Symptoms Contributing to Mobility Limitations and Fear of Falls in Older Adults

Mobility limitations in older adults are associated with negative outcomes including fear of falls (FOF) and poorer quality of life. However, self-reported symptoms contributing to mobility difficulty have not been fully explored as an area for intervention. The study aimed to identify the prevalence of self-reported symptom causes of difficulty walking and stair-climbing. In addition, we examined associations between symptoms and FOF in a population-based cohort of community-dwelling older adults in the MOBILIZE Boston Study. Of the 243 older adults who reported difficulty with walking one quarter of a mile or climbing stairs, 67% were women, 72% were white, average age=79.4y (SD=5.7). FOF was measured with the Tinetti Falls Efficacy Scale. Pain was most commonly reported as the primary symptom responsible for mobility difficulty (38.4%) followed by endurance (21.1%), multiple symptoms (15.6%), weakness (13.2%), balance (8.7%), other symptoms (2.9%). Factorial ANCOVA determined gender differences in associations between symptoms and FOF, adjusting for age. In pairwise comparisons, women who identified balance as their primary symptom had higher FOF than women identifying endurance (p=.017), pain (p=.015), other (p=.017), or multiple (p=.050) symptoms. There were no FOF differences for women identifying balance compared to weakness as the primary issue (p=.395). Men who identified balance as their primary symptom had higher FOF than those who identified pain (p=.036); no other FOF differences were noted in men identifying balance compared to other symptoms. Understanding common symptoms experienced by older adults, and symptoms associated with greatest FOF, will assist in developing tailored interventions for mobility improvement.

Falls As a Problem of an Aging Population, a Modern Look at Risk Factors and Assessment Methods. Role of Fear of Falls in Increasing their Risk

The article presents modern views on the problem of falls in the elderly. There is a global trend of changing the demographic situation - the permanent increase in the proportion of elderly and senile people in the general population, the issues of geriatrics as one of the medical specialties are becoming the most relevant. Among the problems that geriatricians and all specialists involved in the treatment of elderly patients have to solve, one of the most serious is the problem of falls. The article provides a medical review of the assessment of the frequency of falls depending on gender, age, diseases and external factors. The main risk factors for falls and their prevention measures are discussed in detail. Special attention is given to the fear of falls as a significant risk factor. The methods of validation the risk factor with the use of unified questionnaires - “The scale of assessment of the fear of fa lls” and “the Falls efficacy scale” are presented. The purpose of this article is to attract the attention of practitioners to the problem of falls and the fear of falls as one of the significant risk factors, methods of its identification and prevention

Multifactorial interventions to prevent falls in older adults

BACKGROUND: Falls are one of the most common syndromes in old age. An estimated 646,000 deaths from falls occur each year worldwide. Moreover, most fatal falls occur in people over 65 years of age. Most falls are the result of the interaction of several factors. AIMS: To examine the long-term effectiveness of multifactorial interventions in preventing falls in elderly and senile patients. MATERIALS AND METHODS: A sample of patients territorially attached to the Family Medicine Center of the North-Western State Medical University named after I.I. Mechnikov was established four years ago. Individual fall prevention programs were developed for all study participants (n = 260) because they had different falls risk factors. Patient follow-up was continued for 12 months. The results of the multifactorial intervention were evaluated after 12 months and after 3 years, 2 times in total, the last study in a random subsample of patients (n = 84). Aging asthenia screening, questionnaires, assessment of emotional status, and presence of sleep disturbances were performed to assess the risk of falls. The effectiveness of multifactorial interventions was assessed based on repeated assessment of risk factors for falls. RESULTS: Participants with a history of falls were significantly more likely to have symptoms of depression, anxiety, symptoms of frailty, visual and hearing impairment (p 0.05). On average, each participant in the group with falls had 6.1 2.1 risk factors for falls and 3.8 2.3 in the group without falls (p = 0.000). During the follow-up period after the interventions, the incidence of falls decreased 9-fold after one year (from 28.5% to 3.1%) and then increased to 23.8%. All patients who fell after the multifactorial intervention had a history of cognitive impairment and falls. In addition, in the group of patients with falls, fall risk factors such as low levels of physical activity, hearing impairment, and the presence of a traumatic environment at home were not eliminated. As a result of the interventions, fear of falls disappeared in 9 patients, 95% CI (2.35-65.89), p = 0.039. CONCLUSIONS: The study demonstrated a decrease in the effectiveness of multifactorial interventions to prevent falls at three years. A less persistent effect was seen in patients with a history of falls. A history of falls, symptoms of frailty, complaints of fear of falls, sleep disturbances, and anxiety symptoms were factors that increased the risk of falls. Individualized fall prevention programs resulted in decreased fear of falls.

The influence of physical activity on balance, risk and fear of fall in the elderly / A influência da atividade física no equilíbrio, risco e medo de queda em idosos

The purpose is to evaluate possible relationships between the level of structured physical exercise and the risk of falls in the elderly. The volunteers were elderly of both genders aged from 60 to 70 years old, sorted into 3 groups, which were: Structured Exercise Group (SEG); Sufficiently Active Group (SAG); Insufficiently Active Group (IAG). For data collecting, validated tools were used, being the International Physical Activity Questionnaire (IPAQ), Falls Efficacy Scale International (FES-I-BRASIL) and Test Up and Go (TUG) for the level of physical activity, risk of fall, and mobility, respectively. In addition, perimetry of the abdomen, waist, and hip were collected, in addition to body mass and height. It was found that the level of physical activity is directly related to the fear of falls and that the exercises structured by a professional and Physical Education further reduce this fear.

A Cross-Sectional Study on Balance Deficits and Gait Deviations in COPD Patients

Background. The gait abnormalities were linked to the balance deficits in the previous studies. However, the deviations in the gait parameters in COPD are currently not known. The study aims to compare gait parameters, static and dynamic balance, and risk of falls in COPD with those in non-COPD individuals. Method. Fourty-two patients with COPD aged 45 years and gender-matched control subjects were included in the study. Gait parameters were assessed by Win-Track gait analyzer, the static balance was assessed by posturography, and the dynamic balance was assessed by the time up and go test. The fear of falls was assessed by Falls Efficacy Scale. Results. COPD individuals had decreased static and dynamic balance as assessed by posturography ( p < 0.05 ) and TUG ( p < 0.01 ), respectively. A significant difference in swing duration ( p = 0.004 ) and also increased risk of falls ( p < 0.01 ) was observed in COPD patients as compared to non-COPD individuals. Conclusion. COPD individuals have increased swing duration, reduced static and dynamic balance, and increased fear of falls as compared to non-COPD individuals.

The fear of falls in the caregivers of institutionalized elders

ABSTRACT Aims To understand how the fear of falls emerges and manifests itself in caregivers of institutionalized elders. Method It is a qualitative study, based on the Grounded Theory and carried out with 24 informal caregivers, 5 nurses, 2 physicians and 2 directors of two Portuguese nursing homes. Data collection took place through interviews, participant observation, and documentation analysis, between October 2016 and January 2018. Data was collected and analyzed simultaneously, following the stages of open, axial, and selective coding. Results The comparative analysis of the findings identified the conceptual category "Fear of falls in the caregivers of institutionalized elders". The main category is associated with the categories: maintaining safety, hidden fear of falls, the perceived self-efficacy in the prevention of falls, falls and interpersonal relations, previous experiences, and team support. Conclusions The fear has an influence on the self-efficacy perceived in the prevention of falls; the quality of the teamwork, in turn, is affected by previous negative experiences and by the support of the team.

Predictors for Confidence in Self-Management of Falls and the Role of Fear of Falls

Falls have been a crucial threat for older adults to stay independent. Once they have fallen, older adults are more likely to receive injuries and become people with disabilities. Conventionally, the measurement of fall efficacy focused on the capacity of performing certain activities such as walking or bathing without a fall. However, given the fact that one out of five older adults fall every year, self-efficacy in self-protection when falls do happen calls for a better understanding of confidence in self-management of a fall. Among predictors for fall prevention outcomes, “fear of falls” has received attention. However, “fear of falls” was largely missing in studies exploring self-management of falls in scenarios where falls do happen. This study explores the predictors for CSMoF including “fear of falls”. A series of simultaneous and hierarchical regression analyses with related interaction analyses and a path model were applied to determine the contribution of each predictor variable and the mediating role of “fear of falls”. The findings of the study reported that demographic characteristics, chronic conditions, and perceptions of falls were associated with CSMoF. The path analysis confirmed the mediating role of “fear of falls” as the indirect effects were occupying substantial percentages in the total identified effects. “Fear of falls” should continue to be a core of fall prevention programs and is particularly important for programs that aim to teach older adults what to do when they fall, whom to call for help, and how to avoid injuries upon falling.