Predictors of Incident Fear of Falling in Community-Dwelling Older Adults

doi:10.1016/j.jamda.2019.08.020

Journal of the American Medical Directors Association

Volume 21, Issue 5, May 2020, Pages 615-620

https://doi.org/10.1016/j.jamda.2019.08.020 Get rights and content

Abstract

Objectives

Fear of falling (FoF) is common in older people and may lead to physical decline, disability, poor quality of life, and falls. Several risk factors for FoF have been identified in cross-sectional studies, but evidence on predictors of its incidence is scarce. We investigated the latter in community-dwelling older people undergoing a comprehensive geriatric assessment at baseline and after a 2-year follow-up.

Design

Longitudinal study.

Setting and Participants

Convenience sample of community-dwelling people aged ≥60 years evaluated in an Irish university hospital.

Methods

Participants were evaluated at baseline (August 2007–May 2009) and after a 2-year follow-up. FoF was measured using the Modified Falls Efficacy Scale. Predictors of incident FoF at 2 years were investigated.

Results

At baseline, there were 563 participants (69% female, mean age 73 years). Among individuals that were not fearful at baseline, 105 (18.7%) developed FoF (incident FoF) after a median follow-up of 2.1 years. Individuals reporting incident FoF were older at baseline (P < .001), had worse performance in balance and physical function tests, and more frequently needed a walking aid (P < .001). Anxiety (P = .012) and depressive symptoms (P < .001) were more prevalent, as well as self-reported previous falls (P < .001). In multivariate analysis, older age, walking aid use, and a higher burden of depressive symptoms at baseline were predictors of incident FoF.

Conclusions and Implications

Almost a fifth of older adults using a walking aid and reporting depressive symptoms at baseline developed FoF after 2 years. These identifiable prodromal factors could help design FoF prevention strategies.

Section snippets

Methods

This study analyzed longitudinal data from participants evaluated in an Irish university hospital that offered a comprehensive geriatric assessment to community-dwelling people aged 60 and older. The assessment was carried out in the context of a research project aimed to test new technologies to maintain and enhance the independent living. The majority of participants (66.8%) were self-referrals attracted by the local media, whereas the others were referred as outpatients to receive further

Results

The study sample included 563 participants in whom FoF was investigated both at baseline and at the second assessment. Mean age was 72.7 ± 7.2 (range 60-92); 69.3% were female. At baseline, FoF was reported by 85 participants (15.1%), and the median MFES score was 9.90 (8.9-10.0). After a median follow-up of 2.1 years, the median MFES score was significantly lower [9.4 (7.0-10.0), P < .001]. Among individuals that were not fearful at baseline, 105 developed FoF (18.7%, incident FoF). Among

Discussion

In this longitudinal study of community-dwelling older adults, a 19% incidence of FoF was observed after a 2-year follow-up. Older age, a walking aid, and depressive symptoms at baseline seemed to be independently associated with incident FoF and may allow clinicians to identify patients at high risk of developing future FoF.

In the literature, the reported prevalence of FoF is highly variable, ranging from 3% to 85%,⁴ owing to different study settings and FoF measures. In our study, the

Conclusions and Implications

Incident FoF is common in community-dwelling older people. Older age, a walking aid, and a greater burden of depressive symptoms are independently associated with incident FoF. These predictors can be easily assessed during a routine clinical evaluation and allow to identify patients at risk of developing future FoF. Additionally, modifiable risk factors (eg, depressive symptoms and unsteadiness) may represent a target for prevention strategies. Therefore, our results provide evidence for

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Fear of Falling (FOF) is common among community-dwelling older adults and is associated with increased fall-risk, reduced activity, and gait modifications.
In this cross-sectional study, we examined the relationships between FOF and gait quality.
Older adults (N=232; age 77±6; 65 % females) reported FOF by a single yes/no question. Gait quality was quantified as (1) harmonic ratio (smoothness) and other time-frequency spatiotemporal variables from triaxial accelerometry (Vertical-V, Mediolateral-ML, Anterior-Posterior -AP) during six-minute walk; (2) gait speed, step-time CoV (variability), and walk-ratio (step-length/cadence) on a 4-m instrumented walkway. Mann Whitney U-tests and Random forest classifier compared gait between those with and without FOF. Selected gait variables were used to build Support Vector Machine (SVM) classifier and performance was evaluated using AUC-ROC.
Individuals with FOF had slower gait speed (103.66 ± 17.09 vs. 110.07 ± 14.83 cm/s), greater step time CoV (4.17 ± 1.66 vs. 3.72 ± 1.24 %), smaller walk-ratio (0.53 ± 0.08 vs. 0.56 ± 0.07 cm/steps/minute), smaller standard deviation V (0.15 ± 0.06 vs. 0.18 ± 0.09 m/s²), and smaller harmonic-ratio V (2.14 ± 0.73 vs. 2.38 ± 0.58), all p<.01. Linear SVM yielded an AUC-ROC of 67 % on test dataset, coefficient values being gait speed (-0.19), standard deviation V (-0.23), walk-ratio (-0.36), and smoothness V (-0.38) describing associations with presence of FOF.
Older adults with FOF have reduced gait speed, acceleration adaptability, walk-ratio, and smoothness. Disrupted gait patterns during fear of falling could provide insights into psychosocial distress in older adults. Longitudinal studies are warranted.
Poor sleep health predicts the onset of a fear of falling among community-dwelling older adults
2024, Sleep Health
A greater fear of falling predicts disability, falls, and mortality among older adults. Although poor sleep has been identified as a relevant risk factor for fear of falling among older adults, evidence is primarily shown in cross-sectional studies using isolated sleep characteristics. Less is known about whether prior fall experiences change the sleep health-fear of falling link among older adults. We investigated the longitudinal relationship between sleep health and the incidence of fear of falling among community-dwelling older adults and how the association differed between those with or without prior fall experiences.
Data were from individuals who completed the sleep module in the National Health and Aging Trends Study (2013-2014; n = 686). Fear of falling was assessed with a single item. Multidimensional sleep health was measured with self-reported sleep items based on the SATED model (ie, sleep satisfaction, daytime alertness, timing, efficiency, and duration). Covariates included sociodemographics, assistive device usage, health, risky behavior, and sleep medications. Multiple logistic regression was used to analyze the data.
Poor sleep health was associated with the onset of fear of falling at 1-year follow-up (odds ratios = 1.20, 95% confidence interval = 1.02-1.41). Moreover, poor sleep health increased the odds of having fear of falling among individuals without prior falls experiences and elevated the already heightened risks of developing fear of falling among those who fell at baseline.
Given that fear of falling and experiencing a fall each increase the risk of the other occurring in the future, improving sleep health may prevent older adults from stepping into the vicious cycle of fear of falling and falls.
Tridirectional association between probable depression, fear of falling and falls among middle-aged and older adults in Thailand
2023, Archives of Gerontology and Geriatrics
Depression is a major issue in the aging population, which may be related to fear of falling (FOF) and falls contributing to increased morbidity and mortality. The aim of the study was to assess the tridirectional associations between probable depression (PD), FOF and falls in a longitudinal study in Thailand.
Longitudinal data of participants (≥45 years; N = 3708) from two consecutive waves (in 2015 and 2017) of the Health, Aging and Retirement in Thailand (HART) study were analysed. PD was assessed with the Center for Epidemiologic Studies Depression Scale, self-reported FOF and history of falls.
Having no PD in 2015 and PD in 2017 (aOR: 2.35, 95% CI: 1.67 to 3.30), and having both PD in 2015 and 2017 (aOR: 3.46, 95% CI: 1.92 to 6.23) were positively associated with incident FOF with activity avoidance, and no FOF in 2015 and FOF in 2017 (aOR: 2.29, 95% CI: 1.77 to 2.95), and both FOF in 2015 and 2017 (aOR: 2.38, 95% CI: 1.69 to 3.36) were positively associated with incident PD. Two or more falls in 2015 (aOR: 2.03, 95% CI: 1.29 to 3.19) was positively associated with incident PD, and both PD in 2015 and 2017 (aOR: 3.10, 95% CI: 1.40 to 6.48) were positively associated with incident multiple (≥2) falls.
We found tridirectional associations between PD, FOF and falls. It is suggested to screen and manage older adults for PD, FOF and fall history simultaneously.
Bidirectional relationship between fear of falling and frailty among community-dwelling older adults: A longitudinal study
2023, Geriatric Nursing
This study aims to examine the bidirectional association between fear of falling (FOF) and frailty among community-dwelling older adults. Longitudinal analyses were conducted over a representative sample of 5,829 community-dwelling individuals ≥65 years from the National Health and Aging Trends Study. FOF was ascertained by asking participants whether they worried about falling and if this worry ever limited their activities. Frailty status was assessed based on frailty phenotype. At baseline, 71.4% of participants reported no FOF, 16.7% reported FOF without fear-related activity restriction (FAR), and 11.9% reported FOF with FAR. The proportion of robust, pre-frail and frail respondents at baseline was 36.1%, 48.7% and 15.2%, respectively. Multinomial logistic regression models indicated FOF with and without FAR predicted pre-frailty and frailty. Pre-frailty predicted FOF with and without FAR, while frailty only predicted FOF with FAR. Tailored intervention strategies are needed for preventing adverse outcomes of FOF and frailty among the older population.
Harnessing robot experimentation to optimize the regulatory framing of emerging robot technologies
2022, Data and Policy
The global prevalence of and risk factors for fear of falling among older adults: a systematic review and meta-analysis
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: The TRIL Clinic was funded by Intel Corporation, the Industrial Development Agency (IDA) Ireland, and GE Healthcare (grant no. TRIL2007), with operational support from the Mercer’s Institute for Successful Ageing (MISA) at St James's Hospital, Dublin, Ireland. The financial sponsor played no role in the design, execution, analysis and interpretation of data, or writing of the study.

: The authors declare no conflicts of interest.

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Original StudyPredictors of Incident Fear of Falling in Community-Dwelling Older Adults

Abstract

Objectives

Design

Setting and Participants

Methods

Results

Conclusions and Implications

Section snippets

Methods

Results

Discussion

Conclusions and Implications

Am J Geriatr Psychiatry

Am J Geriatr Psychiatry

Arch Phys Med Rehabil

Am J Geriatr Psychiatry

Gait Posture

Gait Posture

Geriatr Nurs

Am J Geriatr Psychiatry

Exercise for reducing fear of falling in older people living in the community: Cochrane systematic review and meta-analysis

Age Ageing

Fear of falling among the community-dwelling elderly

J Aging Health

Risk factors for falls among elderly persons living in the community

N Engl J Med

Fear of falling: Measurement strategy, prevalence, risk factors and consequences among older persons

Age Ageing

Frequencies and circumstances of falls in the National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA)

J Epidemiol

Fear of falling in robust community-dwelling older people: Results of a cross-sectional study

J Clin Nurs

Recreational physical activity levels in healthy older women: The importance of fear of falling

J Am Geriatr Soc

Characteristics associated with fear of falling and activity restriction in community-living older persons

J Am Geriatr Soc

Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission

J Gerontol A Biol Sci Med Sci

Fear of falling in nursing home patients

Gerontology

Fear of falling and fall-related efficacy in relationship to functioning among community-living elders

J Gerontol

Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention

J Am Geriatr Soc

Activity restriction induced by fear of falling and objective and subjective measures of physical function: A prospective cohort study

J Am Geriatr Soc

The prevalence and correlates of fear of falling in elderly persons living in the community

Am J Public Health

The health-related quality of life and cost implications of falls in elderly women

Osteoporos Int

Original Study
Predictors of Incident Fear of Falling in Community-Dwelling Older Adults