Participation restriction, not fear of falling, predicts actual balance and mobility abilities in rural community-dwelling older adults.

BACKGROUND AND PURPOSE: Fear of falling (FOF) has been correlated with an increased risk for falls, self-restriction of physical activity, and subsequent decrease in quality of life in older adults. The relationship between perceived FOF, participation restriction, and balance and mobility abilities is unclear, as results from prior studies are inconsistent. Few studies have used the Survey of Activities and Fear of Falling in the Elderly (SAFE) as a standard measure of FOF, although this survey provides both a measure of FOF and participation restriction. Only one study has explored the relationship of individual items from the SAFE with balance and mobility tests that predict fall risk. The primary purpose of this study was to investigate the relationships between FOF and participation restriction as measured by the SAFE and actual balance and mobility abilities in a diverse group of older adults. PARTICIPANTS: Eighty-two community-dwelling older adults (17 men) with a mean age of 74 (SD = 8.8; range = 55-91) participated in this study. The sample comprised 45% African Americans and 54% whites. METHODS: Fear of falling and participation restriction were assessed using the SAFE, a self-assessment survey. The SAFE assesses information about participation in 11 functional activities as well as the extent to which fear is a source of participation restriction. Balance and functional mobility were measured using the Berg Balance Scale (BBS) and Timed Get Up & Go Test (TUG), respectively. Participants were categorized as low (N = 36), mixed (N = 19), or high (N = 24) risk for future falls based on their past fall history and results on the BBS and the TUG. Data analysis included χ(2) and Spearman correlation and 2 regression analyses. RESULTS: Both SAFE FOF and participation restriction scores were significantly correlated with BBS and TUG scores. However, SAFE participation restriction scores, but not SAFE FOF scores, predicted BBS and TUG scores. SAFE FOF scores could discriminate older adults at high risk for falls from those at mixed and low risk but could not discriminate between the mixed- and low-risk groups. DISCUSSION/CONCLUSION: The relationship between self-reported participation restriction and objectively measured balance and mobility abilities is stronger than the relationship between self-reported FOF and objectively measured balance and mobility abilities. These findings lend support to the argument that participation restriction may be the critical mediating factor between FOF, balance and mobility limitations, and fall risk. Evaluation of and intervention for FOF and fall risk without direct and specific attention to participation restriction may not yield optimal results. Older adults whose goals include both reduction in fall risk and increase in participation level may need combined treatment approaches.

Fear of falling and its relationship with anxiety, depression, and activity engagement among community-dwelling older adults.

OBJECTIVE: This study examined (1) the relationship of fear of falling to depression, anxiety, activity level, and activity restriction and (2) whether depression or anxiety predicted fear of falling, activity level, activity restriction, or changes in activity level. METHOD: We administered the Survey of Activities and Fear of Falling in the Elderly; the Geriatric Depression Scale-30; and the Hamilton Anxiety Scale, IVR Version, during a one-time visit to 99 community-dwelling adults ≥55 yr old. RESULTS: We found significant relationships between (1) fear of falling and depression, anxiety, and activity level; (2) depression and anxiety; and (3) activity restriction and depression. Activity level was negatively correlated with activity restriction, fear of falling, depression, and anxiety. Anxiety predicted both fear of falling and activity level. Both anxiety and depression predicted activity restriction because of fear of falling and for other reasons. CONCLUSION: Occupational therapy practitioners should consider screening their older adult clientele for fear of falling, anxiety, and depression because these states may lead to fall risk and activity restriction.

Feasibility of interdisciplinary community-based fall risk screening.

OBJECTIVE: This pilot study examined the feasibility of (1) conducting interdisciplinary fall risk screens at a communitywide adult fall prevention event and (2) collecting preliminary follow-up data from people screened at the event about balance confidence and home and activity modifications made after receiving educational information at the event. METHOD: We conducted a pilot study with pre- and posttesting (4-mo follow-up) with 35 community-dwelling adults ≥55 yr old. RESULTS: Approximately half the participants were at risk for falls. Most participants who anticipated making environmental or activity changes to reduce fall risk initiated changes (n = 8/11; 72.7%) during the 4-mo follow-up period. We found no significant difference in participants' balance confidence between baseline (median = 62.81) and follow-up (median = 64.06) as measured by the Activities-specific Balance Confidence scale. CONCLUSION: Conducting interdisciplinary fall risk screens at an adult fall prevention event is feasible and can facilitate environmental and behavior changes to reduce fall risk.

Relationship between fall-related efficacy and activity engagement in community-dwelling older adults: a meta-analytic review.

OBJECTIVE: Fear of falling can lead to restricted activity, but little is known about how this fear affects different aspects of people's lives. This study examined the relationship between fall-related efficacy (i.e., confidence or belief in one's ability to perform activities without losing balance or falling) and activity and participation. METHOD: We conducted a meta-analysis of studies comparing community-dwelling older adults' fall-related efficacy to measures of activity or participation. RESULTS: An examination of 20 cross-sectional and prospective studies found a strong positive relationship between fall-related efficacy and activity (r = .53; 95% CI [.47, .58]). An insufficient number of studies examining fall-related efficacy and participation were available for analysis. CONCLUSION: Low fall-related efficacy may be an important barrier to occupational engagement for many older adults and warrants careful consideration by occupational therapists. Future research should explore interventions that target fall-related efficacy and examine their effects on activity performance and engagement.

Falls in community-dwelling adults aged 50 years and older: prevalence and contributing factors.

The current descriptive study examined the prevalence, selected fall-related contributing factors, and ramifications of falls over 4 yrs in 663 community-dwelling adults older than 50 yrs. The current findings demonstrated an appreciably higher percentage of falls (62.1%) than the national average (33%). Unlike in past studies, those 50 to 60 yrs old reported more falls than those in the other three age categories (61-70, 71-80, and 81+ yrs). The current population reported a higher percentage of injuries from falls (80.3%) and sustained more cuts and bruises than reported in previous studies. Walking was cited as the most frequent cause of falling among both genders and all age groups. Significant findings were as follows: (1) women fell more often than men in the 71- to 80-yr-old group (X(2) p value <0.005); (2) women informed others about falls more often than men (X(2) p value = 0.002); (3) falls occurred more often among those who lived alone (X(2) p value = 0.0005); (4) more women living alone fell compared with men (X(2) p value = 0.0005); (5) women who lived alone fell more often than women who lived with others (X(2) p value = 0.023); (6) those living alone were more likely to tell a friend whereas those living with others were more likely to tell a relative about the fall (X(2) p value = 0.012); and (7) about 36% of respondents who indicated a fear of falling self-restricted engagement in activities (X(2) p value <0.005).