Affective Correlates of Fear of Falling in Elderly Persons

Gagnon, Nadine; Flint, Alastair J.; Naglie, Gary; Devins, Gerald M.

doi:10.1097/00019442-200501000-00003

Cited by 114 publications

(72 citation statements)

References 42 publications

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“…Among these individuals, 42% endorsed restricting their activity in some way because of fears related to falling. Gagnon et al [127] also found that among elderly individuals who had been admitted to medical or orthopedic wards and who had fallen at least once in the previous year, anxiety disorders were associated with greater intensity of fear regarding falling again compared to individuals without anxiety disorders. Elsewhere, among 56 older adults seeking medical help for a postural disturbance, 37.5% met criteria for an anxiety disorder using DSM-III-R criteria.…”

Section: Comorbidity and Differential Diagnosismentioning

confidence: 99%

“…Elsewhere, among 56 older adults seeking medical help for a postural disturbance, 37.5% met criteria for an anxiety disorder using DSM-III-R criteria. [128] Interestingly, Gagnon et al [127] found that only one of their sample of 48 older adults with a fear of falling regarded his/her fear to be excessive, thereby ruling out the diagnosis of phobia in the current edition of the DSM. One study found that up to 40% individuals with Parkinson's experienced significant anxiety symptoms, [129] whereas another study found that 43% individuals with idiopathic Parkinson's Disease met criteria for a current anxiety disorder.…”

Section: Comorbidity and Differential Diagnosismentioning

confidence: 99%

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Anxiety disorders in older adults: a comprehensive review

Wolitzky-Taylor¹,

Castriotta²,

Lenze³

et al. 2010

Depress. Anxiety

545

398

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This review aims to address issues unique to older adults with anxiety disorders in order to inform potential changes in the DSM-V. Prevalence and symptom expression of anxiety disorders in late life, as well as risk factors, comorbidity, cognitive decline, age of onset, and treatment efficacy for older adults are reviewed. Overall, the current literature suggests: (a) anxiety disorders are common among older age individuals, but less common than in younger adults; (b) overlap exists between anxiety symptoms of younger and older adults, although there are some differences as well as limitations to the assessment of symptoms among older adults; (c) anxiety disorders are highly comorbid with depression in older adults; (d) anxiety disorders are highly comorbid with a number of medical illnesses; (e) associations between cognitive decline and anxiety have been observed; (f) late age of onset is infrequent; and (g) both pharmacotherapy and CBT have demonstrated efficacy for older adults with anxiety. The implications of these findings are discussed and recommendations for the DSM-V are provided, including extending the text section on age-specific features of anxiety disorders in late life and providing information about the complexities of diagnosing anxiety disorders in older adults. Depression and Anxiety 27:190-211, 2010.

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Section: Comorbidity and Differential Diagnosismentioning

confidence: 99%

Section: Comorbidity and Differential Diagnosismentioning

confidence: 99%

Anxiety disorders in older adults: a comprehensive review

Wolitzky-Taylor¹,

Castriotta²,

Lenze³

et al. 2010

Depress. Anxiety

545

398

View full text Add to dashboard Cite

show abstract

“…For example, in a study of hospitalized fallers, only 1 of 48 individuals with moderate to severe fear of falling felt that this fear was excessive or unreasonable, even though the fear frequently resulted in avoidance of activities. 26 However, a clear discrepancy between perception of fall risk and objectively determined fall risk (as determined by history of falls, balance and gait performance, lower extremity strength, and physical conditions such as visual impairment and Parkinson's disease that increase the risk of falls) points to fear of falling as being excessive. Delbaere et al 27 found that community-dwelling residents who had low "physiologic" fall risk but high perceived fall risk were significantly more likely to have depressive symptoms, neurotic personality traits, and impaired executive functioning compared with persons whose perceived risk was congruent with physiologic risk.…”

Section: Fear Of Fallingmentioning

confidence: 99%

“…In hospitalized fallers who had moderate to severe fear of falling, 38% met criteria for a depressive disorder, compared with 4% of those who were not fearful: depressive disorder accounted for more of the explained variance in fear of falling than other known risk factors for this fear. 26 Individuals with moderate to severe depressive symptoms are more likely to be severely afraid of falling than those without depression (OR: 2.74; 95% CI: 1.69-4.47). 37 Depressive symptoms predict the persistence of fear of falling 36 and whether someone will restrict their activity level.…”

Section: Fear Of Fallingmentioning

confidence: 99%

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

Iaboni

Flint

2013

The American Journal of Geriatric Psychiatry

Self Cite

220

178

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Depression and falls have a significant bidirectional relationship. Excessive fear of falling, which is frequently associated with depression, also increases the risk of falls. Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways. The management of depression in fall-prone individuals is challenging, since antidepressant medications can increase the risk of falls, selective serotonin reuptake inhibitors may increase the risk of fragility fractures, and data are lacking about the effect of fall rehabilitation programs on clinically significant depression. Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive-behavioral therapy should be considered for the first-line treatment of mild depression in older fallers. Antidepressant medications are indicated to treat moderate to severe depression in fall-prone individuals, but with appropriate precautions including low starting dose and slow dose titration, use of psychotropic monotherapy whenever possible, and monitoring for orthostatic hypotension and hyponatremia. To date, there have been no recommendations for osteoporosis monitoring and treatment in individuals prescribed antidepressant medications, beyond the usual clinical guidelines. However, treatment of the older depressed person who is at risk of falls provides the opportunity to inquire about his or her adherence with osteoporosis and fracture-prevention guidelines. KeywordsAntidepressants; depression; falls; fear of falling; fractures One-third of community-dwelling seniors fall each year, with half of these individuals falling more than once. Ten percent of all falls result in a major injury, which can lead to institutionalization and death. 1 Falls often result in a fear of further falls, leading to fearrelated restriction of activities: this activity restriction has been associated with subsequent impairment in balance, mobility, and disability. 2,3 Send correspondence and reprint requests to Alastair

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“…Notwithstanding the importance of mobility problems, the contribution of non-motor symptoms such as anxiety and depression to FoF in PD is currently unclear. A strong association between affective variables and FoF has been found [29], as has an inter-relation between depression, anxiety, physical ability and FoF [30]. Recent data from Thomas et al suggests that PD patients who fall frequently express less FoF than those who fall infrequently [24].…”

Section: Introductionmentioning

confidence: 98%

On the Nature of Fear of Falling in Parkinson’s Disease

Rahman

Griffin

Quinn

et al. 2011

Behavioural Neurology

112

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Abstract. In the elderly, fear of falling (FoF) can lead to activity restriction and affect quality of life (QoL). Our aim was to identify the characteristics of FoF in Parkinson's disease and assess its impact on QoL. We assessed FoF in 130 patients with Parkinson's disease (PD) on scales measuring perceived self-efficacy in performing a range of activities (FES), perceived consequences of falling (CoF), and activity avoidance (SAFFE). A significant difference was found in FoF between PD patients who had previously fallen and those who had not and between frequent and infrequent fallers. Patient-rated disability significantly influenced FoF. Difficulty in rising from a chair, difficulty turning, start hesitation, festination, loss of balance, and shuffling were the specific mobility problems which were associated with greater FoF in PD. Disability was the main predictor of FoF, additionally depression predicted perceived consequences of falling, while anxiety predicted activity avoidance. The FoF measures explained 65% of the variance of QoL in PD, highlighting the clinical importance of FoF. These results have implications for the clinical management of FoF in PD.

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Affective Correlates of Fear of Falling in Elderly Persons

Cited by 114 publications

References 42 publications

Anxiety disorders in older adults: a comprehensive review

Anxiety disorders in older adults: a comprehensive review

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

On the Nature of Fear of Falling in Parkinson’s Disease

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