Feasibility of a cognitive behavioural group intervention to reduce fear of falling and associated avoidance of activity in community-living older people: a process evaluation

Background  

Fear of falling and associated avoidance of activity are common among older people and may have negative consequences in terms of functional decline, quality of life and institutionalisation. We evaluated the effects of a cognitive behavioural group intervention to reduce fear of falling and associated avoidance of activity among older persons. This intervention showed favourable effects on fear of falling, avoidance of activity, daily activity, and several secondary outcomes. The aim of the present study is to assess the feasibility of this cognitive behavioural group intervention for participants and facilitators.     

Evaluating an intervention to reduce fear of falling and associated activity restriction in elderly persons: design of a randomised controlled trial [ISRCTN43792817]

Background  

Fear of falling and associated activity restriction is common in older persons living in the community. Adverse consequences of fear of falling and associated activity restriction, like functional decline and falls, may have a major impact on physical, mental and social functioning of these persons. This paper presents the design of a trial evaluating a cognitive behavioural group intervention to reduce fear of falling and associated activity restriction in older persons living in the community.     

Automatic fall detectors and the fear of falling

We studied the effect of automatic fall detection units on the fear of falling. Participants were community alarm users living in the community aged over 75 years or those aged 60-74 years who had experienced a fall in the previous six months. Of those approached, 31% consented to take part; the main reason given for potential participants declining involvement was that they were happy with the technology they already had. Subjects were assigned to a control group (n = 21) or intervention group (n = 34) based on age, the number of self-reported falls in the previous six months and their score on the self-administered Falls Efficacy Scale (FES), which measures fear of falling on a scale of 0-100, with higher scores indicating less fear. The monitoring period lasted a mean of 17 weeks (SD 3.1). There was no significant difference between the intervention and control groups in their mean ratings of fear of falls (40.3 vs 37.5, difference 2.8, 95% CI 6.2 to 11.8), health-related quality of life or morale. Differences in fear of falling between an intervention subgroup who wore their detector at least occasionally (62%) and those who did not (38%) suggested that some people may benefit from a fall detector while others may lose confidence if they are provided with one. Most users who wore their detectors at least occasionally felt more confident and independent and considered that the detector improved their safety.     

The relationship between risk factors for falling and the quality of life in older adults

Background  

Falls are one of the major health problems that effect the quality of life among older adults. The aim of this study was to explore the relationship between quality of life (Short Form-12) and the risk factors of falls (balance, functional mobility, proprioception, muscle strength, flexibility and fear of falling) in older adults.     

Mobility limitations and fear of falling in non-English speaking older Mexican-Americans

Objective: To determine whether older Mexican-Americans who cannot speak and/or understand spoken English have higher rates of mobility limitations or fear of falling than their English-speaking counterparts.

Design: We conducted a cross-sectional analysis of 1169 community-dwelling Mexican-Americans aged 72–96 years from the 2000–2001 wave of the Hispanic Established Population for the Epidemiological Study of the Elderly. Mobility limitations were defined as having a Short Physical Performance Battery score ≤9, and fear of falling by participant report of being somewhat, fairly, or very afraid of falling. We determined the rates and odds ratios, for having mobility limitations and fear of falling as a function of English ability in those who were 72–96, <80, and ≥80 years of age.

Results: Among participants who were unable to speak and/or understand spoken English 85.7% had mobility limitations and 61.6% were afraid of falling, compared to 77.6% and 57.5%, respectively, of English speakers. Before adjusting for covariates, participants who did not speak and/or understand spoken English were more likely to have mobility limitations (odds ratio: 1.7; 95% CI: 1.3–2.4) but not fear of falling, compared to English speakers. Among those aged ≥80 years, but not those <80 years, who did not speak or understand English were more likely to have mobility limitations (odds ratio: 4.8; 95% CI:2.0–11.5) and fear of falling (odds ratio: 2.0; 95% CI:1.3–3.1).

Conclusion: Older Mexican-Americans who do not speak or understand spoken English have a higher rate of mobility limitations and fear of falling than their English-speaking counterparts.     

Development and validation of a psychosocial screening instrument for cancer

Background  

We are reporting on the development of a psychosocial screening tool for cancer patients. The tool was to be brief, at a relatively low reading level, capture psychological variables relevant to distress and health-related quality-of-life in cancer patients, possess good reliability and validity, and be free of copyright protection.     

Fragility, fear of falling, physical activity and falls among older persons: some theoretical considerations to interpret mediation

BACKGROUND: In their letters to the editor, Lacherez et al. [Lacherez, P.F., Wood, J.M., Kerr, G.K., 2007. Does activity level mediate or suppress the association between fear of falling and falls? Prev. Med. 31; (Electronic publication ahead of print)] and Hafeman and Schwartz [Hafeman, D., Schwartz, S., 2007. Assessing mediation: The necessity of theoretical considerations. Prev. Med. 26; (Electronic publication ahead of print)] questioned the correctness of using the term 'mediation' in our paper [Wijlhuizen, G.J., Jong, R. de, Hopman-Rock, M., 2007. Older persons afraid of falling reduce physical activity to prevent outdoor falls. Prev. Med. 44, 260-264.]. In this paper, we concluded that (outdoor) Physical activity mediates the relationship between Fear of falling and outdoor Falls. We investigated whether the term 'inconsistent mediation' might be a more appropriate term to use in this context. METHODS: Based on literature, we describe the relationship between fear of falling, physical activity, and falls within a causal model. RESULTS: Two causal pathways between Fear and Falls exist, with the causal pathway going from Fear of falling via Physical activity to Falls counteracting (is inconsistent with) the causal pathway going from Fear of falling via Hesitancy to Falls. CONCLUSION: The term 'inconsistent mediation' might be more appropriate to describe the causal relationships between Fear of falling, Falls, and Physical activity.     

Current quality of life and its determinants among opiate-dependent individuals five years after starting methadone treatment

Purpose  

This study explores the current QoL of opiate-dependent individuals who started outpatient methadone treatment at least 5 years ago and assesses the influence of demographic, psychosocial, drug and health-related variables on individuals’ QoL.     

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

OBJECTIVES. Fear of falling has been recognized as a potentially debilitating consequence of falling in elderly persons. However, the prevalence and the correlates of this fear are unknown. METHODS. Prevalence of fear of falling was calculated from the 1-year follow-up of an age- and gender-stratified random sample of community-dwelling elderly persons. Cross-sectional associations of fear of falling with quality of life, frailty, and falling were assessed. RESULTS. The prevalence of fear increased with age and was greater in women. After adjustment for age and gender, being moderately fearful of falling was associated with decreased satisfaction with life, increased frailty and depressed mood, and recent experience with falls. Being very fearful of falling was associated with all of the above plus decreased mobility and social activities. CONCLUSIONS. Fear of falling is common in elderly persons and is associated with decreased quality of life, increased frailty, and recent experience with falls.     

Interactions of socioeconomic position with psychosocial and environmental correlates of children's physical activity: an observational study of South Australian families

Background  

Evidence for psychosocial and environmental correlates on children's physical activity is scattered and somewhat unconvincing. Further, the moderating influences of socioeconomic position (SEP) on these influences are largely unexplored. The aim of this study was to examine the interactions of SEP, operationalised by mother education, and predictors of children's physical activity based on the Youth Physical Activity Promotion Model.     

A cross-sectional study of awareness of physical activity: associations with personal, behavioral and psychosocial factors

Background  

Interventions to promote physical activity frequently target hypothesized mediators of change, but these might be affected by a person's awareness of their own physical activity behavior. The paper aims to characterize a high-risk population by levels of awareness and to study associations between awareness and selected personal, behavioral and psychosocial factors.     

Physical activity,exercise and self-rated health: a population-based study from Sweden

Background  

In order to screen for the most inactive individuals in the population and target health-related interventions where they are most needed it is important to assess different forms of physical activity in population-based studies. The aims were (1) to identify the most inactive individuals in the population by assessing two dimensions of physical activity, (2) to investigate the correlation between exercise and total physical activity and (3) to investigate the association between exercise, total physical activity and good self-rated health.     

Reliability and validity of psychosocial and environmental correlates measures of physical activity and screen-based behaviors among Chinese children in Hong Kong

Background  

Insufficient participation in physical activity and excessive screen time have been observed among Chinese children. The role of social and environmental factors in shaping physical activity and sedentary behaviors among Chinese children is under-investigated. The purpose of the present study was to assess the reliability and validity of a questionnaire to measure child- and parent-reported psychosocial and environmental correlates of physical activity and screen-based behaviors among Chinese children in Hong Kong.     

Associations between objectively assessed physical activity levels and fitness and self-reported health-related quality of life in community-dwelling older adults

Background  

Previous studies investigated the associations between health-related quality of life (HRQoL) and self-reported physical activity (PA) and/or self-reported physical fitness which are not the most reliable methods to assess PA and fitness. Therefore, this study aimed to examine the associations between HRQoL and each of objectively assessed habitual PA and physical fitness.     

Correlates of objectively measured physical activity in adults and older people: a cross-sectional study of population-based sample of adults and older people living in Norway

Objectives

The aims of the study were to identify correlates of objectively measured physical activity and to determine whether the explanatory power of the correlates differed with sex, weight status or level of education.

Methods

Physical activity was assessed objectively in 3,867 participants, aged 20–85 years, for a consecutive 7 days using the ActiGraph GT1M activity monitor. Demographic and biological variables and levels of psychological, social environmental and physical environmental correlates were self-reported.

Results

The complete set of correlates explained 18.6 % (p < 0.001) of the variance in overall physical activity. Age and physical activity identity were the most important factors, explaining 4.8 and 3.2 % of the variance, respectively, whereas social environmental and physical environmental correlates did not significantly increase the amount of explained variance. Small interaction effects between demographic and biological variables and the correlates were observed.

Conclusions

Self-efficacy, perceived behavioural control and physical activity identity might be important targets for intervention. Intervention efforts aimed at influencing psychological correlates of physical activity may prove equally effective regardless of sex, weight status and level of education.     

Physical activity and sedentary behaviours among rural adults in suixi,china: a cross-sectional study

Background  

Modernisation and urbanisation have led to lifestyle changes and increasing risks for chronic diseases in China. Physical activity and sedentary behaviours among rural populations need to be better understood, as the rural areas are undergoing rapid transitions. This study assessed levels of physical activity and sedentary behaviours of farming and non-farming adults in rural Suixi, described activity differences between farming and non-farming seasons, and examined correlates of leisure-time physical activity (LTPA) and TV viewing.     

Habitual physical activity and health-related quality of life in older adults: interactions between the amount and intensity of activity (the Nakanojo Study)

Purpose  

This study examined relationships between health-related quality of life (HRQOL) and objective assessments of habitual physical activity in older adults, focusing on interactions between the amount and intensity of activity.     

The effects of Tai Chi on fall prevention,fear of falling and balance in older people: A meta-analysis

ObjectiveTai Chi (TC) is an exercise training that is becoming increasingly popular as an intervention for single fall prevention. This meta-analysis was performed to evaluate the efficacy of TC on fall rate, fear of falling and balance in older people.MethodsRandomized controlled trials published between 1988 and January 2009 were included. In the Netherlands (2009) we used random effects models for the analyses, with data reported as incidence rate ratios (IRR) for falls and standardized mean differences (SMD) for fear of falling and balance.ResultsNine trials (representing 2203 participants) were included in the analyses. Compared with exercise controls, TC participants showed significant improvements in fall rates (2 trials included, IRR: 0.51, 95% CI 0.38–0.68) and static balance (2 trials included, SMD: 0.47, 95% CI 0.23–0.72). Compared with non-exercise controls, no improvement was found for TC participants in fall rates (5 trials, IRR: 0.79, 95% CI 0.60–1.03) or static balance (2 trials, SMD: 0.30, 95% CI ? 0.50–1.10), but a significant improvement was found for fear of falling (SMD: 0.37, 95% CI = 0.03–0.70).ConclusionsCurrently there is insufficient evidence to conclude whether TC is effective in fall prevention, decreasing fear of falling and improving balance in people over age 50 years.     

Older persons afraid of falling reduce physical activity to prevent outdoor falls

OBJECTIVE: The aim of this study was to test the assumption that the level of outdoor physical activity mediates the relationship between fear of falling and actual outdoor falls according to the Task Difficulty Homeostasis Theory. METHOD: A prospective follow-up study of 10 months conducted in the year 2000 in three municipalities in the province of Friesland, The Netherlands. The participants were 1752 people aged 65 and older, living independently, in the community. Main baseline data were age, sex, outdoor physical activities (walking, bicycling), and fear of outdoor falls. The number of people who fell outdoors was recorded. RESULTS: People with a high fear of falling were more often low to moderately active or active compared with people who had no such fears and were more often very active. Fear of falling was not associated with outdoor falls, but it was after taking the level of physical activity into account. CONCLUSIONS: Outdoor physical activity mediates the relationship between fear of falling and actual outdoor falls. This implies that the incidence of falls as an outcome in studies does not adequately represent the impact of risk factors for falls and that level of physical activity should be taken into account.