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

BACKGROUND: The aim of this study was to assess the impact of fear of falling on the health of older people. METHODS: A total of 528 subjects (mean age 77 years) were recruited from two hospitals in Sydney, Australia, and followed for approximately 12 months. Eighty-five subjects died during follow-up, and 31 were admitted to an aged care institution. Tinetti's Falls Efficacy Scale (FES) was successfully administered to 418 subjects as part of the baseline assessment. Among those with baseline FES scores, ability to perform 10 activities of daily living (ADLs) was assessed at baseline and follow-up in 307 subjects, and SF-36 scores were assessed at baseline and follow-up in 90 subjects recruited during the latter part of the study. Falls during follow-up were identified using a monthly falls calendar. RESULTS: Compared with those with a high fall-related self-efficacy (FES score = 100), those with a low fall-related self-efficacy (FES score < or = 75) had an increased risk of falling (adjusted relative risk 2.09, 95% confidence interval [CI] 1.31-3.33). Those with poorer fall-related self-efficacy had greater declines in ability to perform ADLs (p < .001): the total ADL score decreased by 0.69 activities among persons with low FES scores (< or =75) but decreased by only 0.04 activities among persons with FES scores of 100. Decline in ADLs was not explained by the higher frequency of falls among persons with low FES scores. SF-36 scores (particularly scores on the Physical Function and Bodily Pain subscales) tended to decline more among persons with poor fall-related self-efficacy. Nonfallers who said they were afraid of falling had an increased risk of admission to an aged care institution. CONCLUSIONS: Fear of falling has serious consequences for older people. Interventions that successfully reduce fear of falling and improve fall-related self-efficacy are likely to have major health benefits.     

Self-efficacy as a mediator between fear of falling and functional ability in the elderly

OBJECTIVES: This study examined falls self-efficacy and fear of falling to determine whether self-efficacy acts as a mediator between fear of falling and functional ability. METHODS. Using the Survey of Activities and Fear of Falling in the Elderly as a fear-of-falling measure and the Activities-Specific Balance Confidence Scale for falls self-efficacy, structural relationships among fear of falling, self-efficacy, functional balance, and physical functioning outcomes were tested with older adults (N = 256, M age = 77.5). RESULTS. Lower levels of fear of falling were significantly related to higher levels of falls self-efficacy, which was in turn associated with better functional outcomes. Moreover, falls self-efficacy mediated the effects of fear of falling on functional outcomes. DISCUSSION. Results substantiate the hypothesized mediational role of falls self-efficacy in fear of falling and underscore the need to consider ways of enhancing falls self-efficacy in interventions aimed at reducing falls and fear of falling.     

Falls efficacy as a measure of fear of falling

We developed the Falls Efficacy Scale (FES), an instrument to measure fear of falling, based on the operational definition of this fear as "low perceived self-efficacy at avoiding falls during essential, nonhazardous activities of daily living." The reliability and validity of the FES were assessed in two samples of community-living elderly persons. The FES showed good test-retest reliability (Pearson's correlation 0.71). Subjects who reported avoiding activities because of fear of falling had higher FES scores, representing lower self-efficacy or confidence, than subjects not reporting fear of falling. The independent predictors of FES score were usual walking pace (a measure of physical ability), anxiety, and depression. The FES appears to be a reliable and valid method for measuring fear of falling. This instrument may be useful in assessing the independent contribution of fear of falling to functional decline among elderly people.     

Development, implementation, and evaluation of an Interprofessional Falls Prevention Program for older adults

This article describes the development and implementation of an Interprofessional Falls Prevention Program (IFPP) designed for community-dwelling seniors. The program was a collaborative pilot research study conducted in a retirement home and an outpatient hospital setting. The pilot was successful and was positioned into a permanent falls prevention program. The IFPP aimed at improving physical function and balance and reducing the fear of falling in seniors with a history of falls. The pilot study included an interprofessional falls assessment followed by a 12-week program of once-weekly group education and exercise sessions, 3- and 6-month follow-up visits, and individual counseling. To measure program effectiveness, the Berg Balance Scale, the Timed Up and Go Test, the Falls Efficacy Scale, and the Morse Fall Risk Scale were used at baseline, upon program completion, and at 3- and 6-month follow-up. Process measures were also collected, including patient satisfaction. Persistent improvements were found in participants' balance, strength, functional mobility, and fear of falling. Patient satisfaction with the program was high. Challenges faced in program implementation are also highlighted.     

Predictors of adherence with the recommended use of hip protectors

BACKGROUND: Hip protectors can prevent many hip fractures in older persons at high risk for falling. Few published studies have investigated the use of hip protectors in community-dwelling older persons, and the level of adherence with their use, and predictors of adherence in this setting, are not clear. The aim of this study was to report the predictors of adherence and the level of adherence with the use of hip protectors in frail community-dwelling older women. METHODS: This cohort study of the intervention group of a randomized, controlled trial recruited participants from aged care health services in urban areas of northern Sydney, Australia. Participants were 302 women who were 74 years or older (mean age, 83 years) and who had 2 or more falls or 1 fall requiring hospital admission in the previous year and who lived in their own homes. The main outcome measure was adherence with the use of hip protectors. RESULTS: Adherence was approximately 53% during the 2 years of the study, and hip protectors were worn at the time of 51% of falls. The significant independent predictors of nonadherence with hip protector use were lower self-efficacy for hip protector use (odds ratio [OR], 0.51; 95% confidence interval [CI],.33 to.79), higher number of perceived barriers to hip protector use (OR, 0.52; 95% CI, .38 to.72), and lower self-rated health (OR, 0.71; 95% CI, .55 to.93). CONCLUSIONS: Three easily measured factors independently predicted subsequent adherence with hip protector use. These findings may form the basis for strategies to improve adherence with the use of hip protectors and with other types of treatment or preventive strategies in older persons.     

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

OBJECTIVES: Previous cross-sectional studies have shown a correlation between falls and fear of falling, but it is unclear which comes first. Our objectives were to determine the temporal relationship between falls and fear of falling, and to see whether these two outcomes share predictors. DESIGN: A 20-month, population-based, prospective, observational study. SETTING: Salisbury, Maryland. Each evaluation consisted of a home-administered questionnaire, followed by a 4- to 5-hour clinic evaluation. PARTICIPANTS: The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations. At baseline, subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher. MEASUREMENTS: Demographics, visual function, comorbidities, neuropsychiatric status, medication use, and physical performance-based measures were assessed. Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation, first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors. RESULTS: Falls at baseline were an independent predictor of developing fear of falling 20 months later (odds ratio (OR) = 1.75; P <.0005), and fear of falling at baseline was a predictor of falling at 20 months (OR = 1.79; P <.0005). Women with a history of stroke were at risk of falls and fear of falling at follow-up. In addition, Parkinson's disease, comorbidity, and white race predicted falls, whereas General Health Questionnaire score, age, and taking four or more medications predicted fear of falling. CONCLUSION: Individuals who develop one of these outcomes are at risk for developing the other, with a resulting spiraling risk of falls, fear of falling, and functional decline. Because falls and fear of falling share predictors, individuals who are at a high risk of developing these endpoints can be identified.     

Cross-sectional and longitudinal risk factors for falls, fear of falling, and falls efficacy in a cohort of middle-aged African Americans

PURPOSE: The purpose of this study is to cross-sectionally and longitudinally identify risk factors for falls, fear of falling, and falls efficacy in late-middle-aged African Americans. DESIGN AND METHODS: We performed in-home assessments on a probability sample of 998 African Americans and conducted two annual follow-up interviews. Multiple logistic regression modeled the associations with falls (any fall or injurious fall) during 2 years prior to the baseline interview, and baseline fear of falling and falls efficacy with 2-year prospective risks for falling and fear of falling. RESULTS: The most consistent association for all outcomes was depressive symptoms. Age was associated with increased risk of prior and prospective falls. Lower-body functional limitations were associated with prior falls, baseline fear of falling, and low falls efficacy, whereas low ability with one-leg stands prospectively predicted fear of falling. The greatest prospective risk for incident falls was having had a prior fall (odds ratio = 2.51), and the greatest prospective risk for fear of falling was having been afraid of falling at baseline (odds ratio = 8.14). IMPLICATIONS: Falls, fear of falling, and low falls efficacy are important issues for late-middle-aged as well as older persons. Interventions should focus on younger adults and attend especially to lower-body function and depressive symptoms as well as building self-efficacy for safe exercise, dealing with falls risks, and managing falls themselves.     

害怕跌倒在老年脑卒中患者中的现状及影响因素分析

目的 了解老年脑卒中患者害怕跌倒（fear of falling,FOF）的现状,并分析其影响因素.方法 采用害怕跌倒单条目问题和修正版跌倒效能量表（modified falls efficacy scale,MFES）分别测量170例老年脑卒中患者的FOF发生率和FOF程度,并应用Berg平衡量表（berg balance scale,BBS）和计时起立-行走测试（time up and gotest,TUGT）测量其平衡力和移动能力.结果 老年脑卒中患者FOF发生率为39.4％,FOF老年患者的跌倒效能得分低于非FOF老年患者[（78.21±21.88） vs （116.15±10.15）,P＜0.001].多因素Logistic回归分析显示平衡力受损、移动能力低下和近6m内跌倒史是发生FOF的独立危险因素,这三个因素可以解释总变量的56.6％.结论 FOF在老年脑卒中患者中较常见,平衡力低下、移动能力受损和近6m内跌倒史是害怕跌倒的危险因素.医护人员应对FOF老年脑卒中患者给予运动锻炼和跌倒预防健康教育相结合的方式进行干预,以改善其害怕跌倒心理.     

Does fear of falling influence spatial and temporal gait parameters in elderly persons beyond changes associated with normal aging?

BACKGROUND: Limited research exists on fear of falling and its affect on gait parameters. Studies have shown a relationship between fear of falling and restriction of activities. The purpose of this study was to determine if a fear of falling in elderly persons was associated with changes in spatial and temporal gait parameters, independent of a history of falls. It was hypothesized that, in elderly persons, gait changes would be associated with a preexisting fear of falling. METHODS: Ninety-five community-dwelling adults, aged 60-97 years (mean age = 74, standard deviation = 8.5) participated in this study. Participant scores on the Modified Falls Efficacy Scale determined an individual's placement into the "fearful" or "fearless" category. Spatial and temporal gait parameters of speed, stride length, step width, and double limb support time were assessed using the GAITRite system, a computerized electronic walkway. RESULTS: The fearful group had a significantly slower gait speed (p <.05) and shorter stride length (p <.05) when compared to the fearless group. Stride width was significantly longer (p =.05) and double limb support time was significantly prolonged (p <.05) in the fearful participants when measured against the fearless participants. CONCLUSIONS: The results of this study support the hypothesis that fear of falling does influence spatial and temporal gait parameter changes in elderly persons. Slower gait speed, shorter stride length, increased stride width, and prolonged double limb support time were found to be associated with a preexisting fear of falling.     

Associations of demographic, functional, and behavioral characteristics with activity-related fear of falling among older adults transitioning to frailty

OBJECTIVES: To determine, in a cohort of older individuals transitioning to frailty (defined by Speechley and Tinetti, 1991) who have previously fallen, whether there are significant associations between demographic, functional, and behavioral characteristics and activity-related fear of falling, using both the Falls Efficacy Scale (FES) and the Activities-Specific Balance Confidence Scale (ABC). DESIGN: Baseline cross-sectional analysis in a prospective cohort intervention study. SETTING: Twenty independent senior living facilities in Atlanta. PARTICIPANTS: Seventeen male and 270 female subjects (n = 287), age 70 and older (mean +/- standard deviation, 80.9 +/- 6.2), with Mini-Mental State Examination score > or = 24, transitioning to frailty, ambulatory (with or without assistive device), medically stable, and having fallen in the past year. MEASUREMENTS: Activity-related fear of falling was evaluated with the FES and ABC Scale. Because of the comparable data derived from each scale, associations with functional measures-related analyses were expressed using the latter. Depression was measured by Center for Epidemiological Studies Depression Scale. Functional measurements included timed 360 degrees turn, functional reach test, timed 10-meter walk test, single limb stands, picking up an object, and three chair stands. RESULTS: No statistically significant association was found between activity-related fear of falling and age. For the proposed activities, about half (ABC, 48.1%; FES, 50.1%) of the subjects were concerned about falling or showed lack of confidence in controlling their balance. A statistically significant inverse correlation was found between FES and ABC (r = -0.65; P < .001). African-American subjects showed more activity-related fear of falling than did Caucasians (odds ratio (OR): 2.7 for ABC; 2.1 for FES). Fearful individuals were more likely to be depressed and more likely to report the use of a walking aid than were nonfearful individuals. Fear of falling was significantly correlated to all of the functional measurements (P < .05). In a multivariable logistic regression model, depression, using a walking-aid, slow gait speed, and being an African-American were directly related to being more fearful of falling. CONCLUSIONS: Activity-related fear of falling was present in almost half of this sample of older adults transitioning to frailty. The significant association of activity-related fear of falling with demographic, functional, and behavioral characteristics emphasizes the need for multidimensional intervention strategies to lessen activity-related fear of falling in this population.     

Pilot study comparing the influence of different types of exercise intervention on the fear of falling in older adults

Background: Individuals who fear falling may restrict themselves from performing certain activities and may increase their risk of falling. Such fear, reflected in the form of falls efficacy, has been measured in only a small number of studies measuring the effectiveness of exercise interventions in the elderly. This may be due to the various types of exercise that can be performed. Hence the effectiveness of exercise on falls efficacy is relatively understudied. Therefore, there is a need to measure falls efficacy as an outcome variable when conducting exercise interventions in the elderly. Methods: A total of 43 elderly community‐dwelling volunteers were recruited and randomly allocated to a conventional exercise intervention, a holistic exercise intervention, or a control group. The interventions were performed 2 days per week for 10 weeks. Falls efficacy was measured at baseline and at the completion of the interventions using the Modified Falls Efficacy Scale (MFES). Results: Within group comparisons between baseline and follow‐up indicated no significant improvements in falls efficacy, however, the difference for the conventional exercise group approached statistical significance (baseline 8.9 to follow‐up 9.3; P = 0.058). Within group comparisons of mean difference MFES scores showed a significant difference between the conventional exercise group and the control group (conventional exercise group 0.4 vs control group ?0.6; P < 0.05). Conclusion: Given the lack of significant improvements in falls efficacy found for any of the groups, it cannot be concluded whether a conventional or a holistic exercise intervention is the best approach for improving falls efficacy. It is possible that the characteristics of the exercise interventions including specificity, intensity, frequency and duration need to be manipulated if the purpose is to bring about improvements in falls efficacy.     

Relationship Between Fear of Falling and Outcomes of an Inpatient Geriatric Rehabilitation Population—Fear of the Fear of Falling

OBJECTIVES: To examine the effects of various risk factors on three functional outcomes during rehabilitation. SETTING: Geriatric inpatient rehabilitation unit. DESIGN: Observational longitudinal study. PARTICIPANTS: One hundred sixty‐one geriatric rehabilitation inpatients (men, women), mean age 82, who were capable of walking at baseline. MEASUREMENTS: Functional status was assessed weekly between admission and discharge and at a follow‐up 4 months later at home using the function component of the Short Form—Late Life Function and Disability Instrument, the Barthel Index, and Habitual Gait Speed. Various risk factors, such as falls‐related self‐efficacy (Falls Efficacy Scale–International), were measured. Associations between predictors and functional status at discharge and follow‐up were analyzed using linear regression models and bivariate plots. RESULTS: Fear of falling predicted functioning across all outcomes except for habitual gait speed at discharge and follow‐up. Visual comparison of functional trajectories between subgroups confirmed these findings, with different levels of fear of falling across time in linear plots. Thus, superior ability of this measure to discriminate between functional status at baseline across all outcomes and to discriminate between functional change especially with regard to the performance‐based outcome was demonstrated. CONCLUSION: Falls‐related self‐efficacy is the only parameter that significantly predicts rehabilitation outcome at discharge and follow‐up across all outcomes. Therefore, it should be routinely assessed in future studies in (geriatric) rehabilitation and considered to be an important treatment goal.     

Hip protectors in aged-care facilities: a randomized trial of use by individual higher-risk residents.

OBJECTIVES: To investigate the effect of use of external hip protectors on occurrence of hip fracture. DESIGN: Randomized controlled trial, with randomization at the individual level. SETTING: residential aged-care facilities in urban areas of New South Wales, Australia. PARTICIPANTS: 174 women, aged 75 years and older, who had had two or more falls or one fall requiring hospital admission in the previous 3 months, and who lived in hostels or nursing homes. Eighty-six subjects were in the intervention group and 88 in the control group. INTERVENTION: Use of external hip protectors and encouragement by nurses to use the protectors. MEASUREMENTS: Follow-up visits at approximately 2 weeks and 2, 10 and 18 months to determine falls and fall injury (including hip fracture); we also measured adherence to hip protector use. RESULTS: The mean age of participants was 85; they lived in 32 different aged-care facilities, two-thirds of which were nursing homes. Intervention and control groups had similar baseline characteristics, with a mean Barthel index of 58 at enrollment and a mean Short Portable Mental Status Questionnaire score of six errors, indicating severe disability and major cognitive impairment. During follow-up, a mean of 4.6 falls per person occurred. There was no difference in mortality, with 28 deaths in each group. Eight hip fractures occurred in the intervention group and seven in the control group (hazard ratio 1.46; 95% confidence interval 0.53-4.51). No hip fractures occurred when hip protectors were being worn as directed. Adherence was about 57% over the duration of the study and hip protectors were worn at the time of 54% of falls in the intervention group. Adherence varied markedly between institutions, but the greatest was about 80%. CONCLUSION: Hip protectors were not effective in reducing the incidence of hip fractures in this study, but because of low statistical power, a reduction in risk of hip fracture of up to 50% may not have been detected. There was limited adherence with their use, resulting in a large number of falls occurring without hip protectors in place. All hip fractures in the intervention group occurred when hip protectors were not being used.     

Severity of sarcopenia is associated with postural balance and risk of falls in community-dwelling older women

Background/Study context: Falls represent the leading cause of accidental deaths in the elderly. Sarcopenia is a geriatric syndrome defined as the loss of muscle mass and strength. However, the association between falls and sarcopenia is still unclear. Thus, the aim of the present study was to investigate the association between different stages of sarcopenia and postural balance, risk of falls, and fear of falling in community-dwelling older women. Methods: A total of 196 women (68.6 ± 6.5 years) underwent body composition (Dual-energy X-ray Absorptiometry), muscle strength (isokinetic), and functional (Timed Up-and-Go) assessments. Sarcopenia was classified according to European Working Group on Sarcopenia in Older People. Center of pressure (CoP) sway, risk, and fear of falling were assessed through force platform, QuickScreen, and Falls Efficacy Scale, respectively. ANOVA models and chi-squared were used to compare groups. Results: Severe sarcopenic subjects presented higher risk of falling when compared to the other stages (p < 0.01). Regarding CoP sway, both mean speed and mediolateral range were significantly higher in severe sarcopenia when compared to both nonsarcopenia and presarcopenia (p < 0.05). Fear of falling was higher in all sarcopenia stages when compared to nonsarcopenic individuals (p < 0.05). Conclusion: Sarcopenia negatively affects balance, and both risk and fear of falling in community-dwelling older women. Moreover, this study provides evidence that sarcopenia severity is further associated to reduced balance and imposes an even greater risk of falls in the elderly.     

Development and initial validation of the Falls Efficacy Scale-International (FES-I)

BACKGROUND: There is a need for a measure of fear of falling that assesses both easy and difficult physical activities and social activities and is suitable for use in a range of languages and cultural contexts, permitting direct comparison between studies and populations in different countries and settings. OBJECTIVE: To develop a modified version of the Falls Efficacy Scale to satisfy this need, and to establish its psychometric properties, reliability, and concurrent validity (i.e. that it demonstrates the expected relationship with age, falls history and falls risk factors). DESIGN: Cross-sectional survey. SETTING: Community sample. Method: 704 people aged between 60 and 95 years completed The Falls Efficacy Scale-International (FES-I) either in postal self-completion format or by structured interview. RESULTS: The FES-I had excellent internal and test-retest reliability (Cronbach's alpha=0.96, ICC=0.96). Factor analysis suggested a unitary underlying factor, with two dimensions assessing concern about less demanding physical activities mainly in the home, and concern about more demanding physical activities mainly outside the home. The FES-I had slightly better power than the original FES items to discriminate differences in concern about falling between groups differentiated by sex, age, occupation, falls in the past year, and falls risk factors (chronic illness, taking multiple or psychoactive medications, dizziness). CONCLUSIONS: The FES-I has close continuity with the best existing measure of fear of falling, excellent psychometric properties, and assesses concerns relating to basic and more demanding activities, both physical and social. Further research is required to confirm cross-cultural and predictive validity.     

Hip protectors and prevention of hip fractures in older persons

Hip fractures are a worldwide problem with consequences for the health care system as well as for the individual patient. Falls in the presence of osteoporosis are the main reason for these fractures. The effectiveness of hip protectors in preventing hip fractures has been proven in several biomechanical studies; however, adherence is low. Therefore clinical studies reveal conflicting results. In order to increase adherence, it is necessary to educate older persons who are at risk on the dangers of hip fractures and the value of hip protectors as a preventive device. The design and wearing comfort of hip protectors are also important factors in adherence. Hip protectors with a more patient-friendly design are now available, and new studies should help clarify relevant issues.     

Falls self-efficacy as a mediator of fear of falling in an exercise intervention for older adults

This study examined the role of falls self-efficacy as a potential mediator of the exercise and fear-of-falling relationship. The study sample involved 256 community-dwelling older adults aged 70-92 years (M = 77.48, SD = 4.95) who were recruited from a local health care system in Portland, Oregon, and participated in either a Tai Chi (n = 125) or a stretching control (n = 131) exercise intervention, three times per week, for 6 consecutive months. Measures of falls self-efficacy and fear of falling were assessed at baseline and at 3-month and 6-month follow-ups. Intention-to-treat analyses were conducted to evaluate the hypothesis of falls self-efficacy as a mediator of change in fear of falling that resulted from the 6-month Tai Chi intervention. Results supported the mediational hypothesis in that Tai Chi participants, who evidenced improvement in falls self-efficacy over the course of the intervention, reported greater reductions in fear of falling, compared with those in the stretching control condition. Results suggest that exercise interventions designed to improve falls self-efficacy are likely to reduce fear of falling in older adults.     

EBM of hip protectors

In Japan, where the population is rapidly growing older, the prevention of hip fractures is becoming increasingly important. Although bisphosphonates were reported to prevent these fractures, their effectiveness was confirmed in relatively younger elderly patients. The prevention of hip fractures, the majority of which occur in older people, may not be achieved sufficiently only by bisphosphonates, and may require other measures including the use of a hip protector. Elderly people who tend to fall, nursing-home residents, and elderly patients who have already suffered from a hip fracture are considered to be good candidates for wearing hip protectors. The main mechanism of hip fractures is falling sideways over the trochanter. Hip protectors have been developed to attenuate the impact force on the trochanter that results from falling. There have been 6 randomized clinical trials and 4 of them confirmed the efficacy of hip protectors in preventing hip fractures. The other 2 reports did not show a statistically significant efficacy, but a large number of falls occurred without wearing hip protectors. The problem of the limited adherence with their use should be solved.     

Exploring the relationship between fear of falling and neuroticism: a cross-sectional study in community-dwelling women over 70

BACKGROUND: Fear of falling in older adults has been associated with generalised anxiety and may lead to avoidance of activities, with a further negative impact on future falls. Individual differences in personality associated with anxiety have not been previously examined in relation to fear of falling. Current assessment measures and interventions designed to reduce fear of falling in older adults do not take into account perceptions of anxiety associated with individual differences in personality. AIM: To determine whether the core personality trait dimension of neuroticism can predict fear of falling in a community-dwelling sample of women > or = 70 years of age. METHODS: Cross-sectional data from 1,691 UK, community-dwelling female participants aged > or = 70 years were examined using multiple and logistic regression analysis. Fear of falling was measured on a 6-point Likert scale. Neuroticism was measured using the Eysenck personality inventory. RESULTS: The significant independent odds ratios (OR) of predicting fear of falling were: neuroticism (OR 1.47 per SD increase, P<0.001), history of falling (OR 1.57, P<0.001), experience of fracture (OR 1.78, P = 0.014), need to use both arms to push up to rise from a chair (OR 1.56, P = 0.001), poor subjective general health, as measured by the SF12 (OR 1.63 per SD decrease, P<0.001) and living alone (OR 1.31, P = 0.031). CONCLUSIONS: Neuroticism seems to be an important psychological factor in the experience of fear of falling in community-dwelling older women. It may be relevant for inclusion in current assessment measures and for consideration in the design of interventions to reduce fear of falling.     

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

OBJECTIVES: To examine whether fear of falling is a probable cause of reduced recreational physical activity levels in healthy older women. DESIGN: Cross-sectional analysis of baseline data from a longitudinal study. PARTICIPANTS: One thousand five hundred older, ambulatory women (aged 70-85), selected at random from the electoral roll. MEASUREMENTS: Self-reported recreational physical activity levels and fear of falling, demographic variables, anthropometric variables and measures of disability, and physical and cognitive function. RESULTS: The study subjects had low levels of physical and cognitive impairments; 24.1% of the group was obese (body mass index> 30). Twenty-six percent of the women did not participate in recreational physical activity; 39% participated in sufficient activity to gain probable health benefits. Although the women who did not participate in recreational activities were most likely to report fear of falling (45.2%), it was common in the group as a whole (33.9%), including the most active women (27.0%). Independent risk factors for nonparticipation in physical activity were fear of falling (odds ratio (OR)=0.70, 95% confidence interval (CI)=0.54-0.90, P=.006), obesity (OR=0.50, 95% CI=0.38-0.66, P=.001), and slower times on the timed up-and-go test (OR=0.88, 95% CI=0.84-0.92, P=.001). Fear of falling was also independently associated with lower recreational physical activity levels in women who were active (beta=-0.09, P=.003). Subgroup analysis suggested that fear of falls affected activity levels at a predisability stage in women with mildly impaired mobility. CONCLUSIONS: Fear of falling is common in healthy, high-functioning older women and is independently associated with reduced levels of participation in recreational physical activity. Fear of falling is an important psychological barrier that may need to be overcome in programs attempting to improve activity levels in older women.