Query: fear of falling

title: Fear of Falling: The Inner Life of the Middle Class
abstract: Like every other social group to rise to fleeting prominence, the yuppies were as much invented as discovered. The term was first employed in the press for the modest purpose of explaining Gary Hart's unexpected success in the 1984 presidential primaries. Someone had voted for him, someone young, urban, and professional, and there was brief hope that this new grouping would provide the Democrats with a much needed new constituency. But what started as a neutral demographic category evolved with alarming speed into a social slur. Four years after their "discovery," Hendrik Hertzberg wrote in Esquire:

title: Experiences of the Built Environment, Falls and Fear of Falling Outdoors among Older Adults: An Exploratory Study and Future Directions
abstract: Falls can have serious impacts on the health, wellbeing and daily mobilities of older adults. Falls are a leading cause of injury and death amongst older adults and outdoor falls comprise a substantial proportion of pedestrian injuries. As well as physical injuries, the psychological impacts of experiencing a fall can result in older adults getting out of the house less often, resulting in lower levels of physical activity and social connection. Despite the known consequences of falls, relatively little research considers the impact of the urban built environment on falls among older adults. This research aimed to explore the experiences of older adults in the urban environment, falling and the fear of falling outdoors. We conducted an online survey with adults aged 50+ using a participatory mapping survey tool and a convenience sample. The study area was Greater Christchurch, New Zealand. Results suggest that both perceived accessibility and neighbourhood conditions are independently associated with fear of falling, after controlling for frequency of falling, gender and activities of daily living. Our findings demonstrate the need for much better understandings of the relationships between the urban environment, outdoor mobility, fear of falling and falling among older adults and we propose suggestions for future research.

title: Psychometric properties of the German version of the Fear of Falling Questionnaire revised (FFQ R) in a sample of older adults after hip or pelvic fracture
abstract: Identifying patients with maladaptive fear of falling (FOF) is important in the rehabilitation phase after serious fall. The 6 item Fear of Falling Questionnaire revised (FFQ R) was seen as promising measurement instrument as it evaluates FOF in a broader way than the one item question and independent of physical activities. The purpose of the analysis was to evaluate the psychometric properties of the translated German FFQ R. Back translation method was applied. Confirmatory factor analysis (CFA) with diagonally weighted least square estimation was used to verify the two factor structure. Data were collected during inpatient rehabilitation from hip and pelvic fracture patients [age 84.3 6.2, Mini Mental State Examination (MMSE) scores 23] participating in an RCT (N 112) and a cross sectional survey (N 40) Internal consistency was 0.78 (Cronbach's alpha) No floor or ceiling effects were found. Discriminatory power on item level was moderate to good (r 0.43 0.65) CFA revealed a good model fit and confirmed the two factor structure. The German FFQ R was moderately correlated (r 0.51) with the Short Falls Efficacy Scale International (Short FES I) used as a proxy measure for FOF. Missing rates up to 9% for specific items were because some individuals, independent of cognitive level or age, had problems to rate items with conditional statements on possible negative consequences of a fall. Results demonstrated moderate to good psychometric properties similar to the original English version in a comparable sample of fracture patients.

title: Lower limb muscle strength, static and dynamic postural stabilities, risk of falling and fear of falling in polio survivors and healthy subjects.
abstract: This study investigated the association between preserved lower limb muscle strength, dynamic and static postural stability, risk of falling, and fear of falling in polio survivors. We also investi.

title: Effects of a resistance and balance exercise programme on physical fitness, health related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial
abstract: Exercise is recommended for people with osteoporosis, but the effect for people who have suffered vertebral fracture is uncertain. This study shows that a multicomponent exercise program based on recommendations for people with osteoporosis improved muscle strength, balance, and fear of falling in older women with osteoporosis and vertebral fracture.  Guidelines for exercise strongly recommend that older adults with osteoporosis or osteoporotic vertebral fracture should engage in a multicomponent exercise programme that includes resistance training in combination with balance training. Prior research is scarce and shows inconsistent findings. This study examines whether current exercise guidelines for osteoporosis, when applied to individuals with vertebral fractures, can improve health outcomes.  This single blinded randomized controlled trial included 149 older women diagnosed with osteoporosis and vertebral fracture, 65+ years. The intervention group performed a 12 week multicomponent exercise programme, the control group received usual care. Primary outcome was habitual walking speed, secondary outcomes were physical fitness (Senior Fitness Test, Functional Reach and Four Square Step Test) health related quality of life and fear of falling. Descriptive data was reported as mean (standard deviation) and count (percent) Data were analyzed following intention to treat principle and per protocol. Between group differences were assessed using linear regression models (ANCOVA analysis)  No statistically significant difference between the groups were found on the primary outcome, walking speed (mean difference 0.04 m/s, 95% CI 0.01 0.09, p 0.132) Statistically significant between group differences in favour of intervention were found on FSST (dynamic balance) (mean difference 0.80 s, 95% CI 1.57 to 0.02, p 0.044) arm curl (mean difference 1.55, 95% CI 0.49 2.61, p 0.005) and 30 s STS (mean difference 1.85, 95% CI 1.04 2.67, p 0.001) as well as fear of falling (mean difference 1.45, 95% CI 2.64 to 0.26, p 0.018) No statistically significant differences between the groups were found on health related quality of life.  Twelve weeks of a supervised multicomponent resistance and balance exercise programme improves muscle strength and balance and reduces fear of falling, in women with osteoporosis and a history of vertebral fractures.

title: Risk for physical dependence in community dwelling older adults: The role of fear of falling, falls and fall related injuries.
abstract: Falls and fall related injuries along with fear of falling (FoF) seem to restrict activities of daily living (ADL) resulting in physical dependence. However, it is still unclear how falls and related injuries or FoF by themselves explain general and specific ADL dependence.  To investigate the relationships between falls and related injuries, FoF and physical dependence on ADL in community dwelling older adults, controlling for age, gender, physical activity and physical fitness as confounders.  This cross sectional descriptive study assessed 588 community dwelling older adults. Falls and fall related injuries, ADL dependence on basic, instrumental and advanced activities, FoF, demographic characteristics and health conditions were assessed through a questionnaire. Physical activity was measured through the International Physical Activity Questionnaire. Physical fitness was assessed by the Senior Fitness Test and the Fullerton Advanced Balance Scale. Body composition was measured through bioimpedance.  Severe injuries occurrence increased the likelihood of moderate and high physical dependence by 3 and 6 times, while FoF increased this likelihood by 3 and 7 times, respectively. Also, the occurrence of previous falls, resulting in severe injuries, increased the likelihood of dependence in two instrumental ADL (3 and 4 times) while FoF increased this likelihood in numerous basic, instrumental and advanced ADL (2 3 times) The FoF was shown to explain overall physical functioning dependence, by itself, representing a constraint on the performance of most basic, instrumental and advanced ADL.  The FoF showed to be a greater threat to ADL dependence than falls and related injuries. Assessment guidelines for older adults living in the community should include the FoF in clinical evaluation.  PRACTICE Understand the isolated interplay of FoF and previous falls and injuries on ADL dependence among older adults allows healthcare professionals to perform more accurate clinical evaluations and develop more successful interventions to prevent further dependence.

title: Fear of Falling among Older Patients Admitted to Hospital after Falls in Vietnam: Prevalence, Associated Factors and Correlation with Impaired Health Related Quality of Life
abstract: Fear of falling (FOF) diminishes older people's independence in daily activities, as well as causes serious health and economic consequences. This study examined the prevalence of FOF in older patients hospitalized due to fall injuries, its effect on health related quality of life (HRQOL) and its associated factors. We conducted a cross sectional study in seven hospitals in Thai Binh, Vietnam. FOF was assessed using a single close ended question. HRQOL was evaluated by the EQ 5D 5L instrument. Multilevel logistic regression and Tobit regression models were utilized. The prevalence of FOF in 405 older patients admitted to hospitals after fall injuries was 88.2% with a mean EQ 5D index and EQ VAS of 0.34 (SD 0.38) and 61.6 (SD 15.2) respectively. Factors associated with FOF included living alone (OR 0.13, 95%CI 0.04; 0.50. history of eye diseases (OR 4.12; 95%CI 1.91; 8.89) and experiencing psychological distress (OR= 3.56, 95% CI 1.05; 12.00) After adjusting for confounders, the EQ 5D index in the FOF group reduced by 0.15 points (Coef. 0.15; 95%CI= 0.24; 0.05) compared to that of non FOF group. Our study shows that FOF had an independent negative relationship with HRQOL of patients. Improving knowledge about fall prevention in patients and caregivers could reduce the burden of falls in older people.

title: Characterizing the Impact of Fear of Falling on Activity and Falls in Older Adults with Glaucoma.
abstract: Fear of falling (FoF) may alter mobility in older adults, especially among those with visual impairment. Using a longitudinal prospective cohort of older glaucoma patients, we investigated whether and how FoF is associated with future falls and physical activity.  Prospective observational cohort study.  Hospital based single center recruitment.  Individuals with glaucoma or suspected glaucoma. MEASUREMENTS FoF was measured annually over a 3 year period using the University of Illinois at Chicago FoF Questionnaire, with lower Rasch analyzed FoF scores (in logit units) indicating less fear. Participants recorded falls prospectively over the 3 year period using monthly mail in calendars. Daily steps were collected annually over 7 days using an accelerometer. Visual field (VF) sensitivity was derived by combining sensitivities from monocular VF results. Participants completed questionnaires to determine other demographic/health characteristics. Multivariate random effects models evaluated within participant changes in fall rates and physical activity across study years.  At lower FoF levels (FoF<=0) each one unit worsening in FoF score across study years was associated with 2.73 times higher odds of reporting at least one fall in the next year (95% confidence interval [CI] 1.55 4.81) but was not associated with average daily steps (P .44) Similar results were seen when fall rates were normalized by number of steps taken (P .97) At higher FoF levels (FoF 0) inter year changes in FoF scores were not significantly associated with reporting a fall in the following year (P .78) but were associated with 407 fewer average daily steps per one unit change in FoF (95% CI 743 to 71) CONCLUSION FoF is an important psychological factor associated with mobility in glaucoma patients, although specific aspects of mobility (fall rates vs activity levels) affected vary by the degree of FoF. Our findings suggest that customizing behavioral interventions for older adults based on their levels of FoF may be an important strategy for fall prevention and activity promotion.

title: Understanding the aetiology of fear of falling from the perspective of a fear avoidance model A narrative review.
abstract: Approximately half of older adults experience fear of falling (FoF) but the aetiology is unclear. The aim is to review the literature on physiological, mood and cognitive factors associated with FoF and to interpret these findings in the context of a fear avoidance model that provides a causal framework for the development of FoF. There is growing evidence that the development of FoF is influenced by balance problems and falls, and emerging evidence for a role for cognitive factors, particularly attention and processing of sensory information. While there may also be a role for mood/temperament in the development of FoF, current evidence is weak. We argue that these factors co exist and interact, which complicates assessment and design of the most appropriate intervention. The fear avoidance model offers a novel framework for explaining the mechanism of developing FoF and the discrepancy between experienced and perceived fall risk. This model specifically capitalizes on recent insights into fundamental learning mechanisms underlying emotion and fear. The proposed models provide hypotheses for future research and indications for improving efficacy of existing treatment programs.

title: Intervention Characteristics Associated With a Reduction in Fear of Falling Among Community Dwelling Older People: A Systematic Review and Meta analysis of Randomized Controlled Trials
abstract: Fear of falling (FoF) is associated with decreased physical functioning and an increased fall risk. Interventions generally demonstrate moderate effects and optimized interventions are needed. Intervention characteristics, such as setting or delivery method may vary. We investigated which overarching intervention characteristics are associated with a reduction in FoF in community dwelling older people.  A systematic review and meta analysis of randomized controlled trials (RCTs) in community dwelling older people without specific diseases was performed. Associations between intervention characteristics and standardized mean differences (SMD) were determined by univariate meta regression. Sensitivity analyses were performed.  Data on 62 RCTs were extracted, 50 intervention groups were included in the meta analysis. Most intervention characteristics and intervention types were not associated with the intervention effect. Supervision by a tai chi instructor (SMD: 1.047, 95% confidence interval [CI] 1.598; 0.496) and delivery in a community setting (SMD: 0.528, 95% CI: 0.894; 0.161) were compared to interventions without these characteristics associated with a greater reduction in FoF. Holistic exercise, such as Pilates or yoga (SMD: 0.823, 95% CI: 1.255; 0.392) was also associated with a greater reduction in FoF. Delivery at home (SMD: 0.384, 95% CI: 0.002; 0.766) or with written materials (SMD: 0.452, 95% CI: 0.088; 0.815) and tailoring were less effective in reducing FoF (SMD: 0.687, 95% CI: 0.364; 1.011)  Holistic exercise, delivery with written materials, the setting and tailoring potentially represent characteristics to take into account when designing and improving interventions for FoF in community dwelling older people. PROSPERO international prospective register of systematic reviews, registration ID CRD42018080483.