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      A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls?


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          Maintaining or improving quality of life (QoL) is a key outcome of clinical interventions in older people. Fear of falling (FoF) is associated with activity restriction as well as with poorer physical and cognitive functions and may be an important contributor to a diminished QoL. The objectives of this systematic review were to determine i) the effect of FoF on QoL in older people, ii) whether the association between these two constructs depends on the use of specific conceptualizations and measurement instruments, and iii) the role of fall events as mediating factor in this relationship. Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Library) were searched from their inceptions to February 2018. Thirty mostly cross-sectional studies in nearly 30.000 people (weighted mean age 75.6 years (SD =6.1); 73% women) were included. FoF was associated with QoL in most studies, and this association appeared to be independent of the conceptualization of FoF. Moreover, this relationship was independent of falls people experienced which seemed to have a lower impact. FoF should be considered not only as by-product of falls and targeted interventions in parts different from those to reduce falls are likely required. Studies are needed showing that reducing FoF will lead to increased QoL.

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          Falls efficacy as a measure of fear of falling.

          We developed the Falls Efficacy Scale (FES), an instrument to measure fear of falling, based on the operational definition of this fear as "low perceived self-efficacy at avoiding falls during essential, nonhazardous activities of daily living." The reliability and validity of the FES were assessed in two samples of community-living elderly persons. The FES showed good test-retest reliability (Pearson's correlation 0.71). Subjects who reported avoiding activities because of fear of falling had higher FES scores, representing lower self-efficacy or confidence, than subjects not reporting fear of falling. The independent predictors of FES score were usual walking pace (a measure of physical ability), anxiety, and depression. The FES appears to be a reliable and valid method for measuring fear of falling. This instrument may be useful in assessing the independent contribution of fear of falling to functional decline among elderly people.
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            Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention.

            Previous cross-sectional studies have shown a correlation between falls and fear of falling, but it is unclear which comes first. Our objectives were to determine the temporal relationship between falls and fear of falling, and to see whether these two outcomes share predictors. A 20-month, population-based, prospective, observational study. Salisbury, Maryland. Each evaluation consisted of a home-administered questionnaire, followed by a 4- to 5-hour clinic evaluation. The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations. At baseline, subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher. Demographics, visual function, comorbidities, neuropsychiatric status, medication use, and physical performance-based measures were assessed. Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation, first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors. Falls at baseline were an independent predictor of developing fear of falling 20 months later (odds ratio (OR) = 1.75; P <.0005), and fear of falling at baseline was a predictor of falling at 20 months (OR = 1.79; P <.0005). Women with a history of stroke were at risk of falls and fear of falling at follow-up. In addition, Parkinson's disease, comorbidity, and white race predicted falls, whereas General Health Questionnaire score, age, and taking four or more medications predicted fear of falling. Individuals who develop one of these outcomes are at risk for developing the other, with a resulting spiraling risk of falls, fear of falling, and functional decline. Because falls and fear of falling share predictors, individuals who are at a high risk of developing these endpoints can be identified.
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              Fear of falling and restriction of mobility in elderly fallers.

              To identify the characteristics of elderly persons who develop a fear of falling after experiencing a fall and to investigate the association of this fear with changes in health status over time. A prospective study of falls over a 2-year period (1991-92). Falls were ascertained using bimonthly postcards plus telephone interview with a standardized (World Health Organisation) questionnaire for circumstances, fear of falling and consequences of each reported fall. Each participant underwent a physical exam and subjective health assessment each year form 1990 to 1993. New-Mexico Aging Process Study, USA. 487 elderly subjects (> 60 years) living independently in the community. Fear of falling after experiencing a fall. 70 (32%) of 219 subjects who experienced a fall during the 2 year study period reported a fear of falling. Women were more likely than men to report fear of falling (74% vs 26%). Fallers who were afraid of falling again had significantly ore balance (31.9% vs 12.8%) and gait disorders (31.9% vs 7.4%) at entry in the study in 1990. Among sex, age, mental status, balance and gait abnormalities, economic resource and physical health, logistic regression analysis show gait abnormalities and poor self-perception of physical health, cognitive status and economic resources to be significantly associated with fear of falling. Subjects who reported a fear of falling experienced a greater increase in balance (P = 0.08), gait (P < 0.01) and cognitive disorders (P = 0.09) over time, resulting in a decrease in mobility level. The study indicated that about one-third of elderly people develop a fear of falling after an incident fall and this issue should be specifically addressed in any rehabilitation programme.

                Author and article information

                Clin Interv Aging
                Clin Interv Aging
                Clinical Interventions in Aging
                24 April 2019
                : 14
                : 701-719
                [1 ]Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg , Nuremberg, Germany
                [2 ]Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg , Erlangen, Germany
                [3 ]Department of General Internal and Geriatric Medicine, Hospital of the Order of St. John of God Regensburg , Regensburg, Germany
                Author notes
                Correspondence: Daniel SchoeneInstitute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg , Kobergerstr. 60, Nuremberg90408, GermanyEmail daniel.schoene@ 123456fau.de
                © 2019 Schoene et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 1, Tables: 2, References: 96, Pages: 19

                Health & Social care
                fear of falling,falls efficacy,quality of life,accidental falls,aged,function
                Health & Social care
                fear of falling, falls efficacy, quality of life, accidental falls, aged, function


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