Fear of falling from a daily life perspective; narratives from later life : Fear of falling from a daily life perspective

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.

Fear of falling may lead to avoidance of activities for seniors, even though they may be able to perform these activities. Specific risk factors for fear of falling that are amenable to change among various populations have been identified within the literature; however, detailed information about the risk factors for fear of falling, specifically among community-based seniors receiving home care services, is limited. The aim of this cross-sectional study was to examine the factors associated with restriction of activity resulting from fear of falling among 2,300 seniors receiving home care services. All participants (n = 2,304) in this study were receiving home care services between 1999 and 2001 from a sample of 10 volunteering community-based agencies (Community Care Access Centres) representing the major geographic regions of Ontario, Canada. Community care access centres act as gatekeeping organisations assessing need and contracting out for a broad range of community-based services. The Minimum Data Set for Home Care, a comprehensive and standardised assessment tool used to evaluate the needs and ability levels of older adults utilising home care services, covers several key domains, such as service use, function, health and social support. Nurses trained to administer the Minimum Data Set for Home Care assessed each of the participants within their homes. Of the 2,304 seniors within the study, 41.2% of participants expressed they restricted their activity for fear of falling. Percentages reporting fear of falling within the literature are considerably lower than the presentfindings, and probably attributable to the frailer, home care population within the present study. In the final logistic regression model, being female, having various impairments/limitations, lack of support and being a multiple faller significantly increased risk of fear of falling, whereas individuals that used antipsychotics and individuals that had Alzheimer's disease were less likely to report restricting their activity. The results from this study provide information about a group void in the literature pertaining to activity restriction from fear of falling - community-based seniors receiving home care services. The comprehensive nature of the Minimum Data Set for Home Care allowed for a myriad of factors to be assessed and subsequently analysed with respect to the outcome variable. The inclusion of items on falls, fear of falling, and risk factors for both adverse outcomes means that home care professionals using this instrument will have a unique opportunity to identify and respond to problems that have an important impact on the client's quality of life.