom-up processes). To our knowledge, this is the first time that a combination of the two has been assessed. There was a specific effect of this therapy on the phobic reaction. Further studies are needed to confirm its efficacy and identify its underlying mechanism.
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Affiliation(s)
- Fanny Levy
- Department of Adults Psychiatry, ICM-A-IHU, UPMC UMR_S 975, Inserm U 1127, CNRS UMR 7225, GH Pitié-Salpêtrière, Paris, France
| | - Pierre Leboucher
- PRISME-Virtual Reality, ICM-A-IHU, UPMC UMR_S 975, Inserm U 1127, CNRS UMR 7225, GH Pitié-Salpêtrière, Paris, France
| | - Gilles Rautureau
- PRISME-Virtual Reality, ICM-A-IHU, UPMC UMR_S 975, Inserm U 1127, CNRS UMR 7225, GH Pitié-Salpêtrière, Paris, France
| | - Odile Komano
- PRISME-Virtual Reality, ICM-A-IHU, UPMC UMR_S 975, Inserm U 1127, CNRS UMR 7225, GH Pitié-Salpêtrière, Paris, France
| | - Bruno Millet
- Department of Adults Psychiatry, ICM-A-IHU, UPMC UMR_S 975, Inserm U 1127, CNRS UMR 7225, GH Pitié-Salpêtrière, Paris, France
| | - Roland Jouvent
- Department of Adults Psychiatry, ICM-A-IHU, UPMC UMR_S 975, Inserm U 1127, CNRS UMR 7225, GH Pitié-Salpêtrière, Paris, France
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Effects of a Community-Based Fall Management Program on Medicare Cost Savings. Am J Prev Med 2015; 49:e109-16. [PMID: 26385160 DOI: 10.1016/j.amepre.2015.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/02/2015] [Accepted: 07/02/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Fall-related injuries and health risks associated with reduced mobility or physical inactivity account for significant costs to the U.S. healthcare system. The widely disseminated lay-led A Matter of Balance (MOB) program aims to help older adults reduce their risk of falling and associated activity limitations. This study examined effects of MOB participation on health service utilization and costs for Medicare beneficiaries, as a part of a larger effort to understand the value of community-based prevention and wellness programs for Medicare. METHODS A controlled retrospective cohort study was conducted in 2012-2013, using 2007-2011 MOB program data and 2006-2013 Medicare data. It investigated program effects on falls and fall-related fractures, and health service utilization and costs (standardized to 2012 dollars), of 6,136 Medicare beneficiaries enrolled in MOB from 2007 through 2011. A difference-in-differences analysis was employed to compare outcomes of MOB participants with matched controls. RESULTS MOB participation was associated with total medical cost savings of $938 per person (95% CI=$379, $1,498) at 1 year. Savings per person amounted to $517 (95% CI=$265, $769) for unplanned hospitalizations; $81 for home health care (95% CI=$20, $141); and $234 (95% CI=$55, $413) for skilled nursing facility care. Changes in the incidence of falls or fall-related fractures were not detected, suggesting that cost savings accrue through other mechanisms. CONCLUSIONS This study suggests that MOB and similar prevention programs have the potential to reduce Medicare costs. Further research accounting for program delivery costs would help inform the development of Medicare-covered preventive benefits.
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Honaker JA, Kretschmer LW. Impact of fear of falling for patients and caregivers: perceptions before and after participation in vestibular and balance rehabilitation therapy. Am J Audiol 2015; 23:20-33. [PMID: 23824441 DOI: 10.1044/1059-0889(2013/12-0074)] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the impact of fear of falling (FoF) on older patients with dizziness history and their caregivers to better determine holistic needs when developing a patient-family centered approach to falling risk reduction. METHOD A mixed-method design was used, incorporating a phenomenological qualitative approach to explore the impact of FoF in 14 patients and a family member or spouse of each patient. Quantitative analysis was used to further interpret results of interviews conducted before and after participation in a vestibular and balance rehabilitation program designed to reduce falling risk and improve balance confidence. RESULTS Qualitative analysis of participant interviews pre and post vestibular rehabilitation revealed lifestyle changes for both participants and family caregivers due to FoF and the need for reducing falling concerns. Patient age showed statistically significant differences in levels of balance confidence, with younger participants (≤ 65 years) showing more concerns about the consequences of falling, even after rehabilitation, than older participants (> 65 years). CONCLUSION The study highlights the impact of FoF on participation and activity levels of patients and family caregivers, as well as the need to thoroughly evaluate falling fears to achieve a holistic rehabilitation outcome.
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Jeoung BJ. Correlation between physical fitness and fall efficacy in elderly women in Korea. J Exerc Rehabil 2015; 11:151-4. [PMID: 26171381 PMCID: PMC4492425 DOI: 10.12965/jer.150208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/08/2015] [Indexed: 11/22/2022] Open
Abstract
The fear of falling is a common psychological consequence of falling, especially for elderly individuals. Fear of falling can lead to activity restriction and medical problems. The primary purpose of this study was to examine the correlation between fall efficacy and physical fitness factors in elderly women. We assessed physical fitness factors and investigated the Korean version of the Fall Efficacy Scale-International (KFES-I) in 173 participants. We investigated the correlation between physical fitness factors and fall efficacy. When the subjects were divided into four groups according to physical fitness level, subjects with high 6-m walk, 30-s chair stand test, 30-s arm curl test, chair sit and reach test, 8-foot up and go test scores and high grip strength had low fall efficacy. Physical fitness factors were strongly associated with decreased fall fear, suggesting that physical fitness improvements play an important role in preventing or reducing the fear of falling.
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Affiliation(s)
- Bog Ja Jeoung
- Department of Exercise Rehabilitation & Welfare, College of Health Science, Gachon University, Incheon, Korea
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Abstract
SummaryFear of falling (FoF) is a common condition in older age. However, there is a paucity of research on its prevalence, impact and treatment in older people with dementia. People with dementia have an increased risk of falls which present a significant threat to their independence, as well as having a significant economic impact on health and social services. This review outlines the key issues in relation to FoF, current guidelines and assessment tools and their use for people with dementia. Further research needs to be completed in both addressing the specific assessment barriers that people with dementia may face regarding the use of current FoF tools, with further exploration surrounding the individual's experience of FoF and how this may be impacting upon their quality of life and functionality. Until a well-validated method has been developed, clinicians need to utilize available tools as guidelines, seek the assistance of proxies at all stages of the care journey, and use clinical judgement to assess FoF in patients with dementia.
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Higuchi Y, Sudo H, Tanaka N, Fuchioka S, Hayashi Y. Does fear of falling relate to low physical function in frail elderly persons?: associations of fear of falling, balance, and gait. JOURNAL OF THE JAPANESE PHYSICAL THERAPY ASSOCIATION 2015; 7:41-7. [PMID: 25792937 DOI: 10.1298/jjpta.7.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2003] [Accepted: 02/07/2004] [Indexed: 11/23/2022]
Abstract
Falls are a major public health problem for older people. Recent research suggests that fear of falling may be a more pervasive and serious problem than falls among the elderly. The present study was conducted to determine whether frail elderly persons with fear of falling have lower physical function. A total of 47 subjects (aged 73 to 95) were recruited from a geriatric health services facility in Osaka. Physical function including balance, mobility, and muscular strength were measured using the following tests: Timed up & go test (TUG), functional reach test, single limb stance with eyes open, ten-meter walk, and knee extensor strength. Twenty-nine subjects (62%) had fear of falling and 18 (38%) had no fear of falling. There was no significant difference in age, sex, or the proportion using assistive devices. Results from the statistical tests showed that there were no differences in physical function, except in the functional reach test. The ratio of TUG to 10 m walk was used to determine the association between balance and mobility. In frail elderly persons with fear of falling and in those without fear of falling, the means of the ratios were 1.20 (SD=0.27) and 1.03 (SD=0.16), respectively. The ratios for frail elderly persons with fear of falling were higher (p=0.024) than the frail elderly without fear of falling. Our study suggests that even if frail elderly individuals walk slowly, they are not afraid of falling if there is a feasible balance function. We conclude that, in low-functioning frail elderly, fear of falling is associated with a combination of balance function and gait speed.
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Affiliation(s)
- Yumi Higuchi
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture College of Nursing, Osaka 583-8555, Japan
| | - Hiroaki Sudo
- Department of Rehabilitation Medicine, Health Care Facility Mahoroba, Osaka 583-0857, Japan
| | - Noriko Tanaka
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture College of Nursing, Osaka 583-8555, Japan
| | - Satoshi Fuchioka
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture College of Nursing, Osaka 583-8555, Japan
| | - Yoshitaka Hayashi
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture College of Nursing, Osaka 583-8555, Japan
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Schmid AA, Acuff M, Doster K, Gwaltney-Duiser A, Whitaker A, Damush T, Williams L, Hendrie H. Poststroke Fear of Falling in the Hospital Setting. Top Stroke Rehabil 2015; 16:357-66. [DOI: 10.1310/tsr1605-357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Physical Function, Fear of Falling, Occupational Status and Falls in a Nigerian Older Adults Sample. AGEING INTERNATIONAL 2014. [DOI: 10.1007/s12126-014-9202-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Borges SDM, Radanovic M, Forlenza OV. Fear of falling and falls in older adults with mild cognitive impairment and Alzheimer's disease. AGING NEUROPSYCHOLOGY AND COGNITION 2014; 22:312-21. [PMID: 24992289 DOI: 10.1080/13825585.2014.933770] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Sheila de Melo Borges
- a Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
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Dewan N, MacDermid JC. Fall Efficacy Scale-International (FES-I). J Physiother 2014; 60:60. [PMID: 24856947 DOI: 10.1016/j.jphys.2013.12.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022] Open
Affiliation(s)
- Neha Dewan
- School of Rehabilitation Sciences, McMaster University, Hamilton
| | - Joy C MacDermid
- School of Rehabilitation Sciences, McMaster University, Hamilton; Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada
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van Landingham SW, Massof RW, Chan E, Friedman DS, Ramulu PY. Fear of falling in age-related macular degeneration. BMC Ophthalmol 2014; 14:10. [PMID: 24472499 PMCID: PMC3922687 DOI: 10.1186/1471-2415-14-10] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/14/2014] [Indexed: 12/01/2022] Open
Abstract
Background Prior studies have shown age-related macular degeneration (AMD) to be associated with falls. The purpose of this study is to determine if (AMD) and AMD-related vision loss are associated with fear of falling, an important and distinct outcome. Methods Sixty-five persons with AMD with evidence of vision loss in one or both eyes and 60 glaucoma suspects with normal vision completed the University of Illinois at Chicago Fear of Falling questionnaire. Responses were Rasch analyzed. Scores were expressed in logit units, with lower scores demonstrating lesser ability and greater fear of falling. Results Compared to glaucoma suspect controls, AMD subjects had worse visual acuity (VA) (median better-eye VA = 20/48 vs. 20/24, p < 0.001) and worse contrast sensitivity (CS) (binocular CS = 1.9 vs. 1.5 log units, p < 0.001). AMD subjects were also older, more likely to be Caucasian, and less likely to be employed (p < 0.05 for all), but were similar with regards to other demographic and health measures. In multivariable models controlling for age, gender, body habitus, strength, and comorbid illnesses, AMD subjects reported greater fear of falling as compared to controls (β = -0.77 logits, 95% CI = -1.5 to -0.002, p = 0.045). In separate multivariable models, fear of falling increased with worse VA (β = -0.15 logits/1 line decrement, 95% CI = -0.28 to -0.03, p = 0.02) and CS (β = -0.20 logits/0.1 log unit decrement, 95% CI = -0.31 to -0.09, p = 0.001). Greater fear of falling was also associated with higher BMI, weaker grip, and more comorbid illnesses (p < 0.05 for all). Conclusions AMD and AMD-related vision loss are associated with greater fear of falling in the elderly. Development, validation, and implementation of methods to address falls and fear of falling for individuals with vision loss from AMD are important goals for future work.
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Affiliation(s)
| | | | | | | | - Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins University, 600 North Wolfe St, Maumenee B-110, Baltimore, MD 21287, USA.
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Abstract
Patients are at a higher risk of falling in the hospital than at home because of their acute illness, medications, other treatments, or unfamiliarity with the hospital environment. Despite numerous efforts, inpatient falls remain a leading adverse event in hospitals and other inpatient settings, resulting in loss of function, death, and higher health costs. This article explores the factors in hospital settings that can reduce and prevent inpatient falls.
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Abstract
This opportune case study describes visual and stepping behaviours of an 87 year old female (P8), both prior to, and following two falls. Before falling, when asked to walk along a path containing two stepping guides positioned before and after an obstacle, P8 generally visually fixated the first stepping guide until after foot contact inside it. However, after falling P8 consistently looked away from the stepping guide before completing the step into it in order to fixate the upcoming obstacle in her path. The timing of gaze redirection away from the target (in relation to foot contact inside it) correlated with absolute stepping error. No differences in eyesight, cognitive function, or balance were found between pre- and post-fall recordings. However, P8 did report large increases in fall-related anxiety and reduced balance confidence, supporting previously suggested links between anxiety/increased fear or falling and maladaptive visual/stepping behaviours. The results represent a novel insight into how psychological and related behavioural factors can change in older adults following a fall, and provide a possible partial rationalisation for why recent fallers are more likely to fall again in the following 12 months. These findings highlight novel possibilities for falls prevention and rehabilitation.
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Zijlstra GAR, van Haastregt JCM, Kempen GIJM. ["A matter of balance--Netherlands": an effective intervention to reduce concerns about falls and related avoidance of activity in older people]. Tijdschr Gerontol Geriatr 2012; 43:164-74. [PMID: 23082409 DOI: 10.1007/s12439-012-0026-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Concerns about falls and related avoidance behavior are common among older people and may lead to decreased quality of life, decreased physical and psychosocial functioning, and premature admission to a nursing home. In a randomized controlled trial among 540 community-dwelling older people we studied the feasibility and effects of a cognitive behavioral program on concerns about falls, related avoidance of activity, and falls. Data of the process evaluation obtained from participants in the intervention group (n = 280) and the trainers (n = 6) showed that the program was considered as feasible by the trainers, and positively judged by participants and trainers. Furthermore, participants experienced benefits from attending the program (61% still reported benefits one year after the program). Prior to the start of the program 26% of the participants of the intervention dropped out, yet, among the participants who started the program completion was high (84%). The effect evaluation showed positive outcomes for concerns about falls, related avoidance of activity, and daily activity at 2 months (after the program) when comparing the intervention group with the control group (n = 260). Long-term effects were also shown for, amongst others, concerns about falls and recurrent falls. Following these positive results the cognitive behavioral group program is currently made available to geriatric care settings nationwide in the Netherlands.
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Affiliation(s)
- G A R Zijlstra
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht.
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Gogulla S, Lemke N, Hauer K. Effekte körperlicher Aktivität und körperlichen Trainings auf den psychischen Status bei älteren Menschen mit und ohne kognitive Schädigung. Z Gerontol Geriatr 2012; 45:279-89. [DOI: 10.1007/s00391-012-0347-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Collerton J, Kingston A, Bond J, Davies K, Eccles MP, Jagger C, Kirkwood TBL, Newton JL. The personal and health service impact of falls in 85 year olds: cross-sectional findings from the Newcastle 85+ cohort study. PLoS One 2012; 7:e33078. [PMID: 22427954 PMCID: PMC3302867 DOI: 10.1371/journal.pone.0033078] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 02/02/2012] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Falls are common in older people and increase in prevalence with advancing old age. There is limited knowledge about their impact in those aged 85 years and older, the fastest growing age group of the population. We investigated the prevalence and impact of falls, and the overlap between falls, dizziness and blackouts, in a population-based sample of 85 year olds. METHODS DESIGN Cross-sectional analysis of baseline data from Newcastle 85+ Cohort Study. SETTING Primary care, North-East England. PARTICIPANTS 816 men and women aged 85 years. MEASUREMENTS Structured interview with research nurse. Cost-consequence analysis of fall-related healthcare costs. RESULTS Over 38% (313/816) of participants had fallen at least once in the previous 12 months and of these: 10.6% (33/312) sustained a fracture, 30.1% (94/312) attended an emergency department, and 12.8% (40/312) were admitted to hospital. Only 37.2% (115/309) of fallers had specifically discussed their falls problem with their general practitioner and only 12.7% (39/308) had seen a falls specialist. The average annual healthcare cost per faller was estimated at £202 (inter-quartile range £174-£231) or US$329 ($284-$377). 'Worry about falling' was experienced by 42.0% (128/305) of fallers, 'loss of confidence' by 40.0% (122/305), and 'going out less often' by 25.9% (79/305); each was significantly more common in women, odds ratios (95% confidence interval) for women: men of 2.63 (1.45-4.55), 4.00 (2.27-7.14), and 2.86 (1.54-5.56) respectively. Dizziness and blackouts were reported by 40.0% (318/796) and 6.4% (52/808) of participants respectively. There was marked overlap in the report of falls, dizziness and blackouts. CONCLUSIONS Falls in 85 year olds are very common, associated with considerable psychological and physical morbidity, and have high impact on healthcare services. Wider use of fall prevention services is needed. Significant expansion in acute and preventative services is required in view of the rapid growth in this age group.
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Affiliation(s)
- Joanna Collerton
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, United Kingdom.
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Uemura K, Shimada H, Makizako H, Yoshida D, Doi T, Tsutsumimoto K, Suzuki T. A Lower Prevalence of Self-Reported Fear of Falling Is Associated with Memory Decline among Older Adults. Gerontology 2012; 58:413-8. [DOI: 10.1159/000336988] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 01/31/2012] [Indexed: 11/19/2022] Open
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Tsai SF, Yin JH, Tung TH, Shimada T. Falls efficacy among stroke survivors living in the community. Disabil Rehabil 2011; 33:1785-90. [DOI: 10.3109/09638288.2010.546938] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dorresteijn TAC, Zijlstra GAR, Delbaere K, van Rossum E, Vlaeyen JWS, Kempen GIJM. Evaluating an in-home multicomponent cognitive behavioural programme to manage concerns about falls and associated activity avoidance in frail community-dwelling older people: Design of a randomised control trial [NCT01358032]. BMC Health Serv Res 2011; 11:228. [PMID: 21933436 PMCID: PMC3189875 DOI: 10.1186/1472-6963-11-228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 09/20/2011] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Concerns about falls are frequently reported by older people. These concerns can have serious consequences such as an increased risk of falls and the subsequent avoidance of activities. Previous studies have shown the effectiveness of a multicomponent group programme to reduce concerns about falls. However, owing to health problems older people may not be able to attend a group programme. Therefore, we adapted the group approach to an individual in-home programme. METHODS/DESIGN A two-group randomised controlled trial has been developed to evaluate the in-home multicomponent cognitive behavioural programme to manage concerns about falls and associated activity avoidance in frail older people living in the community. Persons were eligible for study if they were 70 years of age or over, perceived their general health as fair or poor, had at least some concerns about falls and associated avoidance of activity. After screening for eligibility in a random sample of older people, eligible persons received a baseline assessment and were subsequently allocated to the intervention or control group. Persons assigned to the intervention group were invited to participate in the programme, while those assigned to the control group received care as usual. The programme consists of seven sessions, comprising three home visits and four telephone contacts. The sessions are aimed at instilling adaptive and realistic views about falls, as well as increasing activity and safe behaviour. An effect evaluation, a process evaluation and an economic evaluation are conducted. Follow-up measurements for the effect evaluation are carried out 5 and 12 months after the baseline measurement. The primary outcomes of the effect evaluation are concerns about falls and avoidance of activity as a result of these concerns. Other outcomes are disability and falls. The process evaluation measures: the population characteristics reached; protocol adherence by facilitators; protocol adherence by participants (engagement in exposure and homework); opinions about the programme of participants and facilitators; perceived benefits and achievements; and experienced barriers. The economic evaluation examines the impact on health-care utilisation, as well as related costs. DISCUSSION A total number of 389 participants is included in the study. Final results are expected in 2012. TRIAL REGISTRATION NCT01358032.
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Affiliation(s)
- Tanja AC Dorresteijn
- CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - GA Rixt Zijlstra
- CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Kim Delbaere
- Falls and Balance Research Group, Neuroscience Research Australia and University of New South Wales, Randwick, Sydney, Australia
| | - Erik van Rossum
- CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Centre of Research on Autonomy and Participation and Centre of Research on Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Johan WS Vlaeyen
- Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
- Department of Psychology, University of Leuven, Leuven, Belgium
| | - Gertrudis IJM Kempen
- CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
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Development of a scale to assess avoidance behavior due to a fear of falling: the Fear of Falling Avoidance Behavior Questionnaire. Phys Ther 2011; 91:1253-65. [PMID: 21700763 DOI: 10.2522/ptj.20100304] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND A history of falls or imbalance may lead to a fear of falling, which may lead to self-imposed avoidance of activity; this avoidance may stimulate a vicious cycle of deconditioning and subsequent falls. OBJECTIVE The purpose of this study was to develop a questionnaire that would quantify avoidance behavior due to a fear of falling. DESIGN This study consisted of 2 parts: questionnaire development and psychometric testing. Questionnaire development involved an expert panel and 39 residents of an assisted living facility. Sixty-three community-dwelling individuals with various health conditions participated in psychometric testing. METHOD Questionnaire development included the evaluation of face and content validity and factor analysis of the initial questionnaire. The final result of questionnaire development was the Fear of Falling Avoidance Behavior Questionnaire (FFABQ). In order to determine its psychometric properties, reliability and construct validity were assessed through administration of the FFABQ to participants twice, 1 week apart, and comparison of the FFABQ with other questionnaires related to fear of falling, functional measures of balance and mobility, and daily activity levels using an activity monitor. RESULTS The FFABQ had good overall test-retest reliability (intraclass correlation coefficient=.812) and was found to differentiate between participants who were considered "fallers" (ie, at least one fall in the previous year) and those who were considered "nonfallers." The FFABQ predicted time spent sitting or lying and endurance. LIMITATIONS A relatively small number of people with a fear of falling were willing to participate. CONCLUSION Results from this study offer evidence for the reliability and validity of the FFABQ and support the notion that the FFABQ measures avoidance behavior rather than balance confidence, self-efficacy, or fear.
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Yamada M, Tanaka B, Nagai K, Aoyama T, Ichihashi N. Rhythmic stepping exercise under cognitive conditions improves fall risk factors in community-dwelling older adults: Preliminary results of a cluster-randomized controlled trial. Aging Ment Health 2011; 15:647-53. [PMID: 21815857 DOI: 10.1080/13607863.2010.551341] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this pilot trial was to evaluate whether a 24-week program of rhythmic stepping exercise (RSE) would be effective in improving physical function and reducing fear of falling in older adults. PARTICIPANTS Four units (n = 52) randomized into an RSE group (two units, n = 25) and a non-rhythmic stepping exercise (NRSE) group (two units, n = 27) participated in a pilot cluster randomized controlled trial. METHODS Each exercise group received 60 min group training sessions once a week for 24 weeks. Measurement was based on the difference in physical functions between the RSE and NRSE groups. RESULTS Significant differences were observed between the two groups for locomotive function with significant group × time interaction. Relative risk was calculated as 2.778 (95% CI: 1.030-7.492) for fear of falling for participants in the NRSE group compared with patients in the RSE group (p = 0.037). CONCLUSIONS The results of this pilot trial suggest that the RSE program is more effective in improving locomotive function and fear of falling.
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Affiliation(s)
- Minoru Yamada
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
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Kochtitzky CS, Freeland AL, Yen IH. Ensuring mobility-supporting environments for an aging population: critical actors and collaborations. J Aging Res 2011; 2011:138931. [PMID: 21766029 PMCID: PMC3134094 DOI: 10.4061/2011/138931] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 04/21/2011] [Indexed: 12/04/2022] Open
Abstract
Successful aging takes on an array of attributes, including optimal health and community participation.
Research indicates that (1) persons with disabilities, including age-related disabilities, report frequent barriers to community participation,
including unsuitable building design (43%), transportation (32%), and sidewalks/curbs (31%), and (2) many seniors report an inability
to cross roads safely near their homes. This paper attempts to define mobility-related elements that contribute to optimal health and quality of life,
within the context of successful aging. It then examines the impacts of community design on individual mobility, delving into which traditional
and nontraditional actors—including architects, urban planners, transportation engineers, occupational therapists, and housing
authorities—play critical roles in ensuring that community environments serve as facilitators (rather than barriers) to mobility. As America ages,
mobility challenges for seniors will only increase unless both traditional aging specialists and many nontraditional actors make a concerted effort to
address the challenges.
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Affiliation(s)
- Chris S Kochtitzky
- Division of Emergency and Environmental Health Services, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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Klack L, Möllering C, Ziefle M, Schmitz-Rode T. Future Care Floor: A Sensitive Floor for Movement Monitoring and Fall Detection in Home Environments. LECTURE NOTES OF THE INSTITUTE FOR COMPUTER SCIENCES, SOCIAL INFORMATICS AND TELECOMMUNICATIONS ENGINEERING 2011. [DOI: 10.1007/978-3-642-20865-2_27] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Zijlstra GAR, van Haastregt JCM, van Eijk JTM, de Witte LP, Ambergen T, Kempen GIJM. Mediating effects of psychosocial factors on concerns about falling and daily activity in a multicomponent cognitive behavioral group intervention. Aging Ment Health 2011; 15:68-77. [PMID: 20924813 DOI: 10.1080/13607863.2010.501054] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Concerns about falling, or fear of falling, is highly common in old age and has adverse consequences. The development and understanding of interventions to reduce concerns about falling are therefore relevant. This study explored the mediating effects of psychosocial factors on trajectories of concerns about falling and daily activity in a multicomponent cognitive behavioral group intervention. METHOD The study sample comprised 540 community-dwelling adults aged 70 years or older, with concerns about falling and associated activity avoidance, who participated in a randomized controlled trial evaluating this intervention. Control beliefs, self-efficacy beliefs, outcome expectations, and social interactions, as potential mediators, and concerns about falling and daily activity, as outcome variables, were assessed at baseline, and at two, eight, and 14 months. Data were analyzed with mixed-effects regression models. RESULTS Small to moderate statistically significant effects of the intervention on the potential mediators were found at nearly all follow-up assessments. Separate psychosocial factors showed modest mediating effects on the outcomes. When all mediators were taken into account simultaneously, 44-76% of the association between the intervention and the outcomes was explained. CONCLUSION This study showed that the multicomponent cognitive behavioral intervention improved control beliefs, self-efficacy, outcome expectations, and social interactions. These variables mediated the association between the intervention and concerns about falling or daily activity in community-dwelling older adults. This knowledge may facilitate further improvement and development of interventions to reduce concerns about falling and to increase daily activity.
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Affiliation(s)
- G A Rixt Zijlstra
- Department of Health Care and Nursing Science, Maastricht University, The Netherlands.
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Miedo a las caídas en las personas mayores no institucionalizadas. GACETA SANITARIA 2010; 24:453-9. [DOI: 10.1016/j.gaceta.2010.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 07/30/2010] [Accepted: 09/08/2010] [Indexed: 11/20/2022]
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