A Longitudinal Investigation of Fear of Falling, Fear of Pain, and Activity Avoidance in Community-Dwelling Older Adults

Abstract

The findings confirm the ability of fear of falling to predict falls but challenge preexisting models developed to account for the relationship between falls and fear. The findings also suggest limits on the generalizability of fear-avoidance models of pain. The authors conclude by suggesting mechanisms that could account for the relationship of fears with falls and pain. Unlike previous conceptualizations, these mechanisms do not rely on activity avoidance as an explanation.

Reconceptualizing the Role of Fear of Falling and Balance Confidence in Fall Risk

“…The scale has good reliability and construct and validity . It is predictive, for example, of activity avoidance and falls (Hadjistavropoulos et al, 2007). Although the name of the ABC scale refers to balance confidence and the FES scale refers to falls efficacy, the items in the FES and ABC are similar and appear to be measuring the same construct.…”

“…When low self-efficacy beliefs co-occur with fear, they could be construed as being related to the cognitive aspect of fear. Given the relationship between fear and beliefs (Barlow, 2008), people with low falls efficacy would be likely to present with increased fear of falling which would explain why falls efficacy and fear of falling have been found to be correlated (e.g., Hadjistavropoulos et al, 2007). In examining the interrelationships of falls efficacy and fear of falling, we review scales assessing these constructs as well as studies that clarify the relationship between fear and falls efficacy beliefs.…”

“…Do fear and falls efficacy predict falls? Indeed, fear of falling and falls efficacy have both been associated with both previous falls (Arfken, Lach, Birge, & Miller, 1994;Fletcher & Hirdes, 2004;Lachman et al, 1998) and future falls (Cumming et al, 2000;Hadjistavropoulos et al, 2007;Murphy et al, 2003;Murphy, Williams, & Gill, 2002). Does avoidance predict functional decline?…”

“…The most commonly used measure of falls efficacy is the Falls Efficacy Scale (FES; Tinetti et al, 1990). The scale has good reliability and validity , and predicts falls (Hadjistavropoulos et al, 2007). Modifications of the FES, varying in response format and somewhat expanding its range of items, have been published (Hill, Schwarz, Kalogeropoulos, & Gibson, 1996).…”

“…Interestingly, fear of falling (Delbaere, Crombez, Vanderstraeten, Willems, & Cambier, 2004;Friedman, Munoz, West, Rubin, & Fried, 2002), and falls efficacy (belief that one has the ability to maintain balance) (Cumming, Salkeld, Thomas, & Szonyi, 2000;Hadjistavropoulos et al, 2007), have been found to be predictive of future falls (Cumming et al, 2000;Friedman et al, 2002). In addition, elevated fear of falling has been linked to reduced leaning balance (Delbaere et al, 2004) and an impaired, "cautious" gait (Delbaere, Sturnieks, Crombez, & Lord, 2009).…”