OBJECTIVES. Fear of falling has been recognized as a potentially debilitating consequence of falling in elderly persons. However, the prevalence and the correlates of this fear are unknown. METHODS. Prevalence of fear of falling was calculated from the 1-year follow-up of an age- and gender-stratified random sample of community-dwelling elderly persons. Cross-sectional associations of fear of falling with quality of life, frailty, and falling were assessed. RESULTS. The prevalence of fear increased with age and was greater in women. After adjustment for age and gender, being moderately fearful of falling was associated with decreased satisfaction with life, increased frailty and depressed mood, and recent experience with falls. Being very fearful of falling was associated with all of the above plus decreased mobility and social activities. CONCLUSIONS. Fear of falling is common in elderly persons and is associated with decreased quality of life, increased frailty, and recent experience with falls.

If changes in potentially modifiable risk factors such as activity are associated with the beginning of functional decline, early intervention may be possible before disability ensues, thus reducing the risk of disability and ultimately health care costs.

Fear of falling is a potential cause of excess disability and an emerging public health problem. This study explores fear of falling in a longitudinal study of falls to determine incidence, prevalence, and risk factors for developing fear of falling. Prospective cohort study with annual follow-up for 2 years, conducted in a large urban metropolitan area, included 890 community-dwelling older adults--approximately equal numbers in four age groups over the age of 65. Demographic data, falls, injuries, balance, fear of falling, cognition, health, and functional status were collected through annual interviews. The prevalence of fear of falling increased over 2 years from 23 to 43%; the incidence averaged 22.5% in the 2 follow-up years. Having two or more falls, feeling unsteady, and reporting fair or poor health status were independent risk factors for developing fear of falling. The incidence and prevalence of fear of falling is significant among community-dwelling older adults and has the potential to impact function and quality of life. Public health nurses should consider fear of falling in practice, in developing screening and health programs for older adults, and as an important avenue for further research.

Individuals with Alzheimer’s disease and other dementias have 3.2 million hospital stays annually, which is significantly more than older individuals without dementia. Hospitalized patients with dementia are at greater risk of delirium, falls, overwhelming functional decline that may extend the hospital stay, and prolonged and/ or complicated rehabilitation. These risks support the need for staff education on the special care needs of this vulnerable population. In this article we describe a full-day educational program, the Dementia Friendly Hospital Initiative, designed to teach staff how to provide the specialized care required by patients with dementia. Participants (N=355) from five different hospitals, including 221 nurses, completed a pre-test/ post-test evaluation for the program. Changes in participants’ attitudes/ practices, confidence, and knowledge were evaluated. Scores indicated significant improvement on the post-test. The evaluation provides further evidence for recommending dissemination of the DFHI program.

To determine risk factors for falls, previous studies have classified falls according to the contribution of factors both intrinsic and extrinsic to the host. Due partly to the lack of operational definitions and the absence of information on reliability, no consensus on classification has been reached. Consequently, in a 3-year prospective study of falls occurring in a probability sample of community-dwelling elderly (n = 1,358), a fall classification system was developed and tested for interrater reliability. The 366 falls in the first year of the study were independently classified by two reviewers on the basis of a narrative description and structured interview. The falls in the four major categories of the classification system included: falls related to extrinsic factors (55%), falls related to intrinsic factors (39%), falls from a non-bipedal stance (8%) and unclassified falls (7%). The interrater reliability for the four major categories was 89.9% with a kappa of 0.828. The system provides operational definitions for types of falls and a reliable and flexible method for classifying falls in the elderly.

Home safety is a significant problem for caregivers of people with Alzheimer's disease and other dementias. This focus group study is designed to gain insight into caregivers' experiences of managing safety issues and to explore application of the transtheoretical model of health behavior change (TTM) to this problem, toward development of interventions to improve safety care. Caregivers identified safety problems and management strategies, as well as barriers and factors facilitating management, that can help guide the development of interventions. Caregivers described different stages of adopting actions to prevent accidents and injuries consistent with the TTM. The TTM warrants further study for understanding how to help caregivers make changes to promote safe care.

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Physical restraints continue to be used in acute care settings, despite the challenges and calls to reduce this practice. The current guideline on restraint use is updated with evidence that includes critical care settings and issues related to restraint use in acute care units. Nurses play a significant role in the use of restraints. Factors such as nurse's knowledge and patient characteristics combined with the culture and resources in health care facilities influence the practice of physical restraint use. Nurses can identify patients at high risk for restraint use; assess the potential causes of unsafe behaviors; and target interventions in the areas of physiological, psychological, and environmental approaches to address those unsafe behaviors. Members of the interdisciplinary team can provide additional consultation, and institutions can provide resources and education and implement monitoring processes and quality improvement practices to help reduce the practice of physical restraint use. [Journal of Gerontological Nursing, 42(2), 17-26.].