OBJECTIVES: To determine, in a cohort of older individuals transitioning to frailty (defined by Speechley and Tinetti, 1991) who have previously fallen, whether there are significant associations between demographic, functional, and behavioral characteristics and activity-related fear of falling, using both the Falls Efficacy Scale (FES) and the Activities-Specific Balance Confidence Scale (ABC).

DESIGN: Baseline cross-sectional analysis in a prospective cohort intervention study.

SETTING: Twenty independent senior living facilities in Atlanta.

PARTICIPANTS: Seventeen male and 270 female subjects (n = 287), age 70 and older (mean ± standard deviation, 80.9 ± 6.2), with Mini-Mental State Examination score ≥24, transitioning to frailty, ambulatory (with or without assistive device), medically stable, and having fallen in the past year.

MEASUREMENTS: Activity-related fear of falling was evaluated with the FES and ABC Scale. Because of the comparable data derived from each scale, associations with functional measures-related analyses were expressed using the latter. Depression was measured by Center for Epidemiological Studies Depression Scale. Functional measurements included timed 360° turn, functional reach test, timed 10-meter walk test, single limb stands, picking up an object, and three chair stands.

RESULTS: No statistically significant association was found between activity-related fear of falling and age. For the proposed activities, about half (ABC, 48.1%; FES, 50.1%) of the subjects were concerned about falling or showed lack of confidence in controlling their balance. A statistically significant inverse correlation was found between FES and ABC (r = −0.65; P < .001).

CONCLUSIONS: Activity-related fear of falling was present in almost half of this sample of older adults transitioning to frailty. The significant association of activity-related fear of falling with demographic, functional, and behavioral characteristics emphasizes the need for multidimensional intervention strategies to lessen activity-related fear of falling in this population.

REFERENCES

1 Tinetti ME, Inouye SK, Gill TM et al. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA 1995; 273: 1348 – 1353.
2 Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 1701 – 1707.
3 Tinetti ME, Mendes de Leon CF, Doucette JT et al. Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. J Gerontol 1994; 49: M140 – M147.
4 Franzoni S, Rozzini R, Boffelli S et al. Fear of falling in nursing home patients. Gerontology 1994; 40: 38 – 44.
5 Vellas BJ, Wayne SJ, Romero LJ et al. Fear of falling and restriction of mobility in elderly fallers. Age Ageing 1997; 26: 189 – 193.
6 Arfken CL, Lach HW, Birge SJ et al. The prevalence and correlates of fear of falling in elderly persons living in the community. Am J Public Health 1994; 84: 566 – 570.
7 Lawrence RH, Tennstedt SL, Kasten LE et al. Intensity and correlates of fear of falling and hurting oneself in the next year. J Aging Health 1998; 10: 267 – 286.
8 Speechely M & Tinetti M. Falls and injuries in frail and vigorous community elderly persons. J Am Geriatr Soc 1991; 39: 46 – 52.
9 Maki BE, Holliday PJ, Topper AK. Fear of falling and postural performance in the elderly. J Gerontol 1991; 46: M123 – M131.
10 Baloh RW, Spain S, Socotch TM et al. Posturography and balance problems in older people. J Am Geriatr Soc 1995; 43: 638 – 644.
11 Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. J Gerontol 1990; 45: P239 – P243.
12 Powell LE & Myers AM. The activities-specific balance confidence (ABC) scale. J Gerontol 1995; 50: M28 – M34.
13 Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psych Rev 1977; 84: 191 – 215.
14 Myers AM, Powell LE, Maki BE et al. Psychological indicators of balance confidence: Relationship to actual and perceived abilities. J Gerontol A Biol Sci Med Sci 1996; 51A: M37 – M43.
15 Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34: 119 – 126.
16 Gill TM, Williams CS, Tinetti ME. Assessing risk for the onset of functional dependence among older adults: The role of physical performance. J Am Geriatr Soc 1995; 43: 603 – 609.
17 Duncan PW, Studenski S, Chandler J et al. Functional reach: Predictive validity in a sample of elderly male veterans. J Gerontol 1992; 47: M93 – M98.
18 Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas 1977; 1: 385 – 401.
19 Buchner DM, Hornbrook MC, Kutner NG et al. Development of the common data base for the FICSIT trials. J Am Geriatr Soc 1993; 41: 297 – 308.
20 Berkmann LF, Berkmann CS, Kasl S et al. Depressive symptoms in relation to physical health and functioning in the elderly. Am J Epidemiol 1986; 124: 372 – 388.
21 Bandura A. Self-efficacy mechanism in human agency. Am Psych 1982; 37: 122 – 147.
22 Wolf SL, Barnhart HX, Kutner NG et al. Reducing frailty and falls in older persons: An investigation of tai chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc 1996; 44: 489 – 497.
23 Lachmann ME, Howland J, Tennstedt S et al. Fear of falling and activity restriction: The survey of activities and fear of falling in the elderly (SAFE). J Gerontol B Psycho Sci Soc Sci 1998; 53B: P43 – P50.
24 Howland J, Lachman ME, Peterson EW et al. Covariates of fear of falling and associated activity curtailment. Gerontologist 1998; 38: 549 – 555.
25 Simonsick EM, Guralnik JM, Fried LP. Who walks? Factors associated with walking behavior in disabled older women with and without self-reported walking difficulty. J Am Geriatr Soc 1999; 47: 672 – 680.
26 Savage I. Demographic influences on risk perceptions. Risk Anal 1993; 13: 413 – 420.
27 Vellas B, Cayla F, Bocquet H et al. Prospective study of restriction of activity in old people after falls. Age Ageing 1987; 16: 189 – 193.
28 Howland J, Peterson EW, Levin WC et al. Fear of falling among the community-dwelling elderly. J Aging Health 1993; 5: 229 – 243.
29 Maki BE. Gait changes in older adults: Predictors of falls or indicators of fear? J Am Geriatr Soc 1997; 45: 313 – 320.
30 Alexander NB. Postural control in older adults. J Am Geriatr Soc 1994; 42: 93 – 108.
31 Horak FB, Shupert CL, Mirka A. Components of postural dyscontrol in the elderly: A review. Neurobiol Aging 1989; 10: 727 – 738.
32 Guralnik J, Simonsick EM, Ferrucci L et al. A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994; 49: 85 – 94.
33 Halbert JA, Silagy CA, Finucane P et al. Recruitment of older adults for a randomized, controlled trial of exercise advice in a general practice setting. J Am Geriatr Soc 1999; 47: 477 – 481.

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Volume49, Issue11

November 2001

Pages 1456-1462

Associations of Demographic, Functional, and Behavioral Characteristics with Activity-Related Fear of Falling Among Older Adults Transitioning to Frailty

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