Cognitive Appraisal and Knowledge as Risk Factors for High Fear of Falling in Older and Middle-Aged Adults in Singapore

Abstract

Fear-of-falling (FOF) can be adaptive or maladaptive depending on one’s appraisal of knowledge and beliefs, but few have elucidated this cognitive process in older adults surrounding falls. We aim to identify risk factors for high FOF amongst community-dwelling older adults (OA) and middle-aged adults (MA) in Singapore. This was a cross-sectional survey of a nationally-representative sample of OA (≥60 years) and MA (40-59 years) identified by stratified random sampling. Primary outcome was high FOF measured by a single-item (4-point scale). Independent variables were history-of-falls, quality-of-life, fall-related cognitive appraisal (balance problems, importance to restrict activities to prevent falls) and knowledge indicators (knowledge of other OA who fell, ability to identify out of 13 fall risk factors). MA were also asked if they’re caregivers. Multiple logistic regressions identified risk factors for high FOF separately by age-groups, adjusting for socio-demographics and comorbidities. The final analysis included 549 OA (70.6±6.88 years) and 309 MA (49.7±5.89 years). No differences in high FOF was found among OA and MA (37% vs. 38%, p=0.305), but there were more falls among OA (19% vs 12%, p=0.010). Higher knowledge of fall risk factors and self-reported balance problems were significant risk factors for high FOF among OA only, while a history-of-falls and being a caregiver were significant among MA only. Perceived importance to restrict activities was associated with high FOF in both age-groups. Although findings suggest differences in the mechanism of high FOF between OA and MA, both age-groups have maladaptive appraisal tendencies related to restrict activities to prevent falls.

Pragmatic multicentre stepped-wedge cluster randomised trial to investigate the effectiveness of community-based falls prevention programme for older adults with falls risk in Singapore: a protocol paper

“…Open access community-dwellers aged 60 years and older. 3 In addition, 76% of trauma cases presented at emergency departments in Singapore were due to falls. 4 It is well established that falls have a multifactorial aetiology.…”

“…Falls are a major public health concern as 30%–39% of community-dwelling adults above 60 years had a fall in a 12 month period, of which 30% resulted in injuries, and 15% of emergency visits are due to falls 1 2. In Singapore, fall prevalence was found to be 19% in a nationally representative sample of community-dwellers aged 60 years and older 3. In addition, 76% of trauma cases presented at emergency departments in Singapore were due to falls 4…”