Identifying frailty risk profiles of home-dwelling older people: focus on sociodemographic and socioeconomic characteristics.

OBJECTIVES: This paper investigates risk profiles of frailty among older people, as these are essential for detecting those individuals at risk for adverse outcomes and to undertake specific preventive actions. Frailty is not only a physical problem, but also refers to emotional, social, and environmental hazards. METHODS: Using data generated from the Belgian Ageing Studies, a cross-sectional study (n = 28,049), we tested a multivariate regression model that included sociodemographic and socioeconomic indicators as well as four dimensions of frailty, for men and women separately. RESULTS: The findings indicated that for both men and women, increased age, having no partner, having moved house in the previous 10 years, having a lower educational level and having a lower household income are risk characteristics for frailty. Moreover, when looking at the different frailty domains, different risk profiles arose, and gender-specific risk characteristics were detected. DISCUSSION: This paper elaborates on practical implications, and formulates a number of future research recommendations to tackle frailty in an aging society. The conclusion demonstrates the necessity for a thorough knowledge of risk profiles of frailty, as this will save both time and money and permit preventive actions to be more individually tailored.

Feasibility of a nurse-led in-home cognitive behavioral program to manage concerns about falls in frail older people: a process evaluation.

Concerns about falls and related avoidance of activities are common problems among older people living in the community. In this study we examined the feasibility and acceptability of AMB-Home (the Dutch in-home version of A Matter of Balance), a nurse-led in-home cognitive behavioral program developed for frail community-living older people with concerns about falls and related activity avoidance. The multicomponent program consisted of seven individual sessions, including three home visits and four telephone contacts. Data were collected from eight nurses and 194 participants. Generally, the program was considered acceptable and feasible by both the nurses and the participants. When AMB-Home turns out to be effective, the implementation of a fine-tuned version of this in-home program in regular health care, would be a natural next step.

Older people's preferences regarding programme formats for managing concerns about falls.

OBJECTIVE: to explore the preferences of community-dwelling older persons regarding different programme formats for managing concerns about falls. SUBJECTS AND DESIGN: cross-sectional study of 5,755 community-dwelling people aged ≥ 70 years in the Netherlands. METHODS: a questionnaire assessed people's willingness to participate per programme format (n=6), i.e. a programme at home, via telephone, via home visits and telephone consultations, via television or via Internet. RESULTS: of the 2,498 responders, 62.7% indicated no interest in any of the formats. The willingness to participate per programme format varied between 21.5 (at home) and 9.4% (via Internet). Among people interested in at least one of the formats (n=931), higher levels of fall-related concerns were associated with increased preference for a programme with home visits. Poor perceived health and age ≥ 80 years were associated with less preference for a group programme. Higher educated people were more in favour of a programme via Internet compared with their lower educated counterparts. CONCLUSION: the majority of community-dwelling older people are not likely to participate in any of the six proposed programme formats for managing concerns about falls. However, when diverse formats of effective programmes will be made available, uptake and adherence may be increased since programme preferences are associated to specific population characteristics.

Depressive symptoms and fear of falling in previously community-dwelling older persons recovering from proximal femoral fracture.

BACKGROUND AND AIMS: Depression and fear of falling are common problems following proximal femoral fracture. The role of fear of falling in depressive symptoms after such a fracture has not yet been investigated. The aim of this study was to establish possible changes during recovery in fear of falling and depressive symptoms following rehabilitation in this population and to explore their association. METHODS: Observational study with pre-post design at a single geriatric rehabilitation hospital in Germany. Data were collected during in-hospital rehabilitation and four months later at participants' home. The data of 51 participants living in the community at the time of fracture could be analysed. MAIN MEASURES: Fear of falling, depressive symptoms, cognition, pain, ADL functioning, and physical performance. RESULTS: Although physical and ADL performance improved between admission to rehabilitation and follow-up four months later, the prevalence of depressive symptoms increased, and levels of fear of falling remained at the same level. There was a significant correlation between fear of falling and depressive symptoms at follow-up, but the two were not significantly correlated at baseline. Fear of falling and depressive symptoms were not significantly associated in a path analysis model. CONCLUSIONS: Fear of falling and depressive symptoms are highly prevalent after proximal femoral fracture. Yet there seems to be no simple association between either psychological parameter in older persons recovering from fall-related fractures. Further research is warranted, in order to develop interventions targeting these psychological outcomes.