Fear of falling in older adults living at home: associated factors

The global prevalence of and risk factors for fear of falling among older adults: a systematic review and meta-analysis

BACKGROUND

As a common psychological problem among older adults, fear of falling was found to have a wide range prevalence in different studies. However, the global prevalence of it was unknown and a lack of the large sample confirmed its risk factors.

OBJECTIVES

To report the global prevalence of fear of falling and to explore its risk factors among older adults for further developing precise interventions to systematically manage FOF.

DESIGN

A systematic review and meta-analysis was conducted by PRISMA guidelines.

METHODS

Searches were conducted in PubMed, Web of Science, EMBASE, the Cochrane Library and the manual search in August 20, 2022, updated to September 2, 2023. Observational studies published in English were included and two researchers independently screened and extracted the data. Fixed or random effects mode was used to estimate the pooled prevalence of and risk factors for fear of falling. Heterogeneity resources were analyzed by subgroup and sensitivity analysis. Publication bias was assessed through funnel plots, Egger's test and Begg's test.

RESULTS

A total of the 153 studies with 200,033 participants from 38 countries worldwide were identified. The global prevalence of fear of falling was 49.60%, ranging from 6.96-90.34%. Subgroup analysis found the estimates pooled prevalence of it was higher in developing countries (53.40%) than in developed countries (46.7%), and higher in patients (52.20%) than in community residents (48.40%). In addition, twenty-eight risk factors were found a significant associations with fear of falling, mainly including demographic characteristics, physical function, chronic diseases and mental problems.

CONCLUSION

The global prevalence of FOF was high, especially in developing countries and in patients. Demographic characteristics, Physical function, chronic diseases and mental problems were a significant association with FOF. Policy-makers, health care providers and government officials should comprehensively evaluate these risk factors and formulate precise intervention measures to reduce FOF.

TRIAL REGISTRATION

The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD42022358031.

Contributing factors and interventions for fear of falling in stroke survivors: a systematic review

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).

Evaluating the Balancing Ability of Older Adults with Diabetes Mellitus Using the Multi-directional Reach Test

BACKGROUND

The incidence of elderly people experiencing falls is currently increasing, which results in serious medical issues, such as fear of falling, limited physical activity, disability, and bone fractures, especially hip fractures. This study aimed to investigate balancing ability using a multi-directional reach test (MDRT) in older adults with and without diabetes mellitus.

METHODS

72 older adults with and without diabetes mellitus were recruited, and divided into two groups, including older adults without diabetes mellitus (n = 36) and older adults with diabetes mellitus (n = 36). All subjects completed all directions of the MDRT.

RESULTS

There were no significant differences in MDRT scores in all directions between the two groups (p>0.05). Both groups achieved the highest MDRT scores in the forward direction. In contrast, the two groups had the lowest scores of MDRT in a backward direction. Furthermore, older adults with diabetes mellitus had lower MDRT scores in all directions than older adults without diabetes mellitus.

CONCLUSION

The current study indicated that MDRT could be used to investigate the ability of balance in individuals with diabetes mellitus.

Is waist circumference associated with fear of falling in community-dwelling older adults? A cross-sectional study

INTRODUCTION

Fear of falling (FOF) is a prevalent condition among older adults and several variables have been pointed out as risk factors.

OBJECTIVES

To identify the cut-off point on waist circumference (WC), capable of discriminating between older adults with and without FOF, and to test the association between WC and FOF.

METHODS

A cross-sectional observational study was carried out with older adults of both sexes from Balneário Arroio do Silva, Brazil. We used Receiver Operating Characteristic (ROC) curves to determine the cut-off point on WC and logistic regression adjusted for potential confounding variables to test the association.

RESULTS

Older women with WC >93.5 cm [area under the curve: 0.61 (95%CI 0.53; 0.68)] had 3.30 (95%CI 1.53; 7.14) greater chances of having FOF compared with older women with WC ≤93.5 cm. WC was not able to discriminate FOF in older men.

CONCLUSION

WC values >93.5 cm are associated with higher chances of FOF in older women.

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

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

Classification of Center of Mass Acceleration Patterns in Older People with Knee Osteoarthritis and Fear of Falling

(1) Background: The preoccupation related to the fall, also called fear of falling (FOF) by some authors is of interest in the fields of geriatrics and gerontology because it is related to the risk of falling and subsequent morbidity of falling. This study seeks to classify the acceleration patterns of the center of mass during walking in subjects with mild and moderate knee osteoarthritis (KOA) for three levels of FOF (mild, moderate, and high). (2) Method: Center-of-mass acceleration patterns were recorded in all three planes of motion for a 30-meter walk test. A convolutional neural network (CNN) was implemented for the classification of acceleration signals based on the different levels of FOF (mild, moderate, and high) for two KOA conditions (mild and moderate). (3) Results: For the three levels of FOF to fall and regardless of the degree of KOA, a precision of 0.71 was obtained. For the classification considering the three levels of FOF and only for the mild KOA condition, a precision of 0.72 was obtained. For the classification considering the three levels of FOF and only the moderate KOA condition, a precision of 0.81 was obtained, the same as in the previous case, and finally for the classification for two levels of FOF, a high vs. moderate precision of 0.78 was obtained. For high vs. low, a precision of 0.77 was obtained, and for the moderate vs. low, a precision of 0.8 was obtained. Finally, when considering both KOA conditions, a 0.74 rating was obtained. (4) Conclusions: The classification model based on deep learning (CNN) allows for the adequate discrimination of the acceleration patterns of the moderate class above the low or high FOF.

Gait in Cerebral Amyloid Angiopathy

Background Gait is a complex task requiring coordinated efforts of multiple brain networks. To date, there is little evidence on whether gait is altered in cerebral amyloid angiopathy (CAA). We aimed to identify impairments in gait performance and associations between gait impairment and neuroimaging markers of CAA, cognition, and falls. Methods and Results Gait was assessed using the Zeno Walkway during preferred pace and dual task walks, and grouped into gait domains (Rhythm, Pace, Postural Control, and Variability). Participants underwent neuropsychological testing and neuroimaging. Falls and fear of falling were assessed through self-report questionnaires. Gait domain scores were standardized and analyzed using linear regression adjusting for age, sex, height, and other covariates. Participants were patients with CAA (n=29), Alzheimer disease with mild dementia (n=16), mild cognitive impairment (n=24), and normal elderly controls (n=47). CAA and Alzheimer disease had similarly impaired Rhythm, Pace, and Variability, and higher dual task cost than normal controls or mild cognitive impairment. Higher Pace score was associated with better global cognition, processing speed, and memory. Gait measures were not correlated with microbleed count or white matter hyperintensity volume. Number of falls was not associated with gait domain scores, but participants with low fear of falling had higher Pace (odds ratio [OR], 2.61 [95% CI, 1.59-4.29]) and lower Variability (OR, 1.64 [95% CI, 1.10-2.44]). Conclusions CAA is associated with slower walking, abnormal rhythm, and greater gait variability than in healthy controls. Future research is needed to identify the mechanisms underlying gait impairments in CAA, and whether they predict future falls.

Associations between Muscle Strength, Physical Performance and Cognitive Impairment with Fear of Falling among Older Adults Aged ≥ 60 Years: A Cross-Sectional Study

(1) Background: Fear of falling has become a significant health problem in older adults and is already considered as important as falling because of its long-term detrimental effects on older adults' physical and psychosocial functioning. The aim of this study was to analyze the associations between both upper and lower limb strength, gait parameters and cognitive impairment with fear of falling in older adults. (2) Methods: A cross-sectional study involving 115 older-adult participants was used to assess the impact of both upper (Handgrip dynamometer, TKK 5401 Grip-D, Takey, Tokyo, Japan) and lower limb strength (Chair stand test), gait parameters (OptoGait-System Bolzano, Bolzano, Italy) and cognitive impairment (COWAT word association test) with fear of falling in older adults (Falls Efficacy Scale-International FES-I). (3) Results: Multivariate linear regression analysis showed several independent associations with the fear of falling. A higher time to perform the Chair Stand test was associated with higher scores in FES-I (R² = 0.231), while a lower score in both Semantic Fluency (S COWA) and Phonologic Fluency (P COWA) was associated with a decreased score in FES-I (R² = 0.052 and 0.035). (4) Conclusions: Both higher step and stride length (OptoGait), lower body strength (Chair test) and both poorer semantic (S COWA) and phonologic (P COWA) fluency were all associated with fear of falling.

Physical Exercise Program on Fall Prevention Using Technological Interface: Pretest Study

Background

Prevention of falls among older adults has boosted the development of technological solutions, requiring testing in clinical contexts and robust studies that need prior validation of procedures and data collection tools.

Objective

The objectives of our study were to test the data collection procedure, train the team, and test the usability of the FallSensing Games app by older adults in a community setting.

Methods

This study was conducted as a pretest of a future pilot study. Older adults were recruited in a day care center, and several tests were applied. Physical exercise sessions were held using the interactive FallSensing Games app. Nurse training strategies was completed.

Results

A total of 11 older adults participated. The mean age was 75.08 (SD 3.80) years, mostly female (10/11, 91%) and with low (3-6 years) schooling (10/11, 91%). Clinically, the results show a group of older adults with comorbidities. Cognitive evaluation of the participants through the Mini Mental State Examination showed results with an average score of 25.64 (SD 3.5). Functional capacity assessed using the Lawton Instrumental Activities of Daily Living Scale (overall score from 0-23, with lower scores reflecting worse capacity to perform activities) showed impairment in different instrumental activities of daily living (average score 14.27). The data collection tool proved to enable easy interpretation; however, its structure needed small adjustments to facilitate the data collection process. Despite the length of the questionnaire, its implementation took an average of 21 minutes. For the assessment of the prevalence of fear of falling, the need to add a question was identified. The performance of functional tests under the guidance and presence of rehabilitation nurses ensured the safety of the participants. The interactive games were well accepted by the participants, and the physical exercises allowed data collection on the functionality of the older adults, such as the number of repetitions in the tests, range of movement (angle), duration of the movements, and execution of each cycle. Concerning the training of the nurses, it was crucial that they had experience with the platform, specifically the position of the chair facing the platform, the position of the feet, the posture of participants, and the use of sensors.

Conclusions

In the future pilot study, the researchers point out the need to design a study with mixed methods (quantitative and qualitative), thus enriching the study results.

Quedas, medo de cair e capacidade funcional

Objetivo: avaliar a capacidade funcional e o medo de cair em idosos cadastrados em uma unidade de saúde da família. Método: estudo descritivo e transversal, com abordagem quantitativa, realizado em janeiro de 2019, no domicílio de 157 idosos cadastrados em uma unidade de saúde da família do município de João Pessoa, Paraíba, Brasil. Para a coleta foi utilizado um instrumento semiestruturado, composto de questões sociodemográficas, histórico de quedas, o índice de Barthel e a Escala Internacional de Eficácia em Quedas. A análise foi efetivada pela estatística descritiva e inferencial, utilizando-se o teste de correlação de Spearman. Resultados: houve correlação entre atividades que compõem a análise da capacidade funcional e o medo de cair, em que se observou significância estatística entre elas, verificando-se que quanto menor a capacidade funcional, maior será o medo de cair. Considerações Finais: concluiu-se que, frente ao declínio fisiológico, social e psicológico oriundos do envelhecimento humano, é importante o planejamento de intervenções que abordem o medo de cair em idosos, com vistas a preservar sua capacidade funcional.

The Prevalence and Associated Risk Factors of Fear of Fall in the Elderly: A Hospital-Based, Cross-Sectional Study

Background

Falls are one of the most common but serious health issues faced by the elderly population. Falls-related injuries not only add to the morbidity and economic burden they also have a significant negative impact on psychological health and the quality of life of the elderly. In this study, we assess the prevalence of fear of falling among the geriatric population and the risk factors associated with fear of falling.

Methodology

This prospective, cross-sectional study was conducted among geriatric patients aged more than 60 years attending the medical outpatient department of a tertiary care hospital in Uttarakhand, India. This study aimed to determine the prevalence of fear of falling among the geriatric population and compare various demographic and clinical parameters in elderly patients with and without fear of falling. Fear of fall was assessed using a questionnaire by asking the elderly if they had fear of falling, how often they had fear of falling, and under which circumstances did they have fear of falling. Information regarding demographics, history of daily activities, and chronic diseases was collected and assessed from all geriatric patients with and without fear of falls.

Results

Almost half (334; 42%) of the geriatric population had a history of fear of falling. Demographic parameters such as age over 80 years, female gender, living alone, and rural background were significantly associated with fear of falling. Similarly, a history of chronic diseases such as stroke, hypertension, and history of visual and motility impairment was significantly related to fear of falls among geriatric patients. Around 70% (571) of geriatric patients aged over 60 years had associated health problems.

Conclusions

This study reinstates that fear of falls is a significant health issue in the elderly age group. It also highlights multiple risk factors related to fear of falling which if controlled can significantly improve the quality of life of the geriatric population.

The effect that the Otago Exercise Programme had on fear of falling in community dwellers aged 65-80 and associated factors

BACKGROUND

Falls are a major public health problem. Fear of falling is highly prevalent amongst community-dwelling older adults who have already fallen and it is also a risk factor for recurrent falls. There has been limited research about the impact that exercises programs have on the fear of falling. The aim of this study was to evaluate whether the Otago Exercise Programme (OEP) reduced the fear of falling in non-institutionalised people aged 65-80 years in Spain. It also evaluated the factors associated with the fear of falling.

METHODS

This was a quasi-experimental study that focused on people aged 65-80 who attended 21 primary healthcare centres, lived in the community, were able to walk independently and provided written, informed consent. They were recruited from September 2017 to December 2019. The OEP sessions took place at the primary healthcare centres and were provided on an individual or group basis by trained OEP instructors. The participants attended five weekly sessions, where they were given exercises to develop their strength, balance and endurance. They then continued the programme at home. The subjects were followed up 12 months after baseline and the analyses included a bivariate analysis and a multivariate analysis with logistic regression.

RESULTS

We enroled 498 patients (67.07% female) with an average age of 71.81 years. More than two-thirds (65.06%) lived with a partner and 42.37% were overweight. Significant reductions were observed in the mean level of fear of falling between baseline and 12 months (p = 0.000). A number of factors associated with fear of falling also showed significant differences. These were: age (p = 0.033), sex (p = 0.000), living alone (p = 0.000), body mass index (p = 0.003) and whether psychotropic drugs were used (p = 0.000). The multivariate analysis showed a moderate to high fear of falling amongst participants who were female (p = 0.000), 72-80 years of age (p = 0.017), obese (p = 0.045) and used psychotropic drugs (p = 0.021).

CONCLUSIONS

Taking part in the OEP reduced the overall fear of falling. There were significant associations between fear of falling and being female, taking psychotic drugs and having a history of falls. This study is a quasi-experimental sign nested an experimental study (randomized controlled trial previously published and registered on ClinicalTrials.org (NCT03320668)). Retrospectively registered on 25/10/2017.

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

Background

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

Methods

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

Results

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

Conclusions

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

Fear of falling and associated factors among older people living in Bahir Dar City, Amhara, Ethiopia- a cross-sectional study

BACKGROUND

Fear of falling (FOF) is the most common public health problem, which can lead to loss of confidence, reducing physical and social activities, depression, loss of mobility, increased risk of falls, physical weakness, and strong negative impact on an older people's quality of life. However, studies in developing country were lacking, particularly in the study area. Therefore, the aim of the current study was to fill this gap in the study area in particular and the country in general. The purpose of the current study was to assess the prevalence and associated factors with fear of falling among older people 60 years and older who were living in Bahir Dar city, Ethiopia.

METHODS

A community based cross sectional study design was conducted with a total sample size of 527 participants and multistage random sampling technique was used to select the study participants. The fall efficacy scale tool was used to develop the questionnaire. Data were coded, cleaned and entered into SPSS version 23 for analysis. Multi-collinearity and model fitting were checked. In bivariate logistic regression analyses, variables with p-value< 0.25 were considered as potential candidates for multivariable logistic regression analyses. A variable with p-value< 0.05 at 95% CI was considered as statistically significant. Finally, the odds ratio and 95% confidence interval were estimated and interpreted.

RESULTS

A total of 481 participants was included in this study. The prevalence of fear of falling among the older people was 59.9% (95% CI; 55.7-64.4). Fear of falling was significantly associated with the following variables:- advanced age (AOR = 4.01, 95% CI; 1.65-9.74), female (AOR = 4.25, 95% CI; 2.25-8.01), lower education level (AOR = 2.77, 95% CI; 1.12-6.82), anxiety [AOR = 9.03, 95% CI; 4.78-17.07), confirmed medical conditions (AOR = 2.01, 95% CI; 1.03-3.91) and walking aids used (AOR = 13.82; 95% CI; 5.21-36.63).

CONCLUSIONS

A moderate prevalence of fear of falling was observed. The major associated factors were advanced age, being female, lower educational level, anxiety, confirmed medical conditions and walking aids used. Hence, we recommend the need of rehabilitation programs that enable healthy aging and further rigor research is recommended.

Fear of Falling and Related Factors in Older Adults With Spinal Diseases

Fear of falling is common among older adults with spinal diseases. The purpose of the current study was to examine fear of falling and related factors in this population. A total of 138 participants were recruited and completed survey questionnaires along with the Timed Up & Go Test. Participants were 73.7 years old on average, 52% had fall experience, and 56% were taking more than four medications. Multivariate regression analyses revealed that the use of sleeping pills, residence type, pain, activities of daily living, gait ability, and gait efficacy were significant predictors of fear of falling. Findings suggest that a fall prevention intervention for older adults with spinal diseases should include pain management, functional improvement, and gait rehabilitation with a focus on gait performance and gait efficacy. In addition, it is important to improve living environment and sleep hygiene, which are conducive to falls. [Journal of Gerontological Nursing, 47(8), 29-35.].

Life satisfaction and health self-assessment of older adults assisted through home care

OBJECTIVE

to identify sociodemographic and health characteristics according to age groups and to analyze the association between self-assessed health status and satisfaction with regular/bad life with sociodemographic characteristics, global functioning and falls of older adults linked to home care within the primary health care network.

METHOD

cross-sectional study with 124 older adults, conducted using home interviews. A sociodemographic data and health status questionnaire was used, together with Barthel Index, Lawton Instrumental Activities of Daily Living Scale (IADL), the Mini-Mental State Examination, the Geriatric Depression Scale and the Timed Up and Go Test. Bivariate and multivariate analyses (Poisson regression) were applied.

RESULTS

there was a predominance of female octogenarians. Self-assessment of regular/bad health was associated with mild (p=0.002) and severe (p<0.001) depressive symptoms. Satisfaction with regular/bad life was associated with fear of falling (p=0.019) and with mild (p<0.001) and severe (p<0.001) depressive symptoms.

CONCLUSION

depressive symptoms were associated with a worse life satisfaction and health self-assessment.

Validation of a Laser Ranged Scanner-Based Detection of Spatio-Temporal Gait Parameters Using the aTUG Chair

This article covers the suitability to measure gait-parameters via a Laser Range Scanner (LRS) that was placed below a chair during the walking phase of the Timed Up&Go Test in a cohort of 92 older adults (mean age 73.5). The results of our study demonstrated a high concordance of gait measurements using a LRS in comparison to the reference GAITRite walkway. Most of aTUG's gait parameters demonstrate a strong correlation coefficient with the GAITRite, indicating high measurement accuracy for the spatial gait parameters. Measurements of velocity had a correlation coefficient of 99%, which can be interpreted as an excellent measurement accuracy. Cadence showed a slightly lower correlation coefficient of 96%, which is still an exceptionally good result, while step length demonstrated a correlation coefficient of 98% per leg and stride length with an accuracy of 99% per leg. In addition to confirming the technical validation of the aTUG regarding its ability to measure gait parameters, we compared results from the GAITRite and the aTUG for several parameters (cadence, velocity, and step length) with results from the Berg Balance Scale (BBS) and the Activities-Specific Balance Confidence-(ABC)-Scale assessments. With confidence coefficients for BBS and velocity, cadence and step length ranging from 0.595 to 0.798 and for ABC ranging from 0.395 to 0.541, both scales demonstrated only a medium-sized correlation. Thus, we found an association of better walking ability (represented by the measured gait parameters) with better balance (BBC) and balance confidence (ABC) overall scores via linear regression. This results from the fact that the BBS incorporates both static and dynamic balance measures and thus, only partly reflects functional requirements for walking. For the ABC score, this effect was even more pronounced. As this is to our best knowledge the first evaluation of the association between gait parameters and these balance scores, we will further investigate this phenomenon and aim to integrate further measures into the aTUG to achieve an increased sensitivity for balance ability.

[Prevalence of fear of falling and related factors in community-dwelling older people]

Objetivo

El objetivo general del estudio es conocer la prevalencia de la preocupación a caer en personas mayores, independientes para la deambulación, que viven en la comunidad, según la versión reducida del FES-I y los factores asociados que influyen en esta preocupación.

Diseño

Estudio descriptivo transversal.

Emplazamiento

Centro de Salud El Greco (Getafe), Gerencia Asistencial de Atención Primaria de Madrid.

Participantes

Ciento ochenta y nueve pacientes ≥ 70 años independientes o con dependencia funcional leve-moderada (índice de Barthel ≥ 60) e independientes para la deambulación (camina 45 min sin ayuda o con bastón). El estudio se ofreció a 328 personas: 217 aceptaron y rechazaron 111.

Mediciones principales

La variable dependiente, miedo a caerse (MC), fue evaluada mediante el cuestionario Short FES-I, considerando como punto de corte para el cribado positivo del MC una puntuación ≥ 11. Como variables independientes se consideraron: índice de Barthel, escala Downton, prueba de fragilidad Short Physical Performance Battery (SPPB), caídas en el último año, lesiones asociadas a las caídas, tiempo desde la última caída, déficit sensorial, uso de dispositivos de la marcha, comorbilidad y tratamiento farmacológico.

Resultados

La prevalencia del MC fue del 42,9% (IC 95%: 35,5-50,2). Los factores asociados al MC en el análisis multivariante final fueron: sexo femenino, vivir solo, alto riesgo de caídas, presencia de fragilidad, uso de hipotensores y lesiones asociadas a caídas previas.

Conclusiones

La prevalencia del miedo a caer en personas mayores es elevada. Los profesionales de atención primaria deben sistematizar el cribado de este problema de salud, priorizando especialmente en las personas que presentan los siguientes factores de riesgo: ser mujer, vivir solo, tener una puntuación baja en el SPPB (como indicador de fragilidad) o presentar un elevado riesgo de caídas.

VALIDATION OF THE INTERNATIONAL 7-ITEM FALLS EFFICACY SCALE IN PORTUGUESE COMMUNITY-DWELLING OLDER ADULTS

ABSTRACT Objective to determine the psychometric properties of the international 7-item Falls Efficacy Scale. Method a psychometric study. Convenience sample consisting of 170 older adults living in the Madeira Autonomous Region, Portugal. A two-part instrument was used (sociodemographic characterization and the Falls Efficacy Scale-International-Portugal). The starting point was the translation and transcultural adaptation already carried out for the Falls Efficacy Scale - International (16 items). Construct validity (factorial analysis and discriminant validity) and the reliability (Cronbach's α) of the 7-item scale were evaluated. Previous authorization was obtained from the Ethics Commission and from the people involved. Results in the exploratory factorial analysis, the International 7-item Falls Efficacy Scale presents an explained variance of 65.8%. The Spearman's correlation between the score obtained based on the 7 items and the score obtained based on the 16 items is significant and very strong (r=0.987, p<0.0001). Internal consistency was 0.958. Conclusion the validity and reliability study of the International 7-item Falls Efficacy Scale revealed that it is an adequate scale for the evaluation of the fear of falling in the community-dwelling older adults.

Validation of Igbo version of the modified falls efficacy scale among community-dwelling older adults: a validation study

Background

Fear of falling (FOF) is a very pervasive problem among older adults. Consequently, many scales have been developed for its assessment. The Modified Falls Efficacy Scale (MFES) is one of the most popular FOF scales. The MFES was originally developed for use in developed countries, and thus may not be entirely suitable for use in developing countries due to cultural and environmental differences between the two country categories. This study was therefore designed to cross-culturally adapt and validate the MFES to Igbo culture and environment among community-dwelling older adults in Nnewi community using established guidelines.

Methods

The original English version of the MFES (E-MFES) was translated, synthesized, back-translated, subjected to expert panel review, and pretested before producing the final Igbo version of the MFES (I-MFES). The I-MFES and the Short Falls Efficacy Scale International were randomly administered to consecutively recruited 109 consenting older adult residents of Nnewi (43.1% males; mean age = 74.45 ± 8.78 years). Convergent and structural validities and internal consistency of the I-MFES were assessed at 0.05 level of significance.

Results

All the 14 items on the E-MFES were retained on the I-MFES. The I-MFES exhibited the same structure as the E-MFES. The correlation between the total scores on the I-MFES and the Short Falls Efficacy Scale International was excellent (rho = − 0.93) indicating evidence of convergent validity of the I-MFES. The Cronbach’s alpha value of the I-MFES was 0.97 showing evidence of excellent internal consistency of the items on the I-MFES.

Conclusion

This study provides evidence of some aspects of validity and reliability of the I-MFES.

Controle postural estático e risco de quedas em mulheres idosas com e sem incontinência urinária

RESUMO A incontinência urinária (IU) está associada à ocorrência de quedas em idosos e pode ter relação com déficits no controle postural. O objetivo deste trabalho é comparar o controle postural estático, na condição de olhos abertos e fechados, e o risco de quedas entre idosas com IU e idosas sem IU. A amostra foi dividida em dois grupos: idosas com IU (n=21, idade=65,33±4,57 anos) e idosas sem IU (n=19, idade=66,37±5,26 anos). As características da perda urinária do grupo com IU foram avaliadas por meio do International Consultation on Incontinence Questionnaire: Short Form (ICIQ-SF). O controle postural estático dos grupos foi mensurado pelo deslocamento do centro de pressão (COP) por meio de uma plataforma de força; e o risco de quedas foi avaliado pelo teste timed up and go. Para a análise estatística, foi utilizado o teste U de Mann-Whitney e o teste qui-quadrado. A maioria das participantes com IU perdiam urina em pequena quantidade e todas perdiam em baixa frequência. Não foi observada diferença entre os grupos em relação às variáveis do COP (p>0,05) e o risco de quedas (p=0,082). Entretanto, na análise intragrupos, houve diferença na velocidade do COP de ambos os grupos na comparação olhos abertos versus olhos fechados (p<0,05). Não houve diferença no controle postural estático e no risco de quedas entre idosas com e sem IU.

Medo de cair e o risco de queda: revisão sistemática e metanálise

Resumo Objetivo Verificar se o medo de cair é fator de risco em pessoas idosas que vivem na comunidade. Métodos Foi realizada uma revisão sistemática com metanálise baseada na Preferred Reporting Items for Systematic Reviews and MetaAnalyses. Utilizou-se a estratégia de busca PECOS: Paciente - pessoa idosa com 60 anos, ou mais, que vive em comunidade com história pregressa de quedas; Exposição- medo de cair, Comparação -grupo sem medo de cair, o “Outcome” - o desfecho queda e o “Studies”- foram incluídos os estudos observacionais comparativos. As buscas foram realizadas em maio de 2018 nos seguintes bancos de dados eletrônicos CINAHL, Medline, Cochrane, Embase, Lilacs, PsycINFO e PEDro, por meio dos seguinte descritores: “aged”, “elderly”, older adults, fear, fear of falling, accidental falls, fall, fallls. Foram também realizadas buscas de referências cruzadas e literatura cinzenta. Dois revisores realizaram a identificação, seleção, elegibilidade e inclusão dos estudos de maneira independente. A qualidade metodológica dos estudos foram efetuada pela aplicação do instrumento STROBE. Para a metanálise, utilizou-se o Programa ReviewMananger 5.3®. Resultados De 4.891 publicações, cinco estudos possibilitaram a metanálise com 3.112 idosos. Evidenciou-se uma chance de queda de 12,15 vezes maior para o grupo de idosos com medo de cair. Conclusão O medo de cair foi identificado como fator de risco de queda na população idosa que vive na comunidade e que possui história pregressa de queda, torna-se necessário a investigação pelos profissionais da ara da saúde afim de estabelecer medidas preventivas.

Falls in institutionalized elderly with and without cognitive decline A study of some factors

Falls in long-stay institutions for elderly people have a high prevalence, contributing to the physical and mental deterioration of institutionalized elderly.

Objective

To determine the prevalence of falls among institutionalized elderly with and without cognitive decline, and to characterize the practices and behaviors of those with and without cognitive decline in managing fall risks, and relate them to some factors.

Methods

The present correlational study was carried out with a sample of 204 institutionalized elderly, 50% of whom had cognitive decline.

Results

The elderly with cognitive decline (40.2%) fell less often than those who did not have cognitive decline (42.2%) (p>0.05). Safety practices and behaviors were better in the elderly with cognitive decline (p<0.05). Most of the elderly with cognitive decline who fell took benzodiazepines (65.9%), in contrast with those without cognitive decline (32.2%). It was observed that 81.4% of the elderly without cognitive decline and 43.9% of those with cognitive decline who fell had a performance of over 12 seconds on the Timed Up and Go Test, where differences reached statistical significance in both groups of elderly.

Conclusion

Data collected in the present study further the knowledge on risk factors in the genesis of falls and on the behavior of elderly with and without cognitive decline in maintaining their safety in self-care and accessibility.

Características dos idosos atendidos em um pronto-socorro em decorrência de queda

Resumo OBJETIVO Descrever as características dos idosos atendidos no pronto-socorro de um hospital de ensino em decorrência de queda. MÉTODO Estudo descritivo, quantitativo, transversal, realizado no pronto-socorro de um hospital. Os dados foram coletados no mês de novembro de 2017, no prontuário de 1.460 idosos, com registro de queixa principal relacionado à queda. Foi realizada análise descritiva dos dados. RESULTADOS Os principais resultados demonstram que a maioria dos idosos era do sexo feminino (66,92%), com idade acima de 80 anos (27,27%), solteiros (41,37%) e hipertensos (78,79%). 88,56% tiveram queda do mesmo nível, tendo como principal consequência o trauma (55,65%) e 66,30% receberam alta após consulta. CONCLUSÃO As características dos idosos foram: sexo feminino, idade acima de 80 anos, estado civil solteiro, e presença de hipertensão arterial. O tipo de queda mais frequente foi do mesmo nível, sendo o trauma a principal consequência e a alta após consulta o desfecho mais apontado.

Both psychological factors and physical performance are associated with fall-related concerns

BACKGROUND

Fall-related concern strongly correlates to activity avoidance in older people. In this complex phenomenon, different terminology and instruments are often used interchangeably. Three main concepts make up fall-related concerns: fear of falling, consequence concern, and falls self-efficacy. It is suggested that fall-related concerns are mediated by psychological and physical factors.

AIMS

Our aims were to describe the prevalence of fall-related concerns and find explanatory factors for its most studied concept-falls self-efficacy-in an older population.

METHODS

We executed a cross-sectional study on a random sample of 153 community-dwelling older people (70 years or older). We used validated and reliable instruments as well as structured interviews to gather data on the three concepts of fall-related concerns and possible mediating factors. We then calculated descriptive statistics on prevalence and regression models for the total group, and men and women, separately.

RESULTS

70% of the total sample (80% of women and 53% of men) reported at least one of the three concepts of fall-related concern. For the total sample, fear of falling, morale, and physical performance were associated factors with falls self-efficacy. For women, the number of prescription medications was added. For men, physical performance and concerns for injury were associated.

CONCLUSION

Fall-related concern is prevalent in large proportions with higher prevalence for women than for men. Important factors are fear of falling, morale, and physical performance. Gender differences in the emergence and variance of fall-related concern and the relation between physical performance and fall-related concern should be targeted in future research endeavors.