The risk of being fearful or fearless of falls in older people: an empirical validation

PURPOSE: To investigate the risk of being fearful or fearless of falls in older people. METHODS: Using a force plate, postural control in different sensory and rhythmic conditions was measured in 263 community-dwelling older people. Other assessments included fear of falling, and handgrip strength. Fall incidence was assessed at baseline and during a one-year follow-up period. RESULTS: Logistic regression analysis revealed that increased lateral sway in near-tandem stance with eyes open (OR = 5.33; p < 0.01) and a worse performance on anteroposterior rhythmic weight shifts (OR = 0.65; p < 0.05) were related to falls. Univariate analyses revealed that older people with inappropriate high fear of falling according to their fall incidence had worse balance capacities on the rhythmic weight shifts (p < 0.05) but had similar static balance and physical capacities. Older people with inappropriate low fear of falling had a better hand grip (p < 0.05) but equally worse balance capacities than the comparison group. CONCLUSIONS: The results indicate the importance of lateral stability in relation to falls. They also suggest a substantial impact of inappropriate fear of falling on physical performance. Inappropriate high fear of falling may result in worse performance during dynamic balance tests, whereas older people with inappropriate low fear seem to overrate their capacities because of higher strength.     

Perceptions of older people living in the community about their fear of falling

Purpose. A fear of falls is widespread amongst older Australians. It increases the risk of falls and can lead to restriction of activity. The aim of this study was to gain insight into the precursors of a fear of falls and the experiences associated with this fear.

Methods. Using a qualitative, phenomenological method, individual, semi-structured interviews were conducted with 9 community-based participants who reported moderate to high levels of fear of falling.

Results. Most participants did not fear falling until they had experienced a fall themselves. The fear of falls was described as a negative experience, often linked with incapacitation, fear of dependence and having to leave their home. Participants chose to avoid falls by ‘taking care’. Five themes emerged from data analysis: activity levels; view of the future; perceptions of fall experiences; fall avoidance; and development of fear of falls.

Conclusions. The results indicated that factors other than a fear of falling resulted in a restriction of activities for these participants; therefore, it cannot be assumed that a fear of falls alone results in reduction of activity. Fear of falls, in combination with other potential issues that could restrict activities, should be taken into account in the development of fall-prevention programs in order to ensure clients' needs are being met.     

Fall risk factors in older people with dementia or cognitive impairment: a systematic review

Title.  Fall risk factors in older people with dementia or cognitive impairment: a systematic review.
Aim.  This paper is a report of a review conducted to identify and summarize specific risk factors for falls in older people with dementia or cognitive impairments as documented by prospective or case–control studies.
Background.  People with dementia have a doubled to threefold risk for falls, but the reasons for this have not yet been fully explained. Several integrative literature reviews discuss possible specific fall risk factors. However, there is lack of a systematic evaluation of studies.
Data sources.  The CINAHL, PubMed, EMBASE and PsychInfo databases were searched for the period between 1980 and May 2007.
Review methods.  A systematic review was conducted. Cohort or case–control studies published in English or German were included if they investigated risk factors for falls or fall-related injuries in a sample consisting of participants with dementia or cognitive impairment. Two reviewers independently assessed study quality.
Results.  Six prospective studies were included in the review. These differed concerning samples, settings, follow-up periods and examined variables. Therefore, meta-analysis was not possible. Eight categories of risk factors emerged: disease-specific motor impairments, impaired vision, type and severity of dementia, behavioural disturbances, functional impairments, fall history, neuroleptics and low bone mineral density.
Conclusion.  There is lack of sound studies examining fall risk factors in cognitively impaired elders. Well-known risk factors such as motor impairment show particular characteristics in people with dementia. In addition, behavioural disturbances contribute to their high risk for falls. Further prospective studies are needed.     

Polypharmacy and falls in older people: Balancing evidence-based medicine against falls risk

The term polypharmacy has negative connotations due to its association with adverse drug reactions and falls. This spectrum of adverse events widens when polypharmacy occurs among the already vulnerable geriatric population. To date, there is no consensus definition of polypharmacy, and diverse definitions have been used by various researchers, the most common being the consumption of multiple number of medications. Taking multiple medications is considered a risk factor for falls through the adverse effects of drug–drug or drug–disease interactions. Falls studies have determined that taking ≥ 4 drugs is associated with an increased incidence of falls, recurrent falls, and injurious falls. In light of existing evidence, careful and regular medication reviews are advised to reduce the effect of polypharmacy on falls. However, intervention studies on medication reviews and their effectiveness on falls reduction have been scarce. This article reviews and discusses the evidence behind polypharmacy and its association with falls among older individuals, and highlights important areas for future research.     

Achieving changes in practice from national audit: national audit of the organization of services for falls and bone health in older people

Aims Falls in older people are associated with increased mortality, physical injury, loss of function and independence. The extent to which trusts had met the requirements to implement an integrated falls service for older people by April 2005 was assessed by the performance of a national organizational audit. Method A report was produced for each participating site, containing their local audit results compared to the national picture. A scoring system was devised so that each site could be attributed an ‘organizational’ score and section scores. Thus, plans for a workshop developed to: learn from ‘High Performers’ regarding how they achieved services; use ‘expert’ knowledge and gain understanding about how to formulate action points. Results To complete the audit process, chief executives were asked to provide their action plans. Some sites had clearly used their audit results and their scores. This was identified by statements such as ‘recognised that performance was well below the national average in two sector scores’, as a result of which, an immediate action plan was drawn up. Conclusion The results of a national audit, especially when linked to a scoring system, can help local services benchmark themselves which, in association with action planning workshops and commitment from trusts, can achieve changes in practice.     

Incidence and risk factors for developing fear of falling in older adults

Fear of falling is a potential cause of excess disability and an emerging public health problem. This study explores fear of falling in a longitudinal study of falls to determine incidence, prevalence, and risk factors for developing fear of falling. Prospective cohort study with annual follow-up for 2 years, conducted in a large urban metropolitan area, included 890 community-dwelling older adults--approximately equal numbers in four age groups over the age of 65. Demographic data, falls, injuries, balance, fear of falling, cognition, health, and functional status were collected through annual interviews. The prevalence of fear of falling increased over 2 years from 23 to 43%; the incidence averaged 22.5% in the 2 follow-up years. Having two or more falls, feeling unsteady, and reporting fair or poor health status were independent risk factors for developing fear of falling. The incidence and prevalence of fear of falling is significant among community-dwelling older adults and has the potential to impact function and quality of life. Public health nurses should consider fear of falling in practice, in developing screening and health programs for older adults, and as an important avenue for further research.     

Diabetes management in older people: a focus on cardiovascular risk reduction

Cardiovascular disease remains the most common cause of death in persons with diabetes regardless of age. Increasing age combined with diabetes exert a synergistic effect on the vascular system increasing the atherosclerosis burden in older people with diabetes. Due to their high baseline risk, they stand to benefit most from interventions to reduce cardiovascular risk. Older people with diabetes are functionally heterogeneous and their management is challenging. Fit and independent individuals are likely to benefit from tight targets while a relaxed approach putting quality of life at the heart of management plans is more appropriate in the frail and dependent individuals with limited life expectancy.     

The fear and risk of community falls in patients following an intensive care admission: An exploratory cohort study

BackgroundMuscle weakness and impairments in physical functioning are well-recognised sequelae after critical illness. Whether individuals have a higher risk of community falls and a fear of falling has not been examined amongst individuals after critical illness.ObjectivesThe objective of this study was to explore the prevalence of falls, fear of falling, and fall risk in intensive care unit (ICU) survivors over a 6-month period after hospital discharge.MethodsThis was a nested exploratory study within a medical ICU. Fall prevalence was measured in line with established guidelines over 6 months after ICU discharge. Fear of falling and prediction of fall risk were assessed at 2, 4, and 6 months after discharge.ResultsTwelve individuals were included. Half of the cohort (n = 6) had at least one fall, with one-third sustaining more than one fall. There were 17 falls reported across the six individuals. Injuries requiring medical intervention were reported with five falls. Almost one-third were classified as ‘moderate’ to ‘severe’ injurious falls. Loss of balance and fatigue were reported as the main contributors to the falls. All individuals who had a fall reported a severe fear of falling at 2 months. Individuals classified as having ‘moderate’ to ‘high’ risk of falls at 2 months were more likely to have at least one fall.ConclusionsThis study suggests that ICU survivors may have a high fall risk, fear of falling, and fall prevalence, which can result in significant injury.     

Fear of Falling: A Qualitative Study Among Community-Dwelling Older Adults

The aim of this qualitative study was to uncover why older adults experience the fear of falling and discover the perceived consequences older adults fear. Seven participants between 61 and 88 (M = 75.4, SD = 9.1) years were interviewed. It was identified that participants developed the fear of falling after they had fallen or as they aged. Six themes related to the fear of falling were revealed, including Physical Injury, the Feeling Experienced when Falling, Becoming an Invalid or Burden, Losing Independence and Being Institutionalized, A Long Lie, and Being Confined to a Wheelchair or Unable to Walk. The results from this study indicated that older adults fear the consequences of falling. However, they fear not only physical injury as a result of the fall, but the injury's consequences that may precipitate the individual becoming more dependent on others and experiencing life altering events.     

The importance of 'approaching' older people: a grounded theory

jonasson l‐l. & berterö c. (2012) The importance of ‘approaching’ older people: a grounded theory. International Journal of Older People Nursing 7 , 29–36
doi: 10.1111/j.1748‐3743.2010.00248.x Aims and objectives. The aim of this study was to identify and describe the ethical values in caring encounters as experienced by older patients in their daily interaction with nurses in wards for older people. Background. Ethical values and morals are important aspects that influence the quality of care. Methods. Empirical observational study including follow‐up interviews. Twenty‐two older patients participated voluntarily in this study. Constant comparative analysis, the core foundation of grounded theory was used. Results. Five categories: being addressed, receiving respect, desiring to participate, increasing self‐determination and gaining self‐confidence formed the bases for the core category. Approaching. Approaching concerns how people become closer to each other in a physical space. It also includes how people become closer to each other in a dialogue, involving verbal or bodily communication. Conclusions and relevance to clinical practice. Approaching indicates the ethical values that guide nurses in their caring encounters with older patients. These values are noted by the patient and have an individual value as well as leading to improved quality of their care. The older patient will be confident and satisfied with the caring encounter if the desired components in the nurse's approaching are exhibited.     

The care of older people with dementia in acute hospitals

cowdell f. (2010) The care of older people with dementia in acute hospitals. International Journal of Older People Nursing 5 , 83–92. Aim. To explore the experiences of patients and nursing staff of the care received by older people with dementia in acute hospitals. Background. The prevalence of dementia is steadily increasing as is the number of people with the condition requiring acute hospital care. Significant concerns about the quality of this care have been raised. There is a paucity of knowledge about the views of such care from the perspectives of people with dementia and nurses. Method. An ethnographic approach was used and data were collected thorough observation and interviews in one acute hospital in the United Kingdom. Findings. Findings suggest that care for older people with dementia in acute hospitals is not always optimum although there are clear exceptions. Generally, people with dementia found the delivery of care and the experience of being in hospital distressing as they did not know what was happening and they were often ignored. Nurses strive to give good care but do not always achieve this. Conclusion. Bourdieu’s Model of Practice assists in explaining why care is as it is. There is a clear need to improve current practice. Relevance to clinical practice. It is imperative that innovative methods of developing practice are implemented and evaluated. Education alone will not lead to sustained changes in practice. Further research into this subject needs to be undertaken.