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Steckhan GM, Warner LM, Fleig L. Falls prevention is more than just promoting physical health: evaluation of the group-based, out-patient prevention program 'Staying safe and active in old age - falls prevention'. Health Psychol Behav Med 2024; 12:2358915. [PMID: 38831976 PMCID: PMC11146244 DOI: 10.1080/21642850.2024.2358915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction The aim of this study was to evaluate the German falls prevention program 'Staying safe and active in old age - falls prevention', which is already established in practice. Methods The single-arm intervention study consisted of two time points, 6 months apart, to evaluate the multifactorial falls prevention program (n = 125 at Time 2). We observed the groups and their trainers and assessed which behavior change techniques (BCTs) were used. According to our evaluation framework, changes in the following three domains were assessed: (a) fall-related variables (i.e. number of falls, fear of falling), (b) physical functioning (i.e. performance-based gait speed, coordination, self-reported leg strength, balance, as well as habitual execution of the exercises), and (c) psychosocial functioning (i.e. quality of life, activities of daily living, mobility, and loneliness). Linear mixed models were used to determine changes in each variable. Results Demonstration of behavior was the most frequently used BCT. The program showed significant benefits for fear of falling, balance, coordination, habitual execution, and loneliness over time (Cohen's d between -0.59 and 1.73). Number of falls, gait speed, coordination (dual task), activities of daily living, and quality of life were maintained (Cohen's d between -0.26 and 0.30), whereas leg strength and mobility decreased significantly at Time 2 (Cohen's d = -0.55 and -0.36). Discussion Group-based falls prevention programs may facilitate social integration among older adults and may also enhance and maintain physical functioning in old age.Trial registration: German Clinical Trials Register identifier: DRKS00012321.
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Affiliation(s)
| | | | - Lena Fleig
- MSB Medical School Berlin, Berlin, Germany
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Baltes M, Stephan A, Andrich S, Meyer G. Development of Fear of Falling after proximal femoral fracture. Pflege 2024. [PMID: 38809228 DOI: 10.1024/1012-5302/a000999] [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: 05/30/2024]
Abstract
Background: Proximal femoral fracture is common in older people. Beyond a long recovery process and significant permanent functional limitations, older people often experience subsequent Fear of Falling. The phenomenon of Fear of Falling is not fully understood; qualitative research is underrepresented but can provide insights into the experience of those affected. Objectives: We aimed to explore the experiences of Fear of Falling development and to what extent it affects peoples' life after proximal femoral fracture. Methods: We conducted semi-structured, in-depth interviews with nine older people, aged between 61 and 88, who participated in a prospective observational study. Interview data were analysed through inductive content analysis. Results: Six major themes emerged: The development of Fear of Falling; the effect of FoF and hope for recovery; alternating between moments of fear and security; fear of helplessness and of losing independence; strategies for dealing with Fear of Falling and maintaining independence; need of support by health care professionals. Conclusion: To identify and support older people in coping with Fear of Falling (after proximal femoral fracture), strategies for dealing with Fear of Falling across occupational groups and all healthcare settings should be implemented. Nurses have a key role in this process.
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Affiliation(s)
- Marion Baltes
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Uniklinik RWTH Aachen, Germany
| | - Astrid Stephan
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Uniklinik RWTH Aachen, Germany
| | - Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | - Gabriele Meyer
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Tian X, Mai YH, Guo ZJ, Chen JW, Zhou LJ. Contributing factors and interventions for fear of falling in stroke survivors: a systematic review. Top Stroke Rehabil 2024:1-16. [PMID: 38566465 DOI: 10.1080/10749357.2024.2333172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The purpose of this study was to provide a comprehensive overview of the prevalence, measurement tools, influencing factors, and interventions for fear of falling (FOF) in stroke survivors. METHODS A PRISMA-guided systematic literature review was conducted. PubMed, EMBASE, Cochrane, and Web of Science were systematically searched. The search time was up to February 2023. All observational and experimental studies investigating FOF in stroke patients were included. The assessment tool of the Joanna Briggs Institute was used to assess the quality of the included studies and the risk of bias assessment. (PROSPERO: CRD42023412522). RESULT A total of 25 observational studies and 10 experimental studies were included. The overall quality of the included studies was "low" to "good." The most common tool used to measure the FOF was the Falls Efficacy Scale-International (FES-I). The prevalence of FOF was 42%- 93.8%. Stroke survivors with physical impairments have the highest prevalence of FOF. The main risk factors for the development of FOF in stroke survivors were female gender, use of assistive devices, balance, limb dysfunction, and functional mobility. The combination of cognitive behavioral and exercise interventions is the most effective strategy. CONCLUSIONS This review suggests that the prevalence of FOF in stroke survivors is high and that understanding the factors associated with FOF in stroke patients can help develop multifactorial prevention strategies to reduce FOF and improve quality of life. In addition, a uniform FOF measurement tool should be used to better assess the effectiveness of interventions for stroke survivors. ETHICS APPROVAL PROSPERO registration (CRD42023412522).
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Affiliation(s)
- Xue Tian
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Ying-Hong Mai
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Zai-Jin Guo
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Jia-Wen Chen
- School of Nursing, School of Public Health, Yangzhou University, Yangzhou, China
| | - Luo-Jing Zhou
- Science and Technology Division, North Jiangsu People's Hospital of Jiangsu province, Yangzhou, China
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Savvakis I, Adamakidou T, Kleisiaris C. Physical-activity interventions to reduce fear of falling in frail and pre-frail older adults: a systematic review of randomized controlled trials. Eur Geriatr Med 2024; 15:333-344. [PMID: 38411771 PMCID: PMC10997712 DOI: 10.1007/s41999-024-00944-9] [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: 08/18/2023] [Accepted: 01/15/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Frailty in older adults leads to progressive deterioration of their physical condition and makes them prone to develop Fear of Falling (FoF). Physical-activity interventions appear to be effective in managing the components of frailty but there is no clear evidence to determine whether physical-activity may affect FoF in frail and pre-frail older adults. OBJECTIVE Τhis systematic literature review aims to synthesize evidence on the relationship between the physical interventions to ameliorate balance, strength, and mobility and FoF reduction in frail and pre-frail older adults. METHODS Studies assessing physical-activity interventions for frail and pre-frail older adults aged 60 years and older were identified in English through searches in PubMed, ScienceDirect, and Cochrane Central Register of Controlled Trials databases till February 2023. Study quality was assessed, and a qualitative synthesis of results was performed. RESULTS A total of 13 studies published were included. All of them were Randomized Control Trials and the most frequent assessment tool used to assess FoF (10 of 13 studies) was the Fall Efficacy Scale-International (FES-I). Six studies were assessed as having a low risk of bias. Cumulatively, the findings of this review indicate that physical-activity interventions are effective in reducing the FoF of frail and pre-frail older adults. CONCLUSION The results are encouraging and recapitulate the positive role of physical interventions in FoF reduction. However, future research would benefit from longer follow-up periods, longer intervention duration, and participation of interdisciplinary teams.
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Affiliation(s)
- Ioannis Savvakis
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, Heraklion, Greece.
| | - Theodoula Adamakidou
- Department of Nursing, Faculty of Health Sciences, University of West Attica, Athens, Greece
| | - Christos Kleisiaris
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, Heraklion, Greece
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Lenouvel E, Ullrich P, Siemens W, Dallmeier D, Denkinger M, Kienle G, Zijlstra GAR, Hauer K, Klöppel S. Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community. Cochrane Database Syst Rev 2023; 11:CD014666. [PMID: 37965937 PMCID: PMC10646947 DOI: 10.1002/14651858.cd014666.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Fear of falling (FoF) is a lasting concern about falling that leads to an individual avoiding activities that he/she remains capable of performing. It is a common condition amongst older adults and may occur independently of previous falls. Cognitive behavioural therapy (CBT), a talking therapy that helps change dysfunctional thoughts and behaviour, with and without exercise, may reduce FoF, for example, by reducing catastrophic thoughts related to falls, and modifying dysfunctional behaviour. OBJECTIVES To assess the benefits and harms of CBT for reducing FoF in older people living in the community, and to assess the effects of interventions where CBT is used in combination with exercise. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1, 2023), MEDLINE Ovid (from 1946 to 11 January 2023), Embase Ovid (from 1980 to 11 January 2023), CINAHL Plus (Cumulative Index to Nursing and Allied Health Literature) (from 1982 to 11 January 2023), PsycINFO (from 1967 to 11 January 2023), and AMED (Allied and Complementary Medicine from 1985 to 11 January 2023). We handsearched reference lists and consulted experts for identifying additional studies. SELECTION CRITERIA This review included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs assessing CBT with and without exercise interventions compared to control groups with sham-treatment, or treatment as usual. We defined CBT as a collaborative, time-limited, goal-oriented, and structured form of speaking therapy. Included studies recruited community-dwelling older adults, with a mean population age of at least 60 years minus one standard deviation, and not defined by a specific medical condition. DATA COLLECTION AND ANALYSIS Two review authors used standard methodological procedures expected by Cochrane. For continuous data, as assessed by single- or multiple-item questionnaires, we report the mean difference (MD) with 95% confidence interval (CI) when studies used the same outcome measures, and standardised mean difference (SMD) when studies used different measures for the same clinical outcome. For dichotomous outcomes, we reported the treatment effects as risk ratios (RR) with 95% CIs. We measured the primary outcome, FoF, immediately, up to, and more than six months after the intervention. We analysed secondary outcomes of activity avoidance, occurrence of falls, depression, and quality of life when measured immediately after the intervention. We assessed risk of bias for each included study, using the GRADE approach to assess the certainty of evidence. MAIN RESULTS We selected 12 studies for this review, with 11 studies included for quantitative synthesis. One study could not be included due to missing information. Of the 11 individual studies, two studies provided two comparisons, which resulted in 13 comparisons. Eight studies were RCTs, and four studies were cluster-RCTs. Two studies had multiple arms (CBT only and CBT with exercise) that fulfilled the inclusion criteria. The primary aim of 10 studies was to reduce FoF. The 11 included studies for quantitative synthesis involved 2357 participants, with mean ages between 73 and 83 years. Study total sample sizes varied from 42 to 540 participants. Of the 13 comparisons, three investigated CBT-only interventions while 10 investigated CBT with exercise. Intervention duration varied between six and 156 hours, at a frequency between three times a week and monthly over an eight- to 48-week period. Most interventions were delivered in groups of between five and 10 participants, and, in one study, up to 25 participants. Included studies had considerable heterogeneity, used different questionnaires, and had high risks of bias. CBT interventions with and without exercise probably improve FoF immediately after the intervention (SMD -0.23, 95% CI -0.36 to -0.11; 11 studies, 2357 participants; moderate-certainty evidence). The sensitivity analyses did not change the intervention effect significantly. Effects of CBT with or without exercise on FoF may be sustained up to six months after the intervention (SMD -0.24, 95% CI -0.41 to -0.07; 8 studies, 1784 participants; very low-certainty evidence). CBT with or without exercise interventions for FoF probably sustains improvements beyond six months (SMD -0.28, 95% CI -0.40 to -0.15; 5 studies, 1185 participants; moderate-certainty of evidence). CBT interventions for reducing FoF may reduce activity avoidance (MD -2.57, 95% CI -4.67 to -0.47; 1 study, 312 participants; low-certainty evidence), and level of depression (SMD -0.41, 95% CI -0.60 to -0.21; 2 studies, 404 participants; low-certainty evidence). We are uncertain whether CBT interventions reduce the occurrence of falls (RR 0.96, 95% CI 0.66 to 1.39; 5 studies, 1119 participants; very low-certainty evidence). All studies had a serious risk of bias, due to performance bias, and at least an unclear risk of detection bias, as participants and assessors could not be blinded due to the nature of the intervention. Downgrading of certainty of evidence also occurred due to heterogeneity between studies, and imprecision, owing to limited sample size of some studies. There was no reporting bias suspected for any article. No studies reported adverse effects due to their interventions. AUTHORS' CONCLUSIONS CBT with and without exercise interventions probably reduces FoF in older people living in the community immediately after the intervention (moderate-certainty evidence). The improvements may be sustained during the period up to six months after intervention (low-certainty evidence), and probably are sustained beyond six months (moderate-certainty evidence). Further studies are needed to improve the certainty of evidence for sustainability of FoF effects up to six months. Of the secondary outcomes, we are uncertain whether CBT interventions for FoF reduce the occurrence of falls (very low-certainty evidence). However, CBT interventions for reducing FoF may reduce the level of activity avoidance, and may reduce depression (low-certainty evidence). No studies reported adverse effects. Future studies could investigate different populations (e.g. nursing home residents or people with comorbidities), intervention characteristics (e.g. duration), or comparisons (e.g. CBT versus exercise), investigate adverse effects of the interventions, and add outcomes (e.g. gait analysis). Future systematic reviews could search specifically for secondary outcomes.
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Affiliation(s)
- Eric Lenouvel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern (UPD), Bern, Switzerland
- Graduate School for Health Science, University of Bern, Bern, Switzerland
| | - Phoebe Ullrich
- Geriatrisches Zentrum am Universitätsklinikum Heidelberg, AGAPLESION Bethanien Krankenhaus, Heidelberg, Germany
- Department of Thoracic Oncology, Thoraxklinik Heidelberg, Heidelberg University Hospital, Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Röntgenstraße 1, D-69126, Heidelberg, Germany
| | - Waldemar Siemens
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Dhayana Dallmeier
- AGAPLESION Bethesda Clinic Ulm, Research Unit on Ageing, Ulm, Germany
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Michael Denkinger
- Institute for Geriatric Research, University of Ulm Medical Center, Ulm, Germany
- AGAPLESION Bethesda Clinic Ulm, Geriatric Centre Ulm/Alb-Donau, Ulm, Germany
| | - Gunver Kienle
- Department of Medicine II, Medical Center, University of Freiburg, Freiburg, Germany, Freiburg, Germany
| | - G A Rixt Zijlstra
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, Netherlands
- Public Health Service Flevoland (GGD Flevoland), Department of Health Policy & Research, Lelystad, Netherlands, Netherlands
- Health Care and Social Work Division, Windesheim University of Applied Sciences, Almere The Netherlands, Netherlands
| | - Klaus Hauer
- Geriatrisches Zentrum am Universitätsklinikum Heidelberg, AGAPLESION Bethanien Krankenhaus, Heidelberg, Germany
- Robert Bosch Gesellschaft für Medizinische Forschung mbH, Stuttgart, Germany
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern (UPD), Bern, Switzerland
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Lai WX, Chan AWM, Matchar DB, Ansah JP, Lien CTC, Ismail NH, Wong CH, Xu T, Ho VWT, Tan PJ, Lee JML, Sim RSC, Manap N. Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach. BMC Geriatr 2023; 23:586. [PMID: 37740182 PMCID: PMC10517526 DOI: 10.1186/s12877-023-04294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/08/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Falls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors can enable clinicians, researchers, and policymakers to clarify goals in falls intervention in older adults. METHODS A Group Model Building (GMB) exercise was conducted with researchers and clinicians from academic units and public healthcare institutes in Singapore. The aim of the exercise was to produce a shared visual representation of the causal structure for falls and engage in discussions on how current and future falls intervention programmes can address falls in the older adults, especially in the Asian context. It was conducted in four steps: 1) Outlining and prioritising desirable patient outcomes, 2) Conceptual model building, 3) Identifying key intervention elements of effective falls intervention programmes, 4) Mapping of interventions to outcomes. This causal loop diagram (CLD) was then used to generate insights into the current understanding of falls causal relationships, current efforts in falls intervention in Singapore, and used to identify gaps in falls research that could be further advanced in future intervention studies. RESULTS Four patient outcomes were identified by the group as key in falls intervention: 1) Falls, 2) Injurious falls, 3) Fear of falling, and 4) Restricted mobility and life space. A CLD of the reciprocal relationships between risk factors and these outcomes are represented in four sub-models: 1) Fear of falling, 2) Injuries associated with falls, 3) Caregiver overprotectiveness, 4) Post-traumatic stress disorder and psychological resilience. Through this GMB exercise, the group gained the following insights: (1) Psychological sequelae of falls is an important falls intervention outcome. (2) The effects of family overprotectiveness, psychological resilience, and PTSD in exacerbating the consequences of falls are not well understood. (3) There is a need to develop multi-component falls interventions to address the multitude of falls and falls related sequelae. CONCLUSION This work illustrates the potential of GMB to promote shared understanding of complex healthcare problems and to provide a roadmap for the development of more effective preventive actions.
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Affiliation(s)
- Wei Xuan Lai
- Duke-NUS Medical School, Programme in Health Services and Systems Research, 8 College Road, Singapore, 169857, Singapore.
| | | | - David Bruce Matchar
- Duke-NUS Medical School, Programme in Health Services and Systems Research, 8 College Road, Singapore, 169857, Singapore
- Department of Medicine, Duke University, Durham, NC, USA
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Tower, Singapore, Singapore
| | - John Pastor Ansah
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
| | | | - Noor Hafizah Ismail
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore, Singapore
- Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Tianma Xu
- Health & Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Vanda Wen Teng Ho
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Pey June Tan
- Ageing and Age-Associated Disorders Research Group, Health and Translational Medicine Cluster, University of Malaya, Kuala Lumpur, Malaysia
| | - June May Ling Lee
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Rita Siew Choo Sim
- Duke-NUS Medical School, Programme in Health Services and Systems Research, 8 College Road, Singapore, 169857, Singapore
| | - Normala Manap
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
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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: 9] [Impact Index Per Article: 9.0] [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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Scheffers-Barnhoorn MN, Haaksma ML, Achterberg WP, Niggebrugge AH, van der Sijp MP, van Haastregt JC, van Eijk M. Course of fear of falling after hip fracture: findings from a 12-month inception cohort. BMJ Open 2023; 13:e068625. [PMID: 36918243 PMCID: PMC10016251 DOI: 10.1136/bmjopen-2022-068625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVES To examine the course of fear of falling (FoF) up to 1 year after hip fracture, including the effect of prefracture FoF on the course. DESIGN Observational cohort study with assessment of FoF at 6, 12 and 52 weeks after hip fracture. SETTING Haaglanden Medical Centre, the Netherlands. PARTICIPANTS 444 community-dwelling adults aged 70 years and older, admitted to hospital with a hip fracture. MAIN OUTCOME MEASURE Short Falls Efficacy Scale International (FES-I), with a cut-off score ≥11 to define elevated FoF levels. RESULTS Six weeks after hip fracture the study population-based mean FES-I was located around the cut-off value of 11, and levels decreased only marginally over time. One year after fracture almost one-third of the population had FoF (FES-I ≥11). Although the group with prefracture FoF (42.6%) had slightly elevated FES-I levels during the entire follow-up, the effect was not statistically significant. Patients with persistent FoF at 6 and 12 weeks after fracture (26.8%) had the highest FES-I levels, with a mean well above the cut-off value during the entire follow-up. For the majority of patients in this group, FoF is still present 1 year after fracture (84.9%). CONCLUSIONS In this study population, representing patients in relative good health condition that are able to attend the outpatient follow-up at 6 and 12 weeks, FoF as defined by an FES-I score ≥11 was common within the first year after hip fracture. Patients with persistent FoF at 12 weeks have the highest FES-I levels in the first year after fracture, and for most of these patients the FoF remains. For timely identification of patients who may benefit from intervention, we recommend structural assessment of FoF in the first 12 weeks after fracture.
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Affiliation(s)
| | - Miriam L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- University Network for the Care Sector South Holland, Leiden University Medical Center, Leiden, Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- University Network for the Care Sector South Holland, Leiden University Medical Center, Leiden, Netherlands
| | | | - Max Pl van der Sijp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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9
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Accounting for Diversity in Robot Design, Testbeds, and Safety Standardization. Int J Soc Robot 2023. [DOI: 10.1007/s12369-023-00974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
AbstractScience has started highlighting the importance of integrating diversity considerations in medicine and healthcare. However, there is little research into how these considerations apply, affect, and should be integrated into concrete healthcare innovations such as rehabilitation robotics. Robot policy ecosystems are also oblivious to the vast landscape of gender identity understanding, often ignoring these considerations and failing to guide developers in integrating them to ensure they meet user needs. While this ignorance may be for the traditional heteronormative configuration of the medical, technical, and legal world, the ending result is the failure of roboticists to consider them in robot development. However, missing diversity, equity, and inclusion considerations can result in robotic systems that can compromise user safety, be discriminatory, and not respect their fundamental rights. This paper explores the impact of overlooking gender and sex considerations in robot design on users. We focus on the safety standard for personal care robots ISO 13482:2014 and zoom in on lower-limb exoskeletons. Our findings signal that ISO 13482:2014 has significant gaps concerning intersectional aspects like sex, gender, age, or health conditions and, because of that, developers are creating robot systems that, despite adherence to the standard, can still cause harm to users. In short, our observations show that robotic exoskeletons operate intimately with users’ bodies, thus exemplifying how gender and medical conditions might introduce dissimilarities in human–robot interaction that, as long as they remain ignored in regulations, may compromise user safety. We conclude the article by putting forward particular recommendations to update ISO 13482:2014 to reflect better the broad diversity of users of personal care robots.
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Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, Aguilar-Navarro S, Alexander NB, Becker C, Blain H, Bourke R, Cameron ID, Camicioli R, Clemson L, Close J, Delbaere K, Duan L, Duque G, Dyer SM, Freiberger E, Ganz DA, Gómez F, Hausdorff JM, Hogan DB, Hunter SMW, Jauregui JR, Kamkar N, Kenny RA, Lamb SE, Latham NK, Lipsitz LA, Liu-Ambrose T, Logan P, Lord SR, Mallet L, Marsh D, Milisen K, Moctezuma-Gallegos R, Morris ME, Nieuwboer A, Perracini MR, Pieruccini-Faria F, Pighills A, Said C, Sejdic E, Sherrington C, Skelton DA, Dsouza S, Speechley M, Stark S, Todd C, Troen BR, van der Cammen T, Verghese J, Vlaeyen E, Watt JA, Masud T. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 2022; 51:afac205. [PMID: 36178003 PMCID: PMC9523684 DOI: 10.1093/ageing/afac205] [Citation(s) in RCA: 253] [Impact Index Per Article: 126.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/26/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. OBJECTIVES to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. METHODS a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. RECOMMENDATIONS all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. CONCLUSIONS the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.
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Affiliation(s)
- Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Nathalie van der Velde
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Finbarr C Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Maw Pin Tan
- Centre for Innovation in Medical Engineering (CIME), Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sara Aguilar-Navarro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Neil B Alexander
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan; Veterans Administration Ann Arbor Healthcare System Geriatrics Research Education Clinical Center, Ann Arbor, MI, USA
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Hubert Blain
- Department of Geriatrics, Montpellier University hospital and MUSE, Montpellier, France
| | - Robbie Bourke
- Department of Medical Gerontology Trinity College Dublin and Mercers Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney. Department of Medicine (Neurology) and Neuroscience and Mental Health, Sydney, NSW, Australia
| | - Richard Camicioli
- Department of Medicine (Neurology), Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Lindy Clemson
- Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
- Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia; School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Leilei Duan
- National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Gustavo Duque
- Research Institute of the McGill University HealthCentre, Montreal, Quebec, Canada
| | - Suzanne M Dyer
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Ellen Freiberger
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute for Biomedicine of Aging, Nürnberg, Germany
| | - David A Ganz
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Fernando Gómez
- Research Group on Geriatrics and Gerontology, International Association of Gerontology and Geriatrics Collaborative Center, University Caldas, Manizales, Colombia
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Orthopaedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David B Hogan
- Brenda Strafford Centre on Aging, O’BrienInstitute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan M W Hunter
- School of Physical Therapy, Faculty of Health Sciences, Elborn College, University of Western Ontario, London, ON, Canada
| | - Jose R Jauregui
- Ageing Biology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nellie Kamkar
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Rose-Anne Kenny
- Department of Medical Gerontology Trinity College Dublin and Mercers Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Sarah E Lamb
- Faculty of Health and Life Sciences, Mireille Gillings Professor of Health Innovation, Medical School Building, Exeter, England, UK
| | | | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, England, UK
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Louise Mallet
- Department of Pharmacy, Faculty of Pharmacy, McGill University Health Center, Université de Montréal, Montreal, QC, Canada
| | - David Marsh
- University College London, London, England, UK
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Rogelio Moctezuma-Gallegos
- Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Mexico City, Mexico
- Geriatric Medicine Program, Tecnologico de Monterrey, School of Medicine and Health Sciences. Monterrey, Nuevo León, Mexico
| | - Meg E Morris
- Healthscope and Academic and Research Collaborative in Health (ARCH), La Trobe University, Australia
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium
| | - Monica R Perracini
- Master’s and Doctoral programs in Physical Therapy, Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, Brazil
| | - Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Alison Pighills
- Mackay Institute of Research and Innovation, Mackay Hospital and Health Service, Mackay, QLD, Australia
| | - Catherine Said
- Western Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
- Melbourne School of Health Sciences The University of Melbourne, Parkville, Australia
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Dawn A Skelton
- School of Health and Life Sciences, Research Centre for Health (ReaCH), Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland, UK
| | - Sabestina Dsouza
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Susan Stark
- Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Bruce R Troen
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University of Buffalo; Research Service, Veterans Affairs Western New York Healthcare System, Buffalo, New York, USA
| | - Tischa van der Cammen
- Department of Human-Centred Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joe Verghese
- Division of Geriatrics, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jennifer A Watt
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tahir Masud
- Department of Geriatric Medicine, The British Geriatrics Society, Nottingham University Hospitals NHS Trust, Nottingham, England, UK
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11
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Freiberger E, Fabbietti P, Corsonello A, Lattanzio F, Artzi-Medvedik R, Kob R, Melzer I, Britting S. Transient versus stable nature of fear of falling over 24 months in community-older persons with falls- data of the EU SCOPE project on Kidney function. BMC Geriatr 2022; 22:698. [PMID: 35999522 PMCID: PMC9396801 DOI: 10.1186/s12877-022-03357-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fear of falling (FoF) is an important risk factor for falls among older people. The objectives of our investigations were: a.) to present characteristics of older community-dwelling (CD) fallers with persistent or transient FoF (P-FoF or T-FoF) over 12 months, and b.) to investigate clinical predictors of P-FoF and T-FoF and c.) to explore differences between P-FoF and T-FoF. METHODS Our series consisted of 389 older people reporting a fall or injurious fall at baseline and during 24 months follow-up participating in a multicenter prospective study. T-FoF was defined as participants reported "not at all" at baseline and "somewhat/fairly/very concerned" at follow-up, or "not at all" at follow-up, and "somewhat/fairly/very concerned" at baseline, and P-FoF was defined as participants answered "somewhat/fairly/very concerned" in both assessments at baseline and at follow-up. The association between risk factors and T-FoF or P-FoF was investigated by logistic regression analysis. RESULTS The mean age of fallers in our sample was 79.0 years (SD 6.0), and 54.2% were females. Out of 389 older adults with a fall history at baseline, 83 participants (21.3%) did not report any FoF over time, P-FoF and T-FoF were observed in 42.7% and 35.9% of participants, respectively. After adjusting for potential confounders (e.g. age, gender), osteoporosis (OR = 2.04, 95%CI = 1.03-4.05) and impaired physical performance (OR = 2.38, 95%CI = 1.12-5.03) were significant predictors of T-FoF vs No-FoF. Osteoporosis (OR = 2.68, 95%CI = 1.31-5.48), depressive symptoms (OR = 3.54, 95%CI = 1.23-10.1) and living alone (OR = 2.44, 95%CI = 1.17-5.06) were significantly associated with P-FoF vs No-FoF. When comparing T-FoF and P-FoF, female gender (OR = 1.95, 95%CI = 1.16-3.27), BMI (OR = 1.08, 95%CI = 1.02-1.14), overall comorbidity (OR = 1.07, 95%CI = 1.02-1.13) and depression (OR = 2.55, 95%CI = 1.33-4.88) were significant predictors of P-FoF. CONCLUSIONS T-FoF and P-FoF may be predicted by different sets of risk factors among older fallers. Thus, fallers should be screened for FoF especially when carrying specific risk factors, including female gender, osteoporosis, depression, living alone, impaired physical performance, BMI, comorbidity. These findings may be helpful in designing tailored intervention to blunt the risks related to consequence of FoF among older people experiencing falls. TRIAL REGISTRATION The SCOPE study was registered prospectively at clinicaltrials.gov (NCT02691546; 25/02/2016).
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Affiliation(s)
- Ellen Freiberger
- Department of Internal Medicine-Geriatrics, Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Paolo Fabbietti
- Italian National Research Center On Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy
| | - Andrea Corsonello
- Italian National Research Center On Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy
| | - Fabrizia Lattanzio
- Italian National Research Center On Aging (IRCCS INRCA), Ancona, Fermo and Cosenza, Italy
| | - Rada Artzi-Medvedik
- Department of Nursing, Recanati School for Community Health Professions at the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Maccabi Health Services, Israel; and Department of Nursing, Recanati School for Community Health Professions at the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Robert Kob
- Department of Internal Medicine-Geriatrics, Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Itshak Melzer
- Department of Physical Therapy, Recanati School for Community Health Professions at the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Sabine Britting
- Department of Internal Medicine-Geriatrics, Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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12
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Fundenberger H, Stephan Y, Terracciano A, Dupré C, Bongue B, Hupin D, Barth N, Canada B. Subjective Age and Falls in Older Age: Evidence from two Longitudinal Cohorts. J Gerontol B Psychol Sci Soc Sci 2022; 77:1814-1819. [PMID: 35861191 DOI: 10.1093/geronb/gbac094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Falls are a common and serious health problem. The present study examined the association between subjective age (i.e., feeling younger or older than one's chronological age) and falls in two large national samples. METHOD Participants, aged 65 to 105 years old, were drawn from the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Data on falls, subjective age, demographic factors, was available from 2,382 participants in HRS and 3,449 in NHATS. Falls were tracked for up to 8 (HRS) and 7 (NHATS) years. RESULTS Cox regression analyses that included demographic covariates indicated that older subjective age increased the risk of falling in HRS (hazard ratio [HR]=1.17, 95% confidence interval [CI]=1.08-1.27), and in NHATS (HR=1.06, 95%CI=1.00-1.13). When compared to people who felt younger, people who reported an older subjective age had a higher risk of fall (HRS: HR=1.65, 95% CI=1.33-2.04; NHATS: HR=1.44, 95% CI=1.15-1.79). The associations remained significant after accounting for depressive symptoms, handgrip strength, chronic diseases, and cognitive impairment in HRS only. DISCUSSION These results confirm the role of subjective age as an important health marker in the aging population. Subjective age assessment can help identify individuals at greater risk of falls.
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Affiliation(s)
| | | | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, USA
| | - Caroline Dupré
- SAINBIOSE, Jean Monnet University, Saint-Etienne, FRANCE
| | | | - David Hupin
- SAINBIOSE, Jean Monnet University, Saint-Etienne, FRANCE.,Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, FRANCE
| | - Nathalie Barth
- SAINBIOSE, Jean Monnet University, Saint-Etienne, FRANCE
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13
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Kinesiophobia and Fear Avoidance in Older Adults: A Scoping Review on the State of Research Activity. J Aging Phys Act 2022; 30:1075-1084. [PMID: 35303715 DOI: 10.1123/japa.2021-0409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 11/18/2022]
Abstract
A scoping review was performed to examine the extent and nature of research activity on kinesiophobia and fear avoidance in older adults and summarize research findings. Four databases were searched from January 2006 to May 2021. Eleven papers were selected for inclusion, with a predominance of cross-sectional design (54.5%; n = 6). Most of the studies were associated with chronic pain (n = 9; 81.8%). Higher levels of kinesiophobia were found among frailer and older people, predominantly living in care homes. Kinesiophobia and fear avoidance have been related to other constructs of the fear avoidance model, and the conclusions partially support the assumptions derived from it in older adults. Nevertheless, kinesiophobia proved to be a more dominant factor in determining the level of physical activity than pain in this population. None of the studies aimed to test the effectiveness of interventions directly targeting kinesiophobia or fear avoidance.
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Fundenberger H, Stephan Y, Hupin D, Barth N, Terracciano A, Canada B. Prospective associations between subjective age and fear of falling in older adults. Aging Ment Health 2022; 26:86-91. [PMID: 33291957 PMCID: PMC8978267 DOI: 10.1080/13607863.2020.1856775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Subjective age has been implicated in a range of health outcomes but its associations with Fear of Falling (FoF) are unknown. The present study examined the relation between subjective age and FoF in large national sample. METHODS Participants were drawn from the National Health and Aging Trends Study (NHATS, 2011-2017). 1,679 participants provided data on FoF, subjective age, demographic factors, depressive symptoms, prior falls, self-rated health and measures of the Short Physical Performance Battery. FoF was assessed again 7 years later. RESULTS Regression analyses revealed that an older subjective age was related to a 24% higher likelihood to develop FoF 7 years later. This association was independent of age, sex, educational attainment, race and prior falls. In addition, depressive symptoms, self-rated health, and physical inactivity mediated the associations between subjective age and FoF. CONCLUSIONS The present study showed that an older subjective age is related to the development of FoF over time, and further identified psychological and functional pathways that may explain this association. These results confirm the role of subjective age on one of the markers of frailty in the aging population.
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Affiliation(s)
- Hervé Fundenberger
- SNA EPIS, Jean Monnet University, Saint-Etienne, FRANCE,Corresponding author: Hervé Fundenberger, EA SNA EPIS 4607, Université de Lyon, Université Jean Monnet, Saint-Étienne, 42055 Saint-Etienne cedex 2, France,
| | | | - David Hupin
- SNA EPIS, Jean Monnet University, Saint-Etienne, FRANCE
| | | | - Antonio Terracciano
- Department of Geriatrics, College of Medicine, Florida State University, USA
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15
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Adamczewska N, Nyman SR. Falls-efficacy as a multiple dimension construct: the role of post-traumatic symptoms. Aging Ment Health 2022; 26:92-99. [PMID: 33904780 DOI: 10.1080/13607863.2021.1913474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to provide the basis for a new theoretical understanding of the psychological response to falls. We tested a hypothesised model of multiple dimensions of falls-efficacy (FE) in older adults. The model involved two main components of posttraumatic stress disorder (PTSD) - fear and dysphoria - that were hypothesised to be directly associated with FE. The model proposed three pathways related to FE: 'at the moment FE' related to fear, 'constant FE' related to dysphoria and 'elaborated FE' related to fear of falls (FoF). METHODS In this cross-sectional study a convenience sample of 119 older adults hospitalised in Poland due to fall-related injuries completed a survey involving fear of falls, FE and PTSD assessment. RESULTS All three hypothesised pathways related to FE were supported, which accounted for 61% of the variance in falls efficacy. Very strong relationships were found between FE and dysphoria (.447, 95% CI [.303, .632], p = .006), FE and fear (.261, 95% CI [.109, .416], p = .009), and FE and FoF (-.286, 95% CI [-.396, -.183], p = .006). CONCLUSION FE is not a unidimensional concept but acts differently depending on what influences it. Dysphoria appears to be central to the fall-related constructs of FE and FoF and responsible for their maladaptivity. FoF, which is often misinterpreted as FE, was found to be less prominent in the analyses. Thus, fear of falls may not always be negative, as it is commonly believed, but adaptive and protective.
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Affiliation(s)
| | - Samuel R Nyman
- Department of Medical Science and Public Health, Bournemouth University, Poole, UK
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16
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Lenouvel E, Novak L, Biedermann A, Kressig RW, Klöppel S. Preventive treatment options for fear of falling within the Swiss healthcare system : A position paper. Z Gerontol Geriatr 2021; 55:597-602. [PMID: 34590162 PMCID: PMC9587118 DOI: 10.1007/s00391-021-01957-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022]
Abstract
Fear of falling (FoF) results in social, functional, physical, and psychological symptoms, including secondary disorders, such as depression and general anxiety disorder (GAD). A vicious cycle develops, where symptoms maintain and reinforce FoF and its consequences, including increasing the risk of falling. In this position paper, we suggest screening for FoF using the falls efficacy scale international (FES-I) questionnaire. The presence of a high score (> 23) warrants an investigation into frailty and exclusion of depression and GAD, during the clinical interview. Stratifying frailty, based on the Fried frailty criteria will guide treatment options based on the most significant health concerns. Frail older adults should first receive physiotherapy and exercise interventions, as physical disabilities are their most significant characteristic, while pre-frail and non-frail older adults should receive multicomponent interventions, consisting of cognitive behavioral therapy (CBT) with physical exercise. The non-frail with predominantly GAD and depression should receive specialized CBT interventions. Currently, only exercise interventions are available for FoF treatment in Switzerland. Although some exercise interventions use CBT elements, such as goal setting and reflections on behavior and feelings, they are not systematically used, are not part of a quality-assured procedure, and do not address the psychological-cognitive aspects of FoF. As the pre-frail and non-frail are the largest groups to use these services, adapting current exercise programs by incorporating a CBT component would be the most practical means to provide optimized care.
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Affiliation(s)
- Eric Lenouvel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Murtenstraße 21, 3008, Bern, Switzerland. .,Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Lan Novak
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Murtenstraße 21, 3008, Bern, Switzerland
| | | | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER & University of Basel, Basel, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Murtenstraße 21, 3008, Bern, Switzerland
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History of Falls, Dementia, Lower Education Levels, Mobility Limitations, and Aging Are Risk Factors for Falls among the Community-Dwelling Elderly: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179356. [PMID: 34501947 PMCID: PMC8430505 DOI: 10.3390/ijerph18179356] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/28/2022]
Abstract
Background: Falling is a serious issue among elderly community dwellers, often resulting in disability. We aimed to investigate the risk factors for falls among elderly community dwellers. Methods: We recruited 232 participants from multiple community learning and care centers, who provided their information through questionnaires. They were divided into two groups, according to their falling events after a 1-year follow-up. Univariate and multivariate logistic regressions were used for statistical analysis. Results: A total of 64 participants reported a fall at the 1-year follow-up. The falling group comprised older and single people with lower education levels, higher rates of dementia, a history of falls, lower scores on the Mini-Mental State Examination, and more disability functions when compared to the non-falling group (all p < 0.05). The regression model showed that a history of falls (OR: 62.011; p < 0.0001), lower education levels (OR: 4.088; p = 0.039), mild dementia (OR: 20.729; p = 0.028), older age (OR: 1.176; p < 0.0001), walking for 300 m (OR: 4.153; p = 0.030), and running for 30 m (OR: 3.402; p = 0.015) were 1-year risk factors for falls. Conclusion: A history of falling, low education levels, aging, mild dementia, and certain mobility limitations were strong risk factors for future falling accidents in elderly Taiwanese community dwellers.
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Britting S, Kob R, Sieber CC, Rohleder N, Freiberger E, Becker L. Physiological stress in safer cycling in older age (SiFAr-stress): effect of a multicomponent exercise intervention-a study protocol for a randomized controlled trial. Trials 2021; 22:552. [PMID: 34419134 PMCID: PMC8379566 DOI: 10.1186/s13063-021-05481-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND SiFAr-Stress investigates the impact of cycling on stress levels in older adults. Uncertainty due to change to motorized bicycle or fear of falling can be perceived as stressors for cyclists. Stress activates different physiological signal cascades and stimulates the hypothalamic-pituitary-adrenal (HPA) axis, which leads to the release of the stress hormone cortisol and further effects such as the development of low-grade inflammation. Both can-in the long term-be associated with negative health outcomes. The aim of the study SiFAr-Stress is to analyze inflammatory processes as well as the activity of stress systems before and after a cycling intervention for older adults. METHODS In this study, community-dwelling older adults aged 65 years and older will be randomly assigned to either a cycling or a control intervention in a parallel-group design. Objective HPA axis-related measures (saliva cortisol and hair cortisol) will be assessed before, after, and 6-9 months after the cycling and control intervention (T0, T1, and T2). Furthermore, changes in cortisol reactivity in response to the cycling intervention will be investigated at the second and seventh training lessons. Furthermore, secondary outcomes (fear of falling, perceived stress, salivary alpha amylase, and C-reactive protein) will be assessed at T0, T1, and T2. DISCUSSION The study will be the first, in which stress- and health-related bio-physiological outcomes will be assessed in the context of a multicomponent exercise intervention, addressing cycling in older adults. It will enable us to better understand the underlying patho-physiological and psychological mechanisms and will help to improve interventions for this target group. TRIAL REGISTRATION ClinicalTrials.gov NCT04362514 . Prospectively registered on 27 April 2020.
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Affiliation(s)
- Sabine Britting
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Bavaria, Germany.
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Bavaria, Germany
| | - Cornel Christian Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Bavaria, Germany
- Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Nicolas Rohleder
- Department of Psychology, Chair of Health Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bavaria, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Bavaria, Germany
| | - Linda Becker
- Department of Psychology, Chair of Health Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bavaria, Germany
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Fear of falling is as important as multiple previous falls in terms of limiting daily activities: a longitudinal study. BMC Geriatr 2021; 21:350. [PMID: 34098904 PMCID: PMC8185919 DOI: 10.1186/s12877-021-02305-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Fear of falling and previous falls are both risk factors that affect daily activities of older adults. However, it remains unclear whether they independently limit daily activities accounting for each other. Methods We used the data from Round 1 (Year 1) to Round 5 (Year 5) of the National Health and Aging Trends Study. We included a total of 864 community-dwelling participants who provided data on previous falls, fear of falling and limited activities from Year 1 to Year 5 and had no limited daily activities at Year 1 in this study. Previous falls and fear of falling were ascertained by asking participants how many falls they had in the past year and whether they had worried about falling in the last month. Limited daily activities included any difficulties with mobility (e.g., going outside), self-care (e.g., eating), and household activities (e.g., laundering). Generalized estimation equation models were used to examine whether previous falls and fear of falling independently predicted development of limited daily activities adjusting covariates. Results Participants were mainly between 65 and 79 years old (83 %), male (57 %), and non-Hispanic White (79 %). Among participants who had multiple falls in Year 1, 19.1-31 %, 21.4-52.4 %, and 11.9-35.7 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 5, respectively. Among those who had fear of falling in Year 1, 22.5-41.3 %, 30.0-55.0 %, and 18.8-36.3 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 4, respectively. Fear of falling independently predicted limitations in mobility (Incidence rate ratio [IRR]: 1.79, 95 % CI: 1.44, 2.24), self-care (IRR: 1.25, 95 % CI: 1.08, 1.44) and household activities (IRR: 1.39, 95 % CI: 1.08, 1.78) after adjusting for previous falls and covariates. Multiple previous falls independently predicted limitations in mobility (IRR: 1.72, 1.30, 2.27), self-care (IRR: 1.40, 95 % CI: 1.19, 1.66) and household activities (IRR: 1.36, 95 % CI: 1.01, 1.83) after adjusting fear of falling and covariates. Conclusions Fear of falling seems to be as important as multiple previous falls in terms of limiting older adults’ daily activities.
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Scheffers-Barnhoorn MN, van Eijk M, Schols JMGA, van Balen R, Kempen GIJM, Achterberg WP, van Haastregt JCM. Feasibility of a multicomponent cognitive behavioral intervention for fear of falling after hip fracture: process evaluation of the FIT-HIP intervention. BMC Geriatr 2021; 21:224. [PMID: 33794804 PMCID: PMC8017759 DOI: 10.1186/s12877-021-02170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study describes the process evaluation of an intervention developed to reduce fear of falling (FoF) after hip fracture, within an inpatient geriatric rehabilitation setting. This 'FIT-HIP intervention' is a multicomponent cognitive behavioral intervention, conducted by physiotherapists and embedded in usual care in geriatric rehabilitation in the Netherlands. A previous study (cluster randomized controlled trial) showed no beneficial effects of this intervention when compared to usual care. The aim of this study was to gain insight into factors related to the intervention process that may have influenced the effectiveness of the intervention. METHODS This process evaluation was conducted using an observational prospective study design. Based on quantitative and qualitative data derived from session logs, evaluation questionnaires and interviews, we addressed: 1] recruitment and reach; 2] performance according to protocol; 3] patients' adherence; and 4] opinions of patients and facilitators on the intervention. Participants in this study were: a) patients from 6 geriatric rehabilitation units, who were invited to participate in the intervention (39 adults aged ≥65 years with hip fracture and FoF) and; b) intervention facilitators (14 physiotherapists and 8 psychologists who provide coaching to the physiotherapists). RESULTS Thirty-six patients completed the intervention during inpatient geriatric rehabilitation. Apart from cognitive restructuring and telephonic booster (which was not provided to all patients), the intervention was performed to a fair degree in accordance with protocol. Patients' adherence to the intervention was very good, and patients rated the intervention positively (average 8.1 on a scale 0-10). Although most facilitators considered the intervention feasible, a limited level of FoF (possibly related to timing of intervention), and physiotherapists' limited experience with cognitive restructuring were identified as important barriers to performing the intervention according to protocol. CONCLUSIONS The FIT-HIP intervention was only partly feasible, which may explain the lack of effectiveness in reducing FoF. To improve the intervention's feasibility, we recommend selecting patients with maladaptive FoF (i.e. leading to activity restriction), being more flexible in the timing of the intervention, and providing more support to the physiotherapists in conducting cognitive restructuring. TRIAL REGISTRATION Netherlands Trial Register: NTR5695 (7 March 2016).
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Affiliation(s)
- Maaike N Scheffers-Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands.
| | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbox 9600, Leiden, 2300 RC, The Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Lenouvel E, Novak L, Wirth T, Denkinger M, Dallmeier D, Voigt-Radloff S, Klöppel S. Cognitive behavioural interventions for reducing fear of falling in older people living in the community. Hippokratia 2021. [DOI: 10.1002/14651858.cd014666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Eric Lenouvel
- Department of Old Age Psychiatry and Psychotherapy; University Hospital of Psychiatry, Bern (UPD, Bern); Bern Switzerland
- Graduate School for Health Science; University of Bern; Bern Switzerland
| | - Lan Novak
- Department of Old Age Psychiatry and Psychotherapy; University Hospital of Psychiatry, Bern (UPD, Bern); Bern Switzerland
| | - Thomas Wirth
- University Hospital for Psychiatry and Psychotherapy; University Hospital of Psychiatry, Bern (UPD, Bern); Bern Switzerland
| | - Michael Denkinger
- Geriatric Research Institute; University of Ulm; Ulm Germany
- AGAPLESION Bethesda Clinic Ulm; Geriatric Centre Ulm/Alb-Donau; Ulm Germany
| | - Dhayana Dallmeier
- Geriatric Research Institute; University of Ulm; Ulm Germany
- AGAPLESION Bethesda Clinic Ulm; Geriatric Centre Ulm/Alb-Donau; Ulm Germany
- Department of Epidemiology; Boston University School of Public Health; Boston USA
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine; Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; Freiburg Germany
| | - Stefan Klöppel
- Department of Old Age Psychiatry and Psychotherapy; University Hospital of Psychiatry, Bern (UPD, Bern); Bern Switzerland
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de Bruin ED, Baur H, Brülhart Y, Luijckx E, Hinrichs T, Rogan S. Combining Stochastic Resonance Vibration With Exergaming for Motor-Cognitive Training in Long-Term Care; A Sham-Control Randomized Controlled Pilot Trial. Front Med (Lausanne) 2020; 7:507155. [PMID: 33330519 PMCID: PMC7734185 DOI: 10.3389/fmed.2020.507155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/09/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose: Physical and mental functions allow classifying older adults as “Go-Go” (independent functioning); “Slow-Go” (in need of care with a slight handicap); and “No-Go” (in need of care with severe functional limitation). The latter group exhibits reduced exercise tolerance. More recently technology-based motor-cognitive types of training services emerged as a possible training service. This study examined the use of technology including stochastic resonance whole-body vibration and Exergame-dance training for motor-cognitive training in care home dwelling adults. Methods: Seventeen older adults (10 women, 7 men, age range: 79–98) were randomly assigned to the intervention (IG, n = 9) or the sham group (SG, n = 8). IG performed five sets of 1-min whole-body vibration with 1-min rest in between, three times a week for the first 4 weeks of the training period with varying frequency. From weeks five to eight the Exergame-dance training was conducted after the vibration sessions. SG performed a stochastic resonance whole-body vibration training with the same terms applied, however, with a fixed frequency of 1 Hz, Noise 1. From weeks five to eight a passive trampoline-programme of 5 min was applied following the vibration sessions. Primary outcome was the Short Physical Performance Battery (SPPB). Secondary outcomes were the Trail Making Test A and B (TMT A & B) and the Falls Efficacy Scale–International (FES-I). Outcomes were measured at baseline, after 4 and 8 weeks of intervention and at follow-up (4 weeks after the intervention). The non-parametric Puri and Sen rank-order test was applied, followed by an ANOVA for repeated measures to analyse main and interaction effects. Mann–Whitney U-Test was used to determine differences between the groups. Results: The post-hoc analysis showed significant effects on the SPPB total score with large effect sizes from baseline to 8 weeks (+72%, p = 0.005, η2 = 0.423). The TMT part B displayed significant improvements with large effect sizes from baseline to 8 weeks (+17.5%, p = 0.002, η2 = 0.779) and to follow-up (+21%, p = 0.001, η2 = 0.827). Conclusion: The technology based 8-week training programme consisting of a combination of stochastic resonance whole-body vibration and Exergame-dance training showed beneficial effects on both physical and cognitive performance in older care home dwelling adults.
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Affiliation(s)
- Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Heiner Baur
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Yvonne Brülhart
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Eefje Luijckx
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Timo Hinrichs
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Slavko Rogan
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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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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Peeters G, Bennett M, Donoghue OA, Kennelly S, Kenny RA. Understanding the aetiology of fear of falling from the perspective of a fear-avoidance model – A narrative review. Clin Psychol Rev 2020; 79:101862. [DOI: 10.1016/j.cpr.2020.101862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 12/14/2022]
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25
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Wu SYF, Brown T, Yu ML. Older Adults’ Psychosocial Responses to a Fear of Falling: A Scoping Review to Inform Occupational Therapy Practice. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/0164212x.2020.1735977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sin Yan Flora Wu
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University – Peninsula Campus, Frankston, Australia
| | - Ted Brown
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University – Peninsula Campus, Frankston, Australia
| | - Mong-lin Yu
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University – Peninsula Campus, Frankston, Australia
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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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Udell JE, Drahota A, Mackenzie H. Psychological and educational interventions for preventing falls in older people living in the community. Hippokratia 2019. [DOI: 10.1002/14651858.cd013480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Julie E Udell
- University of Portsmouth; Department of Psychology; King Henry Building King Henry 1 St Portsmouth Hampshire UK PO1 2DY
| | - Amy Drahota
- University of Portsmouth; School of Health and Care Professions; St Michael's Road Portsmouth UK PO1 2PR
| | - Heather Mackenzie
- University of Portsmouth; School of Health and Care Professions; St Michael's Road Portsmouth UK PO1 2PR
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Scheffers-Barnhoorn MN, van Eijk M, van Haastregt JCM, Schols JMGA, van Balen R, van Geloven N, Kempen GIJM, Achterberg WP. Effects of the FIT-HIP Intervention for Fear of Falling After Hip Fracture: A Cluster-Randomized Controlled Trial in Geriatric Rehabilitation. J Am Med Dir Assoc 2019; 20:857-865.e2. [PMID: 31078486 DOI: 10.1016/j.jamda.2019.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/05/2019] [Accepted: 03/10/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Fear of falling (FoF) is common after hip fracture and can impede functional recovery because of activity restriction. The Fear of falling InTervention in HIP fracture geriatric rehabilitation (FIT-HIP intervention) was designed to target FoF and consequently to improve mobility. The aim of this study was to evaluate the effect of the FIT-HIP intervention in patients with FoF in geriatric rehabilitation (GR) after hip fracture. DESIGN, SETTING, AND PARTICIPANTS This cluster-randomized controlled trial was performed in 11 post-acute GR units in the Netherlands (2016-2017). Six clusters were assigned to the intervention group, 5 to the usual care group. We included 78 patients with hip fracture and FoF (aged ≥65 years; 39 per group). INTERVENTION(S) The FIT-HIP intervention is a multicomponent cognitive behavioral intervention conducted by physiotherapists, embedded in usual care in GR. The FIT-HIP intervention was compared to usual care in GR. MEASUREMENTS FoF was assessed with the Falls Efficacy Scale-International (FES-I) and mobility, with the Performance Oriented Mobility Assessment (POMA). Data were collected at baseline, discharge, and 3 and 6 months postdischarge from GR. Primary endpoints were change scores at discharge. Linear mixed models were used to evaluate the treatment effect. RESULTS No significant between-group differences were observed for primary outcome measures. With the usual care group as reference, the FES-I estimated difference between mean change scores was 3.3 [95% confidence interval (CI) -1.0, 7.5, P = .13] at discharge from GR; -4.1 (95% CI -11.8, 3.6, P = .29) after 3 months; and -2.8 (95% CI -10.0, 4.4, P = .44) after 6 months. POMA estimated difference was -0.3 (95% CI -6.5, 5.8, P = .90). CONCLUSION/IMPLICATIONS The FIT-HIP intervention was not effective in reducing FoF. Possibly FoF (shortly) after hip fracture can to some extent be appropriate. This may imply the study was not able to accurately identify and accordingly treat FoF that is maladaptive (reflective of disproportionate anxiety).
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Affiliation(s)
| | - Monica van Eijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Nan van Geloven
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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