The relationship between fear of falling,activities of daily living and quality of life among elderly individuals

Abstract The purpose of the present study was to examine the relationship between functional disability and fear of falling during daily activities. Also examined was the relationship between fear of falling and health-related Quality of Life (QOL). Health-related QOL concepts were measured using the Short Form 36 Health Survey (SF-36) within an elderly day services sample. Eligible subjects were elderly persons using Day Service (type B) who were capable of independently answering a questionnaire and had no memory problems. Forty-three males and 92 females were eligible for this study. Forty-nine (36.3%) subjects expressed no fear of falling, whereas 22 (16.3%) reported that they were very fearful of falling. Among females, walking and bathing had a highly significant relationship with the fear of falling. The fear of falling can contribute to psychological conditions such as depression, and also impacts on the health-related QOL of frail elderly people. Thus, it is critical to provide integrated health care activities for these individuals that address both psychological well-being and physical functioning.     

Factors that affect the quality of life of community-dwelling elderly women with musculoskeletal disorders

[Purpose] This study aimed to examine the quality of life (QOL) of community-dwelling elderly women with musculoskeletal disorders and factors that affect it. [Subjects] The subjects were 27 community-dwelling elderly women with musculoskeletal disorders (mean age: 76.3 ± 7.4 years). Their physical and psychological conditions, QOL, and other characteristics were researched. [Methods] The Japanese version of Life-Space Assessment was used to assess the subjects’ daily life activities; the Japanese version of Fall Efficacy Scale (FES), to assess their fear of falling; the Geriatric Depression Scale (GDS 15), to assess their depression status; and the Life Satisfaction Index K (LSIK), to assess their QOL. [Results] The results indicated that the number of family members living together, degree of pain, fear of falling, and depression affect the LSIK scores of the community-dwelling elderly women with musculoskeletal disorders. [Conclusion] The study results suggest that the LSIK scores of community-dwelling elderly women with musculoskeletal disorders can be improved by easing their pain, improving their physical abilities to prevent falls, and improving their mobility. The results also suggest that continuing rehabilitation treatment is required.Key words: Quality of life (QOL), Life satisfaction, Community dwelling elderly women with musculoskeletal disorders     

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.     

住院老年患者害怕跌倒心理状况的调查

目的探讨住院老年患者害怕跌倒心理的现状。方法使用跌倒效能量表对190例住院老年患者进行问卷调查,比较不同分组的评分差异。结果回收有效问卷185份。住院老年患者跌倒效能量表的平均分为（6.47±2.69）。随着年龄增加,跌倒效能量表评分明显下降,差异有统计学意义（P〈0.05）;有跌倒史患者评分显著低于无跌倒史患者（P〈0.05）;不同性别患者评分无差异（P〉0.05）;有抑郁史患者评分高于无抑郁史患者（P〈0.05）。结论害怕跌倒是住院老年患者的一种较为普遍的心理现象,在高龄、有跌倒史和有抑郁史的患者中更为明显。针对这些患者实施个性化的心理疏导和防范跌倒的指导,可减轻患者对跌倒的害怕,并有效预防跌倒的发生,提高生活质量。     

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.     

Experiencing the disease of breast cancer and getting life under control again

Women experiencing breast cancer are confronted with a live threatening disease and find themselves in a situation that changes and restricts their life psychologically, physically and socially. This qualitative investigation examined the experience of living with breast cancer from the perspective of newly diagnosed women. Ten women were interviewed at the end of their radiotherapy. The interviews are analysed with the method of content analysis. The findings show three domains. First domain: From living in fear of having breast cancer to the confirmation of its diagnosis. These women perceive the confirmation of the diagnosis as a shock and initially plunge into an existential crisis. The life threatening disease with an unpredictable future, feelings of vulnerability, uncertainty, hopelessness and anxiety often make them depressed. They need all their energy to maintain control over their life, by suppressing emotions to protect themselves from overwhelming feelings and suffering. Second domain: Experiencing the therapy. The women undergo weakening aggressive and invasive treatment regimes, leaving them in a condition worse than before. Physically exhausted, they sometimes don't know how to go through and overcome this time. Lack of energy, tiredness and fatigue are ongoing problems. Being diagnosed with breast cancer, the suddenly become patients, having to cope with a complex healthcare system. From doctors and nurses they expect empathy, caring and expertise. When in contact with health care, they often hide their suffering, while in fact, they are extremely vulnerable and in deep despair. Third domain: Hold out and live. Women living with breast cancer have no choice but to go through this situation. By motivating their self they regain and mobilise their vital energy. They try to suppress their suffering and dark, intrusive memories. Support from relatives is very important, however, such women tend to protect them from their suffering. The definition of the role of these relatives and their suffering remain unclear. In a future study, research is needed to determine precisely which psychosocial variables are effective in promoting greater health for women with breast cancer and their families, taking into consideration the dynamic of the relationship between women with breast cancer and their relatives as well as the influence of their mutual support.     

Is physical functioning influenced by activity-related pain prediction and fear of movement in patients with subacute low back pain?

In patients with low back pain (LBP), physical functioning may be negatively influenced by both expectations on pain and pain-related fear. It is unclear whether these factors influence both physical functioning in the laboratory as well as in daily life. The aim of this study was to test if a combination of persistent overprediction of pain and fear of movement predicts lab-based performance and whether these factors are relevant for predicting daily-life functioning.One hundred and twenty four patients with subacute LBP performed a laboratory-based performance test twice. Maximum voluntary contraction, pre-test pain expectations, perceived pain during testing and fear of movement were measured. Patients were classified as correct or incorrect predictors, based on differences between expected and perceived pain on the second attempt. Next, physical activity in daily life was measured with an accelerometer.In explaining physical functioning in the laboratory and in daily life an interaction effect between fear and pain prediction was observed. In overpredictors, fear was negatively associated with lab-based performance (β = ?0.48, p < 0.01), and positively associated with daily-life functioning (β = 0.50, p < 0.05). No significant association between fear and performance or daily-life functioning were found in correct predictors.In contrast to correct predictors, in overpredictors lab-based performance and daily-life functioning was additionally explained by fear of movement. Thus it appears that fear of movement is only predictive of performance in patients with LBP who simultaneously overpredict the consequences of movements in terms of painfulness.     

Gender and the risk of falling: a sociological approach

AIM: This paper reports a grounded theory study of the influence of gender on older people's perceptions of their risk of falling and their actions to prevent future falls. BACKGROUND: The incidence and rates of falls among older people, including injurious falls, are of much international concern. The risk of falling remains a major concern for older people since it increases with age, with those aged 85 years and over at greatest risk. However, research using a sociological approach to the topic is limited. METHODS: An exploratory design, with grounded theory analysis, was used. Data were collected during 2001 through in-depth interviews with a convenience sample of 40 older people living in south east of England. FINDINGS: Two core categories emerged: gendered meanings of risk and gendered responsibility. The social construction of the meaning of the risk of falling and of participants' actions was gendered. Older men and women had specific ways of talking about their 'risk' and identifying the risk factors for falling. Older men perceived themselves as 'responsible' and 'rational' individuals who expected to reduce their own risk of falling. Older women's expectations of themselves and of their peers explained their tendency to blame themselves or others for their falls. These perceptions influenced the actions they took to prevent future falls. CONCLUSION: Nurses and other healthcare professionals need to take account of the gendered meanings attached to falling by older men and women when carrying out risk assessments and giving advice on fall prevention.     

Myocardial infarction: narrations by afflicted women and their partners of lived experiences in daily life following an acute myocardial infarction

Background. The review of the literature showed that many people and their family members share feelings of distress after an acute myocardial infarction. Therefore, it is important to show how the illness affects the relationship in the couple's daily life when the closest relatives involved are men. Aim. The aim was to illuminate the meaning of lived experiences in daily life after an acute myocardial infarction, as narrated by afflicted women and their partners. Methods. Nine women and their partners narrated their experiences three and 12 months after an infarction. The interview texts were then interpreted, using a phenomenological hermeneutic method, inspired by the philosophy of Ricoeur. The text was divided into meaning units that were condensed and abstracted. Two themes and eight sub‐themes were then extracted from the text. Results. The first theme was ‘living in a changed life situation’ with the sub‐themes: ‘showing consideration’, ‘taking responsibility’, ‘living side by side’ and ‘desiring what to do’. The second theme was ‘looking to the future’ with the sub‐themes: ‘feeling uncertain’, ‘feeling powerless’, ‘feeling limited’ and ‘feeling hope’. Conclusions. The results revealed that couples lived in a changed life situation, somewhat in ‘discordance’, and showed consideration to each other in order to protect the partner. There seemed to be a lack of verbal communication, but both women and their partners revealed that they sensed how their partners felt without verbal communication. In this ‘discordance’, couples may experience loneliness, in that they may not share feelings about the event and the situation it causes. Relevance to clinical practice. Women and their partner have specific needs in daily living following an acute myocardial infarction. Therefore, nurses should acknowledge the specific needs for the female patient and the partner more clearly.     

Effects of a water-based program on women 65 years and over: a randomised controlled trial

The purpose of this study was to assess the effects of a water-based exercise and self-management program on balance, fear of falling, and quality of life in community-dwelling women 65 years of age or older with a diagnosis of osteopenia or osteoporosis. Fifty women with an average age of 73.3 years (range 65.5-82.4, SD 3.9) were randomised to intervention or control groups. The intervention group received a 10-week water-based exercise and self-management program compiled by Community Physiotherapy Services and conducted by a physiotherapist at an aquatic centre twice a week for one hour. The control group did not receive any instructions and were not encouraged to change their physical activity, activities of daily living or social habits during the study. Change in balance, measured using the step test, from baseline to follow-up differed between intervention and control groups, with mean (95% CI) between-group differences of 1.7 (0.9 to 2.6) and 2.1 (1.1 to 3.1) steps on the left and right sides respectively. Between-group differences in score changes were also significant in four of the eight domains of quality of life measured using the Short Form 36 questionnaire (SF36; physical function 8.6 (0.4 to 16.8), vitality 12.0 (2.3 to 21.8), social function, and 14.1 (0.6 to 27.7) mental health 10.2 (2.0 to 18.4)), but not fear of falling measured using the modified falls efficacy scale (0.25 (-0.3 to 0.81). It is concluded that a water-based exercise and self-management program produced significant changes in balance and quality of life, but not fear of falling, in this group of community-dwelling women 65 years of age or older with a diagnosis of osteopenia or osteoporosis.     

Embedded spirituality: gardening in daily life and stressful life experiences

Scand J Caring Sci; 2011; 25; 567–574
Embedded spirituality: gardening in daily life and stressful life experiences Background: There is a limited body of research examining the relationship between spirituality and leisure, or the impact of leisure in the context of daily life, and life with stressful events. Aim: To examine the meaning of gardens and gardening across different life experiences using hermeneutic phenomenology to focus on the lived experience of leisure gardening. Methods: Most participants were interviewed once in each season over a 1 year period usually in their home. There were 42 participants (27 women and 15 men) in this study. Fifteen individuals had been diagnosed with cancer and were in varying stages of diagnosis and treatment. Three people had a chronic and progressive disease. Four women were grieving the death of their spouse. Participants ranged in age from 32 to 80 years. Results: In this paper, we focus on the spirituality‐related themes in this study: spirituality as connectedness; spirituality as an expression of inner being; the garden as a spiritual place and gardening as spiritual activity; gardening as a spiritual journey; and, stewardship. Participants with religious views saw their garden as an extension of their spirituality and a confirmation of their beliefs. Participants with secular or sacred views of spirituality that was not related to any religious beliefs were more likely to embed their spirituality in their relationship with nature as manifested in their garden. Conclusion: This study extends current theory regarding leisure and its contribution to meaning focused coping, and spirituality as a significant component of leisure in living with stressful health and life events.     

The importance of a daily rhythm in a supportive environment – promoting ability in activities in everyday life among older women living alone with chronic pain

Abstract

Purpose: The aim of this study was to explore how older women living alone with chronic musculoskeletal pain, describe their ability in performing activities in everyday life and what could promote their ability in activities in everyday life as well as their perceived meaning of a changed ability to perform activities in everyday life. Method: Qualitative interviews were conducted with 12 women, and an inductive content analysis was used. Results: The results showed the importance of a daily rhythm of activities. Activities included in the daily rhythm were socializing with family and friends, physical activities, doing own activities as well as activities supported by relatives and the community. The activities described by the women also promoted their ability in activities in everyday life. Other findings were the women’s perceived meaning of being independent and maintaining that independency, along with the meaning of accepting and adapting to a changed life situation. Conclusion: This paper concludes that it is important to be sensitive of individual needs regarding the daily rhythm of activities when health-care professionals intervene in the activities in everyday life of older women living alone, promote the women’s independency, and enable them to participate in the community.

• Implications for Rehabilitation

• A daily rhythm of activities is important for older women who live alone with chronic musculoskeletal pain.

• The importance of health-care professionals being sensitive to individual needs to promote ability in activities in everyday life and to encourage the everyday activities into a daily rhythm.

• Facilitate the women’s desire and will of independency, despite their needs of help from their environment to manage their everyday life.

     

The impact of bodily change on social behaviour in patients with thyroid-associated ophthalmopathy

Thyroid-associated ophthalmopathy (TAO) is characterized by the altered appearance of face and eyes and changed visual function. TAO has been described as alarming and crippling. It is well documented that TAO influences the patient's quality of life negatively. However, little is known about how the bodily change complicates the patient's social behaviour in everyday situations. The aim of this study was to explore how social behaviour is influenced by the bodily change and what it means to patients with TAO. An ethnographic study was conducted using in-depth interviews and participant observation. A total of 13 patients, nine women and four men, diagnosed with moderate to severe TAO were included. Data analysis was performed concurrently using grounded theory technique. The local ethics committee approved the study, and all participants gave written informed consent. The study reveals that the experience of bodily change had considerable consequences for patients' involvement with people and maintenance of social relations. Uncontrollable eyes were the dominating experience. It contained four sub-themes; the experience of changed facial communication, the experience of being somebody else, the experience of being clumsy among others and the experience of being cut off from the outside world. The bodily change affected people's attitude and behaviour towards them and their own ways of being with people. They struggled to change social behaviour and avoid withdrawal. In their struggle, they used seven different coping strategies. The study contributes to clarification of essential aspects of living with TAO. The condition of uncontrollable eyes may have serious consequences for patients' social behaviour and relationships with others. Early identification of the impact of bodily change and planned support may help prevent serious quality of life change.     

The experience of waiting and life during breast cancer follow-up

Much research exists on quality of life issues with breast cancer survivors. However, there has been little done on the waiting experience itself, and on the experience of follow-up from the women's perspective. Women who have been diagnosed and treated for breast cancer live with the condition for a minimum of 5 years, waiting for the next medical intervention; waiting for the next battery of tests; waiting for the next physician check-up. Throughout most of these years they may feel healthy, but they experience visits to cancer clinics, medical testing, and physician interactions. Women's accounts of their experiences of waiting and life during follow-up for breast cancer has not been the focus of research on the quality of life of breast cancer survivors. In particular research that uses a qualitative approach, in which women recount their experiences in their own language, has been missing. This study used a phenomenological approach, telling the stories of waiting and life throughout follow-up of nine women. The women's experiences are captured in four themes: life-changing; a sense of belonging; uncertainty; needing to know.     

The meaning of incontinence: a qualitative study of non-geriatric urinary incontinence sufferers

The meaning of the problem for incontinence sufferers is known to be a very significant influence on coping The present study was based on in-depth qualitative interviews with 28 young or middle-aged women who suffered urinary incontinence Analysis, aimed at discovering the meaning of their condition for the sufferers themselves, led to the following conclusions Incontinence is taboo, meaning not only that it is a socially unacceptable topic of conversation (inhibiting the approach of sufferers to health professionals), but also that it is difficult for sufferers themselves to focus on and think about clearly Sufferers can react with apathy, or may perpetually teeter on the edge of taking ameliorative action rational ways of tackling the problem are often not followed The problem is seen as one of personal control incontinence is lack of a grip on bodily propriety Sufferers may feel horribly unique, and also worry that the incontinence is their own fault They fear a guilty association with despised groups It is noteworthy that the maintenance of 'normality'— allowing the sufferer to claim that there is no problem and that she is not incontinent — may involve a great deal of work Although there are indications of defensive denial in sufferers' reactions to the problem, an additional interpretation is that they are fighting to subordinate the problem in favour of other priorities Implications for practice of each of these features of the meaning of incontinence are drawn out