Impact of depression and activities of daily living on the fear of falling in Korean community-dwelling elderly

This study determined the predictors of the fear of falling (FOF) in 213 South Korean community-dwelling elderly. The Fall Efficacy Scale, Pittsburgh Sleep Quality Index, Korean Geriatric Depression Screening Scale, and Barthel Index were used to measure the FOF, sleep quality, depression, and activities of daily living, respectively. In addition, information regarding the participants' demographic details and the number of types of medication was collected. The data were analyzed by using hierarchical regression. The general regression model, with the FOF as a dependent variable, was statistically significant. The FOF variance was partially explained. Depression and activities of daily living significantly influenced the FOF. Thus, the results indicate that the FOF in community-dwelling elderly Koreans is affected by depression and activities of daily living. Therefore, an older adult with recognized signs of depression must be provided with more appropriate care and the allocation of specific interventional strategies in order to maintain activities of daily living should be developed to manage the FOF.     

Fear of falling and changed functional ability following hip fracture among community-dwelling elderly people: an explanatory sequential mixed method study

Purpose: The aims of the study were to assess self-reported fear of falling (FOF) and functional ability among community-dwelling elderly people 3–6 months post hospital discharge after a hip fracture, to investigate the association between FOF and functional ability, and to explore the lived experience of FOF and disability when recovering from a hip fracture. Method: A sequential explanatory mixed method design was used in a “face-to-face” survey assessing FOF (Falls Efficacy Scale-International, FES-I), avoidance of activities (Modified survey of Activities and Fear of Falling, mSAFFE), functional ability (Functional Recovery Score, FRS), and mobility (New Mobility Score, NMS) followed by in-depth interviews of four participants. Interviews were analyzed using systematic text condensation. Results: Among the 33 participants 58% had a high degree of FOF and avoided more activities, needed more assistance in activities of daily living, and were less mobile than participants who had a low degree of FOF (p < 0.0001). According to the informants FOF reduced their functional ability and seriously altered their lives. Conclusions: FOF was common and significantly associated with activity avoidance, disability, and affected the lives of elderly recovering from a hip fracture. Some patients were physically incapacitated by FOF.

Implications for Rehabilitation

• Fear of falling can affect post discharge recovery following a hip fracture and is a factor limiting functional ability in elderly patients.

• Fear of falling should be addressed in clinical practice and future research as fear of falling-screening at hospital discharge might be beneficial in tailoring rehabilitation efforts to the individual patient.

• Older patients recovering from hip fracture need to perform activities of daily living independently and overcome fear of falling to sustain quality of life and contain costs to society.

     

The Impact of Falls and Fear of Falling on Health-Related Quality of Life in Taiwanese Elderly

This study aimed to investigate the relationship among falls, fear of falling (FOF), and health-related quality of life (HRQOL) in elderly people living in the community. The study was a community-based surveillance with residents aged 65 or over in Taipei, Taiwan. Data were collected in face-to-face interviews. Of the 4,056 participants, the prevalence of falls was 13.8% and the prevalence of FOF among women (62.6%) was significantly higher than that among men (46.2%). Adjusted by covariate factors, fear of falling was identified as a major factor related to HRQOL in the elderly and should be emphasized to assist the improvement of HRQOL in geriatrics.     

Use of formal community services by elders and their family caregivers 2 weeks following hospital discharge*

Early identification of elders who need care following hospitalization might enhance their health and the health of family members who help them with managing their care. The purpose of this study was to: (a) identify pre-discharge predictors of resource use following hospitalization; (b) describe the formal community services used by elders and their family caregivers during the 2 weeks following hospitalization; and (c) determine whether there is a difference in hospital re-admissions between elders who receive community nursing services compared with those who do not receive any services. The sample consisted of 185 elder/caregiver dyads in which the elders were hospitalized for an acute episode of a chronic condition. Both patients and family caregivers were interviewed before discharge and 2 weeks post-discharge. The findings indicate that pre-discharge functional ability and age are statistically significant predictors of home care services used 2 weeks post-discharge. The findings also suggest that elders who receive visiting nurse services are less likely to be re-admitted to the hospital.     

Effectiveness of Physical Therapy Interventions in Reducing Fear of Falling Among Individuals With Neurologic Diseases: A Systematic Review and Meta-analysis

ObjectiveTo summarize the effectiveness of physical therapy interventions to reduce fear of falling (FOF) among individuals living with neurologic diseases.Data SourcesPubMed, Physiotherapy Evidence Database, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health, and SportDiscuss were searched from inception until December 2019.Study SelectionClinical trials with either the primary or secondary aim to reduce FOF among adults with neurologic diseases were selected.Data ExtractionPotential articles were screened for eligibility, and data were extracted by 2 independent researchers. Risk of bias was assessed by the Cochrane Risk of Bias tool for randomized controlled trials and the National Institutes of Health Quality Assessment Tool for pre-post studies. A meta-analysis was performed among trials presenting with similar clinical characteristics. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to rate the overall quality of evidence.ResultsSixty-one trials with 3954 participants were included in the review and 53 trials with 3524 participants in the meta-analysis. The included studies presented, in general, with a low to high risk of bias. A combination of gait and balance training was significantly more effective compared with gait training alone in reducing FOF among individuals with Parkinson disease (PD) (mean difference [MD]=11.80; 95% CI, 8.22-15.38; P<.001). Home-based exercise and leisure exercise demonstrated significant improvement in reducing FOF over usual care in multiple sclerosis (MS) (MD=15.27; 95% CI, 6.15-24.38; P=.001). No statistically significant between-groups differences were reported among individuals with stroke and spinal cord injury. The overall quality of evidence presented in this review ranges from very low to moderate according to the assessment with the GRADE approach.ConclusionsGait with lower limb training combined with balance training is effective in reducing FOF in individuals with PD. Also, home-based or leisure exercise is effective among individuals with MS. However, because of several limitations of the included studies, further research is needed to examine the effectiveness of FOF intervention among individuals with neurologic diseases.     

Fear of falling does not alter the kinematics of recovery from an induced trip: a preliminary study

Marone JR, Rosenblatt NJ, Troy KL, Grabiner MD. Fear of falling does not alter the kinematics of recovery from an induced trip: a preliminary study.

Objective

To provide preliminary information about the relationships between self-reported fear of falling (FOF) in healthy community-dwelling women, number of falls, and recovery kinematics in response to a laboratory-induced trip.

Design

Cohort study.

Setting

Clinical research laboratory.

Participants

A subset of community-dwelling older women (N=33) recruited from studies of laboratory-induced trips and fall prevention.

Intervention

A laboratory-induced trip.

Main Outcome Measures

Number of fallers in the FOF group versus the control group. Recovery kinematics of FOF group falls versus control group falls, and FOF group recoveries versus control group recoveries were compared. Degree of FOF was assessed by using the Activities-Specific Balance Confidence (ABC) Scale.

Results

Falls occurred in 6 of 14 (43%) FOF and 4 of 16 (25%) control subjects (P=.26). The kinematics of FOF group falls were similar to those of control group falls. At completion of the initial recovery step, the FOF group showed significantly greater trunk extension velocity than controls (−82.1°/s±−66.1°/s vs −25.0°/s±−53.0°/s, respectively; P=.05). All other variables were not significantly different. ABC Scale scores of FOF subjects did not differ significantly between fallers and those who recovered (mean, 75.2±5.6, 71.1±11.8, respectively; P=.84).

Conclusion

Healthy community-dwelling older adults would benefit from fall prevention regardless of the presence of self-reported FOF.     

Is there a relationship between pain and psychological concerns related to falling in community dwelling older adults? A systematic review

Abstract

Purpose: To systematically review and synthesise the research evidence linking pain to psychological concerns about falling in community dwelling older adults. Methods: A systematic review was conducted in accordance with the preferred reporting items of systematic reviews and meta-analysis statement (PRISMA). Major electronic databases were searched from inception until June 2013. Two authors independently conducted the searches, extracted data and completed methodological quality assessments. Articles were included if they measured one of the psychological concerns related to falling in a sample of community dwelling older adults with pain, or explored the association between the two. Results: Of a potential 892 articles, 12 met the eligibility criteria (n?=?3398). The methodological quality of the included studies was variable and none of the included studies primary aim was to investigate the relationship between pain and psychological concerns related to falls. Two studies found significant differences in psychological concerns related to falls in older adults with pain and a control group. Nine out of 10 studies reported a significant correlation between pain and psychological concerns related to falls in their sample. Conclusion: This review provides provisional evidence that pain is associated with fear of falling (FOF), avoidance of activities due to FOF and falls efficacy in community dwelling older adults.

• Implications for Rehabilitation

• Pain is a common and pervasive problem in community dwelling older adults and can affect an individual’s mobility, levels of physical activity and increase their falls risk.

• Psychological concerns related to falls, such as fear of falling (FOF), falls efficacy and balance confidence are also common and troublesome issues in older adults, yet the association with pain has not been investigated with a systematic review.

• This review provides provisional evidence that pain may increase older adult’s risk of developing FOF, avoiding activities due to a FOF and impact their falls efficacy.

• In recognition of the findings of this review, clinicians working with older adults with pain should consider assessing psychological concerns related to falls and if necessary intervene if they identify an individual at risk.

     

Geriatric fear of falling measure: development and psychometric testing

Development of the geriatric fear of falling measure (GFFM) was based on a previous qualitative study of Taiwanese community-dwelling elders. Relevant parameters or items for assessing subscales were identified and tested in a three-stage process: item development, content validity testing and reliability testing. The GFFM was tested on two groups of community-dwelling elders in Taiwan (N=100 and 384) to examine validity and reliability. Good test-retest, internal consistency and inter-rater reliability were found. Confirmatory factor analysis and good overall model fits supported construct validity of the GFFM. Although these data are preliminary, the GFFM could be used as a quick screening instrument to evaluate fear of falling and an outcome indicator of nursing interventions.     

Components of a proper hospital discharge for elders

SIGNIFICANCE: Effective discharge planning is a vital link in continuity of care for elders. Previous studies identify problems with planning for elders' discharge from the hospital and problems elders encounter managing care post-discharge. However, little attention has been given to identifying effective discharge planning processes. Explicating the components of effective discharge planning is critical to replicate the process in other health care settings and predict post-discharge outcomes. PURPOSE: The purpose of this study was to identify the components of effective discharge planning for elders and factors that impede planning. METHODS: Ethical approvals were obtained from the University and National Health Service (NHS) Trust. Qualitative methods were used and data were collected from two wards in a 78-bed geriatric rehabilitation hospital that was part of a National Health Service Trust serving Southwest London. Data included semi-structured interviews and documents related to discharge planning, care delivery, and community resources. A total of 24 semi-structured interviews were conducted with health care professionals who were part of the hospital's multidisciplinary team, those affiliated with the Community Trust that provided aftercare, elders, and family carers. RESULTS: Participants consistently used the term "proper discharge" when referring to effective discharge planning. The multidisciplinary team comprised a vital context for a proper discharge. The findings indicated that three circles of communication were central in a four stage discharge process. Different circles of communication were key at different stages. CONCLUSIONS: The findings provide insights for educating nurses about effective planning practices and examining the global significance of impediments to a proper hospital discharge.     

Influence of Transfer Quality and Wheelchair Type on Fear of Falling Among Full-Time Wheelchair Users

ObjectiveTo evaluate the influence of transfer quality and demographics on fear of falling (FOF) among full-time wheelchair users.DesignSecondary data analysis.SettingUniversity research laboratory and community, United States.ParticipantsNinety-six individuals (N=96) living with multiple sclerosis or spinal cord injury who use a manual or power scooter full time with median age of 54.00 years (interquartile range, 29.00 years), and median duration of health condition of 19.50 years (interquartile range, 23.00 years) were included. Fifty-two participants (54%) were manual wheelchair users.InterventionsNot applicable.Main Outcome MeasuresDemographics information included age, sex, duration of health condition, height, weight, body mass index, and wheelchair type. To assess transfer quality, the Transfer Assessment Instrument versions 3.0 and 4.0 were used. The Spinal Cord Injury Falls Concern Scale was used to quantify FOF. Stepwise linear regression analysis was conducted to examine factors influencing FOF.ResultsParticipant's age, sex, duration of health condition, wheelchair type, and transfer quality were associated with FOF. The regression analysis indicated transfer quality (β=−0.25, P<.01) and wheelchair type (manual wheelchair, β=− 0.32, P<.01) were significant predictors of FOF, R²=20% (F=11.19; P<.01).ConclusionsCompared with manual wheelchair users, power wheelchair/scooter users with poor transfer quality reported higher levels of FOF. Clinicians and researchers working with wheelchair users should emphasize quality of transfers and consider the type of wheelchair while developing interventions to reduce FOF in this population. Further longitudinal prospective studies on modifiable factors associated with FOF among full-time wheelchair users are warranted.     

The effects of group music with movement intervention on agitated behaviours of institutionalized elders with dementia in Taiwan

BACKGROUND: Agitated behaviours are identified by caregivers as the most challenging in dementia care. Alternative approaches reducing occurrence of agitated behaviours and the need for chemical or physical restraints become valuable for institutionalized elders with dementia. OBJECTIVE AND SETTING: This study was to evaluate the effects of group music with movement intervention on occurrence of agitated behaviours of institutionalized elders with dementia in Taiwan. METHODS: A randomized controlled trial was used. Thirty-six institutionalized elders with dementia completed the study, with 18 in the experimental group receiving group music with movement intervention twice a week for 4 weeks and 18 in the control group receiving usual care without intervention. Modified Cohen-Mansfield Agitation Inventory was used to assess agitated behaviours at baseline, weeks 2 and 4. RESULTS: Agitated behaviours were significantly reduced in the experimental group following 4 weeks of group music with movement intervention compared to that of the control group (p<0.001). CONCLUSIONS: Group music with movement intervention can be beneficial in managing agitated behaviours of those with dementia and should be incorporated into care routines in residential facilities.     

What Is the Relation Between Fear of Falling and Physical Activity in Older Adults?

Objective

To describe the association between fear of falling (FOF) and total daily activity in older adults.

Design

Cross-sectional observational study.

Setting

Ambulatory clinical research training center.

Participants

Community-dwelling older adults aged ≥64 years (N=78), who were independent in ambulation with or without an assistive device.

Interventions

Not applicable.

Main Outcome Measures

FOF was defined by self-reported fear ratings using the Survey of Activities and Fear of Falling in the Elderly and self-reported fear status determined by response to the following question: Are you afraid of falling? Physical function was assessed using the Late Life Function and Disability Instrument. Physical activity was recorded using an accelerometer worn on the waist for 7 consecutive days, and mean daily counts of activity per minute were averaged over the 7-day period.

Results

Fear ratings were related to total daily activity (r=−.26, P=.02). The relation was not as strong as the relation of function and physical activity (r=.45, P<.001). When stratified by exercise status or functional status, fear was no longer related to total daily activity. Physical function explained 19% of the variance in physical activity, whereas the addition of fear status did not add to the explained variance in physical activity.

Conclusions

FOF is related to total daily physical activity; however, FOF was not independently associated with physical activity when accounting for physical function. Some FOF may be reported as a limitation in function.     

Fear of falling from a daily life perspective; narratives from later life

Fear of falling is a well-known condition in later life. The aim of this study was to illuminate the experiences and the meaning of fear of falling in a daily-life context. The method used was a qualitative study inspired by interpretive phenomenology. In narrative interviews, five community-dwelling women over 80 years of age told about their fear of falling from a daily-life perspective. The overall thematic analysis resulted in three main themes: the meaning of managing daily life necessities; keeping in contact with the outside; living with fear. The findings showed that to live with fear of falling was to discipline daily life, and to learn to live with the challenge of a vulnerable bodily condition and of losing control at different levels: from falling, from incontinence, from dirt and from the stigma of being in a humiliating situation. The women created a perception of independence while they were dependent on help and community care and on news from the outside. At an existential level, they coped with their fear by strengthening their will. The conclusion was that the older women studied accepted the condition of fear of falling. They shared the ability to cope in various ways with the limitations of their bodily capacity and their imbalance.     

The physical, mental, and emotional health of older people who are living alone or with relatives

In Korea, as in other countries, the number of older adults is growing substantially, and the proportion of older adults is projected to be 14.3% by 2022 [Ministry of Health and Social Affairs, Republic of Korea. (2003). Yearbook of health and social affairs statistics for 2003, vol. 49. Seoul, Korea: Government Printing Office]. The number of older people who are living alone in rural areas has been sharply increasing as a result of the migration of younger adults to urban areas for employment. However, information on the health status of elders who live alone is limited. Therefore, the purpose of this study was to compare the physical, mental, and emotional health status of elders who are living alone and those living with relatives in rural areas in South Korea. A cross-sectional survey design was used, and data were collected by interviewing subjects. A two-stage cluster sampling process was utilized for those living alone (n = 110) and those living with family members (n = 102). Both groups were enrolled in KyungRo-Dangs (senior centers), which are like community centers in the province. The results indicate that elders who are living with relatives scored significantly higher on several physical and mental health parameters than elders who are living alone. However, elders who are living with relatives had a significantly higher emotional health status in almost every item than elders who are living alone. These findings suggest that interventions to increase health status, especially the emotional health of elders who are living alone, are imperative and that the intervention should be sensitive to changes in the social structure of elders who are living alone in rural areas. Further studies are needed to understand the factors that are associated with the physical, mental, and emotional health of elders who are living alone and those who are living with relatives.     

Editorial Board EOV

Aims: This analysis aims to identify what older adults self-report about engagement in home activities (EHA), if there is a difference between perceived and observed activity performance in the home, and what predicts EHA. Methods: Baseline data were analyzed from a randomized controlled trial of an occupational therapy fall prevention intervention with older adults age 65 and older with a fall within 6 months. A multiple linear regression model was used to compare perceived and observed activity performance. Results: Ninety-two participants (mean age 77.7 ± 7.4) were included. EHA can be predicted (F(6, 85) = 13.86, p < 0.001, R = 0.70, R² = 0.50) by perceived activity performance (p = 0.02), fear of falling (FOF) (p < 0.001), and depression (p = 0.05). Conclusions: Perceived activity performance predicts EHA but observed activity performance does not, indicating clinicians should consider older adults' perceptions. Self-efficacy and awareness may be reasons for differences between perceived and observed activity performance in the home. FOF and depression are also predictors of EHA.     

The association between knee temperature and pain in elders with osteoarthritis of the knee: a pilot study

BACKGROUND: Osteoarthritis is a highly prevalent, disabling condition that causes significant pain and suffering among older adults. Cognitively impaired elders are as susceptible to osteoarthritis as their peers. However, since they have diminished ability to communicate their pain, an alternative method to detect osteoarthritis pain in cognitively impaired elders is urgently needed. Because the late stages of osteoarthritis involve joint inflammation with a mild increase in local temperature, skin surface temperature might reasonably be expected to serve as a proxy measure of osteoarthritis pain. If knee surface temperature could be shown to predict pain in cognitively intact elders, it could be used as a proxy measure of pain for cognitively impaired elders. AIM: To test this, the study reported here assessed the relationship between knee surface temperature and pain in cognitively intact elders with osteoarthritis of the knee. METHODS: We recruited 12 cognitively intact elders with documented osteoarthritis of the knee who lived in retirement apartments. Elders' pain and knee temperature were measured three times on three separate occasions. Osteoarthritis pain of the knee was measured using the Knee Pain Scale and the Western Ontario and McMaster Osteoarthritis Index pain subscale. A YSI Model 4000 Dual Channel Display Telethermometer was used to measure knee temperature. RESULTS: We found no significant associations between knee temperature and any of the pain measures used, with one exception. However, body mass index, amount of pain medication used and activity level observed during the interview were significantly related to elders' pain. CONCLUSION: Knee temperature does not appear to predict knee pain in elders with osteoarthritis of the knee. Body mass index, use of pain medication and activity level are better predictors of this.     

Attentional demands and daily functioning among community-dwelling elders

Everyday life is full of numerous demands for attention that can affect the ability to function. For elders, examples of these attentional demands include negotiating public transportation and driving, sensory losses, and physical discomforts and worries that make it harder to concentrate and complete tasks. The purpose of this study was to examine the relation between attentional demands and the ability to manage daily activities requiring concentration for 54 community-dwelling elders (34 women, 20 men). As theorized, attentional demands correlated (r = -.58) significantly with daily functioning: Elders with more attentional demands perceived themselves as having greater difficulty managing tasks requiring concentration. Attentional demands accounted for a significant proportion of variance in functioning (12%), even after partialling out the effects of depressive symptoms and health. Findings support the theorized relation between attentional demands and daily functioning, as well as nursing interventions aimed at decreasing attentional demands to promote effective functioning for elders.