Balance,fear of falling,pain and gait aid use by low care older people: pilot study

Objective: To investigate the influence of balance, fear of falling and pain on the type of gait aids used by low care residential older persons. Method: A cross‐sectional design was used. Valid and reliable measures of balance (Berg Balance Test), fear of falling (Falls Efficacy Scale) and pain (Geriatric Pain Measure) were collected. The influence of these clinical factors on the type of gait aid subjects used (no aid, stick or frame, or both) was analysed using one‐way anova for multiple independent groups. Results: Balance and fear of falling were significantly related to the type of gait aid subjects used (P < 0.05), whereas pain had no significant influence (P > 0.05). Conclusions: Balance and fear of falling are significantly associated with the type of gait aid used in this low care population and thus might be important clinical factors to consider when prescribing gait aids. The Berg Balance Test and the Falls Efficacy Scale appear to be useful quantitative tools that might assist this.     

Systematic review and meta-analysis of fear of falling and fall-related efficacy in a widely disseminated community-based fall prevention program

BackgroundFear of falling restricts mobility and increases fall risk among older adults. Fall-related efficacy (i.e. the confidence to perform activities without falling), a construct related to fear of falling, has also been associated with active living and fall prevention. This study statistically synthesized the program effects of A Matter of Balance Volunteer Lay Leader (AMOB/VLL) model, designed to improve fall-related efficacy and promote daily activities among community-dwelling older adults.MethodsResearch articles and doctoral dissertations that examined the effect of the AMOB/VLL on fear of falling and fall-related efficacy were searched from multiple databases. A random effects model was used to compute mean weighted effect sizes, 95 % CIs, and heterogeneity (I²). Bias was examined through a funnel plot and Egger’s test. Factors associated with heterogeneity were also explored.ResultsSeventeen AMOB/VLL studies involving 3,860 participants were identified. The pooled effects of the 13 studies with sufficient information for effect size calculation, were −0.29 (95 % CI: −0.40, −0.19) for fear of falling and 0.51 (95 % CI: 0.42, 0.60) for fall-related efficacy. Effect sizes differed partially due to outcome measures of fall-related efficacy. Covariate adjustment and study quality were not associated with differences in effect sizes. No substantial evidence of asymmetry and publication bias was found.ConclusionThis study provides evidence supporting AMOB/VLL as an effective intervention for reducing fear of falling and improving fall-related efficacy. A greater consistency in outcome measures is needed to optimally capture changes in fear of falling and fall-related efficacy among community-dwelling older adults.     

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.     

Transient versus persistent fear of falling in community-dwelling older adults: incidence and risk factors

OBJECTIVES: To investigate the incidence of fear of falling (FOF) and the risk factors associated with transient versus persistent FOF in community‐dwelling older adults. DESIGN: Prospective cohort study. SETTING: Bronx County, New York. PARTICIPANTS: Three hundred eighty participants without FOF at baseline in the Einstein Aging Study aged 70 and older. MEASUREMENTS: FOF was assessed at baseline and during follow‐up interviews at 2‐ to 3‐month intervals for a minimum 2 years. Incident FOF was classified as transient or persistent FOF. Transient FOF was defined as new‐onset FOF reported at only one interview, and persistent FOF was FOF reported at two or more interviews over a 2‐year period. RESULTS: Twenty‐four‐month cumulative incidence of incident FOF was 45.4%, with 60.0% of FOF being persistent. Predictors of incident FOF included female sex (adjusted hazard ratio (aHR)=1.55, 95% confidence interval (CI)=1.08–2.23), depressive symptoms (aHR=1.16, 95% CI=1.07–1.26), falls (aHR=1.50, 95% CI=1.01–2.21), and clinical gait abnormality (aHR=2.07, 95% CI=1.42–3.01). The proportion of participants with incident FOF increased linearly with increasing number of risk factors. Predictors for transient and persistent FOF were depressive symptoms and clinical gait abnormality. Female sex and previous falls were predictors of persistent but not transient FOF. CONCLUSION: FOF status in older adults may change over time, with shared and distinct risk factors for persistent and transient FOF. Understanding the dynamic nature of FOF and these risk factors will help identify high‐risk groups and design future intervention studies.     

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

OBJECTIVES: To identify the characteristics associated with restricting activity because of fear of falling (activity restriction) and to determine which characteristics distinguish older persons who restrict activity from those who have fear of falling but do not restrict their activities (fear of falling alone). DESIGN: Population-based cross-sectional study. SETTING: General community. PARTICIPANTS: One thousand sixty-four community-living persons aged 72 and older. MEASUREMENTS: Candidate predictors were identified from the following domains: demographic, health status, physical, psychosocial, and fall-related. The outcome measure was the report of no fear of falling, fear of falling alone,or activity restriction. RESULTS: Fifty-seven percent of the cohort reported no fear of falling, 24% reported fear of falling alone, and 19% reported restricting activity. The proportion of participants with poor health status, slow timed physical performance, activities of daily living disability, and poor psychosocial function was highest in those with activity restriction, intermediate in those with fear of falling alone, and lowest in those with no fear of falling. Of participants with fear of falling, characteristics independently associated with activity restriction were history of an injurious fall, slow timed physical performance, two or more chronic conditions, and depressive symptoms. CONCLUSION: Older persons who restrict activity are more physically frail and have a greater burden of chronic conditions and depressive symptoms than those who have fear of falling alone. These differences between persons with fear of falling may guide the refinement of clinical interventions and preventative programs.     

Fear of falling reduced by a lay led home-based program in frail community-dwelling older adults: A randomised controlled trial

BackgroundIn older adults, fear of falling (FOF) leads to a decline in daily physical activity quality of life and an increased risk of falling. The aim of this randomised controlled trial was to assess the effects of a 12-week home-based intervention program carried out by lay volunteers on FOF in frail older adults.MethodsThirty-nine participants were randomised to a physical training and nutrition (PTN) group and 41 participants to a social support (SOSU) group. In the PTN group, strength training and conversation about optimising nutrition were performed twice weekly, and the SOSU group received home visits without intervention. FOF and change of FOF were assessed using the Falls Efficacy Scale – International (FES-I). The Short Physical Performance Battery (SPPB), the Physical Activity Scale for the Elderly (PASE) and maximum handgrip strength and their changes were also assessed.ResultsThe mean FES-I score at baseline was 42.7 points and was significantly associated with the SPPB and PASE scores. The FES-I score significantly changed in the PTN group from 44.1 to 39.9 points over the course of the intervention. Twenty-seven percent of the participants showed a decreased FES-I score of at least 4 points. This decrease was associated with an increase in the SPPB score and an increase in handgrip strengthConclusionA 12-week structured physical training and nutrition intervention carried out by lay volunteers, which leads to an increase in physical activity and improved physical performance, can reduce FOF by about 10%.     

Prevalence and correlates of fear of falling in Korean community-dwelling elderly subjects

Purpose

This study was conducted to investigate the factors related to fear of falling in elderly subjects, with a view to developing interventions to prevent falls.

Methods

Data from 9033 elderly subjects aged ≥ 65 years were analyzed from the 2008 National Elderly Survey of the Korea Ministry of Health & Welfare.

Results

In total, 76.6% of elderly Korean subjects had fear of falling. Factors associated with an increased risk of fear of falling in elderly subjects were, in order from highest to lowest, previous experience of falling (odds ratio [OR] = 6.41, p < 0.001), experience of body pain (OR = 2.45, p < 0.001), lower perceived health status (OR = 1.89, p < 0.001), presence of depression (OR = 1.82, p < 0.001), receipt of more doses of drugs per day for those receiving 1–2 (OR = 1.72, p < 0.001) or ≥ 3 doses of drugs per day (OR = 1.67, p = 0.001), older age (OR = 1.68, p < 0.001), female gender (OR = 1.64, p < 0.001), dependence for instrumental activities of daily living (OR = 1.55, p < 0.001), dependence for activities of daily living (OR = 1.44, p = 0.017), and lower education level (OR = 1.18, p = 0.016).

Conclusion

The fear of falling can be attenuated by providing interventions to reduce the impact of modifiable risk factors that were identified in this study.     

Reduction in fear of falling through intense tai chi exercise training in older, transitionally frail adults

OBJECTIVES: To determine whether an intense tai chi exercise program could reduce fear of falling better than a wellness education (WE) program in older adults who had fallen previously and meet criteria for transitioning to frailty. DESIGN: Cluster-randomized, controlled trial of 48 weeks' duration. SETTING: Ten matched pairs of congregate living facilities in the greater Atlanta area. PARTICIPANTS: Sample of 291 women and 20 men, aged 70 to 97. MEASUREMENTS: Activity-related fear of falling using the Activities-Specific Balance Confidence Scale (ABC) and the Fall Efficacy Scale at baseline and every 4 months for 1 year. Demographics, time to first fall and all subsequent falls, functional measures, Centers for Epidemiologic Studies Depression Scale, medication use, level of physical activity, comorbidities, and adherence to interventions. RESULTS: Mean ABC was similar in both cohort groups at the time of randomization but became significantly higher (decreased fear) in the tai chi cohort at 8 months (57.9 vs 49.0, P<.001) and at study end (59.2 vs 47.9, P<.001). After adjusting for covariates, the mean ABC after 12 months of intervention was significantly greater in the tai chi group than in the WE group, with the differences increasing with time (mean difference at 12 months=9.5 points, 95% confidence interval=4.8-14.2, P<.001). CONCLUSION: Tai chi led to a significantly greater reduction in fear of falling than a WE program in transitionally frail older adults. The mean percentage change in ABC scores widened between tai chi and WE participants over the trial period. Tai chi should be considered in any program designed to reduce falling and fear of falling in transitionally frail older adults.     

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.     

Detection and management of falls and instability in vulnerable elders by community physicians

OBJECTIVES: To investigate quality of care for falls and instability provided to vulnerable elders. DESIGN: Six process of care quality indicators (QIs) for falls and instability were developed and applied to community-living persons aged 65 and older who were at increased risk of death or decline. QIs were implemented using medical records and patient interviews. SETTING: Northeastern and southwestern United States. PARTICIPANTS: Three hundred seventy-two vulnerable elders enrolled in two senior managed care plans. MEASUREMENTS: Percentage of QIs satisfied concerning falls or mobility disorders. RESULTS: Of the 372 consenting vulnerable elders with complete medical records, 57 had documentation of 69 episodes of two or more falls or fall with injury during the 13-month study period (14% of patients fell per year, 18% incidence). Double this frequency was reported at interview. An additional 22 patients had documented mobility problems. Clinical history of fall circumstances, comorbidity, medications, and mobility was documented from 47% of fallers and two or more of these four elements from 85%. Documented physical examination was less complete, with only 6% of fallers examined for orthostatic blood pressure, 7% for gait or balance, 25% for vision, and 28% for neurological findings. The evaluation led to specific recommendations in only 26% of cases, but when present they usually led to appropriate treatment modalities. Mobility problems without falls were evaluated with gait or balance examination in 23% of cases and neurological examination in 55%. CONCLUSION: Community physicians appear to underdetect falls and gait disorders. Detected falls often receive inadequate evaluation, leading to a paucity of recommendations and treatments. Adhering to guidelines may improve outcomes in community-dwelling older adults.     

Differential determinants of physical daily activities in frail and nonfrail community-dwelling older adults

Background/Purpose

The purpose of this study was to determine whether or not daily activities determined by average daily steps are associated with age, gender, body mass index, fear of falling, and physical functions (locomotive function, balance function, and muscle power) in community-dwelling nonfrail and frail older adults.

Methods

This is a cross-sectional study conducted in community-dwelling older adults in Japan. Based on the Timed Up and Go (TUG) test, 629 elderly adults were divided into two groups: 515 were grouped to nonfrail elderly (TUG time less than 13.5 seconds, mean age 77.0 ± 7.2 years) and 114 to frail elderly (TUG time of 13.5 seconds or more, mean age 76.1 ± 7.5 years). Daily physical activities were determined by average daily steps measured by pedometer and four other physical function tests (10-m walk test, single-leg standing, functional reach, and five-chair stand test) were performed along with the assessment of fear of falling.

Results

Stepwise regression analysis revealed that age, gender, 10-m walk test, and single-leg standing were significant and independent determinants of the average step counts in the nonfrail elderly (R² = 0.282, p < 0.001), whereas fear of falling was the only significant and independent determinant of the average step counts in the frail elderly (R² = 0.119, p < 0.001).

Conclusion

These results indicate that differential factors may be related to daily activities depending on the level of frailty in community-dwelling older adults.     

Fear of falling (FF): Psychosocial and physical factors among institutionalized older Chinese men in Taiwan

Fear of falling (FF) can have multiple adverse consequences in the elderly. Although there are various fall prevention programs, little is known of FF and its associated characteristics. This study examined FF-associated physical and psychosocial factors in older Chinese men living in a veterans home in southern Taiwan. Subjects with a recent episode of delirium, of bed-ridden or wheelchair-bound status, severe hearing impairment or impaired cognition were excluded. Overall, 371 residents (mean age 82.1 ± 5.11 years, all males) participated. The prevalence of FF was 25.3%. Univariate analysis revealed that subjects in the FF group were older age, having lower education level, poorer sitting and standing balance, poorer activities of daily living (ADL), more depressive symptoms, higher chances of using walking aids, neurologic diseases, and a history of fall within the past 6 months. Logistic regression showed that depressive symptoms (odds ratio = OR = 6.73, 95%CI: 3.03-14.93, p < 0.001), activities of daily living (OR = 2.48, 95%CI: 1.08-5.71, p = 0.033), history of fall in the past 6 months (OR = 2.47, 95%CI: 1.04-5.9, p = 0.041), and neurological diseases (OR = 2.75, 95%CI: 1.15-6.56, p = 0.023) were all independent risk factors for FF.     

A randomized trial comparing Tai Chi with and without cognitive-behavioral intervention (CBI) to reduce fear of falling in community-dwelling elderly people

The aim of this randomized trial was to compare the effects of Tai Chi with and without CBI on a primary outcome of reducing the fear of falling, and on secondary outcomes including encouraging better social engagement, improving self-perceived personal wellbeing, and achieving better mobility among elderly people with fear of falling. One hundred and twenty-two community-dwelling elderly people aged ≥65 were randomly assigned to either a Tai Chi or a Tai Chi plus CBI group. Participants’ level of fear of falling, physical mobility, self-perceived personal wellbeing and social participation were compared before and after completing the 8-week intervention and then at a 2-month follow-up. The findings showed that Tai Chi both with and without CBI had a similar effect on reducing elderly people's fear of falling, but only Tai Chi plus CBI had a positive effect on participants’ self-perceived personal wellbeing. Tai Chi both with and without CBI had no effect on participants’ self-perceived social participation and mobility. Apart from a slight improvement in participants’ self-perceived personal wellbeing, other outcome effects were similar for Tai Chi with and without CBI. This finding raises a question about the additive effects of combined intervention over Tai Chi alone in reducing elderly people's fear of falling. In view of the higher demand for resources and manpower to implement a combined intervention, further study is still required to confirm the potential additional benefits of this combined intervention prior to recommending it to community services.     

Generativity affects fear of death through ego integrity in German,Czech, and Cameroonian older adults

This cross-cultural study examined a potential direct effect of generativity and indirect effect through ego integrity on fear of death. In sum, 617 adults aged 60–86 from Germany, the Czech Republic, and Cameroon provided self-report information on their generative concern, ego integrity, and fear of death. Whereas it had no direct effect, generativity had an indirect effect on fear of death: It was associated with increased ego integrity which, in turn, was associated with reduced fear of death. This pattern was verified for the three cultural groups via structural equation modeling. Results suggest that generativity is not sufficient in coming to terms with one’s mortality. Instead, generativity contributes to ego integrity which then helps to face death relatively unafraid.     

Psychometric properties of the activities-specific balance confidence scale and the survey of activities and fear of falling in older women

OBJECTIVES: To compare the psychometric properties of the Activities-specific Balance Confidence Scale (ABC) and the Survey of Activities and Fear of Falling in the Elderly (SAFE).
DESIGN: Secondary analysis using baseline and 12-week data from a randomized, controlled trial on fall prevention.
SETTING: Upper Midwest metropolitan area with assessments conducted in participants' homes.
PARTICIPANTS: Population-based sample of 272 noninstitutionalized female Medicare beneficiaries aged 70 and older at risk of falling.
MEASUREMENTS: Participants self-administered the ABC, SAFE, Geriatric Depression Scale, and Medical Outcomes Study 36-item Short Form Survey. During a home visit, a nurse practitioner administered the Berg Balance Test and Timed Up and Go, measured gait speed, and asked about falls and chronic illnesses.
RESULTS: Baseline internal consistency measured using Cronbach alpha was 0.95 for the ABC and 0.82 for the SAFE. Baseline concurrent validity between the ABC and SAFE measured using a correlation coefficient was −0.65 ( P <.001). ABC and SAFE scores were significantly correlated at baseline with physical performance tests and self-reported health status. The ABC had stronger baseline correlations than the SAFE with most measures. Neither instrument demonstrated responsiveness to change at 12 weeks.
CONCLUSION: The ABC and SAFE demonstrated strong internal-consistency reliability and validity when self-administered. The ABC had stronger associations with physical functioning and may be more appropriate for studies focused on improving physical function. Both instruments demonstrated ceiling effects, which may explain the lack of responsiveness to change in relatively nonfrail older women. Instruments sensitive to measuring lower levels of fear of falling are needed to capture the full range of this phenomenon in this population.     

Usefulness,assessment and normative data of the Functional Reach Test in older adults: A systematic review and meta-analysis

ObjectiveTo identify the evidence about the usefulness of the Functional Reach Test to evaluate balance and falls risk; to verify the Functional Reach Test assessment method and other variables that could interfere in its results; and to establish normative data for older adults.Data sourcesManual and electronic searches (MEDLINE, Embase, Web of Science, LILACS, CINAHL, AgeLine and PsycINFO) were conducted with no language restrictions and published since 1990.Study selectionObservational studies about the Functional Reach Test in older adults with no specific health condition were selected.Data extractionTwo independent reviewers extracted data from studies and a third reviewer provided consensus. The studies methodological quality was appraised using the Newcastle-Ottawa Scale. Studies were submitted to critical analysis and meta-analysis.Results40 studies were selected (8 prospective and 32 cross-sectional). 33 studies used the Functional Reach to assess balance and 21 studies the falls risk. The meta-analysis of Functional Reach normative data was 26.6 cm [95%CI: 25.14; 28.06] for community-dwelling older adults (n = 21 studies) and was 15.4 cm [95%CI: 13.47; 17.42] for non-community older adults (n = 5 studies), with statistics differences between settings. Functional Reach Test performance was found to decrease with age. Sex and prospective history of falls did not influence the test results. Methodological quality analysis determined high to low risk of bias of the studies.ConclusionThis review revealed that the method of assessment and data of the Functional Reach Test varied greatly. Different values should be used for community- and non-community-dwelling older adults.     

The effects of multidimensional exercise on functional decline, urinary incontinence, and fear of falling in community-dwelling elderly women with multiple symptoms of geriatric syndrome: A randomized controlled and 6-month follow-up trial

This study assessed the effects of multidimensional exercises on functional decline, urinary incontinence, and fear of falling in community-dwelling Japanese elderly women with multiple symptoms of geriatric syndrome (MSGS). Sixty-one participants were randomly assigned either to an intervention (n = 31) or to a control group (n = 30). For 3-month period, the intervention group received multidimensional exercise, twice a week, aiming to increase the muscle strength, walking ability, and pelvic floor muscle (PFM). Outcome variables were measured at baseline, and after intervention and follow-up. The functional decline of the intervention group decreased from 50.0% at baseline to 16.7% after intervention and follow-up (Q = 16.67, p < 0.001). For urinary incontinence, the intervention group decreased from 66.7% at baseline to 23.3% after intervention and 40.0% at follow-up (Q = 13.56, p = 0.001), whereas the control group showed no improvement. Intervention group showed greater and significant decrease in the score of MSGS compared to control group (F = 12.66, p = 0.001). Within the subjects that showed improvement to normal status of MSGS, a significantly higher proportion demonstrated increased maximum walking speed at follow-up (Q = 6.50, p = 0.039). These results suggest that multidimensional exercise is an effective strategy for reducing geriatric syndromes in elderly population. An increase in walking ability may contribute to the improvement of MSGS.