Correlates of fear of falling and falls efficacy in geriatric patients recovering from hip/pelvic fracture

Abstract

Objective: To gain a better understanding about the nature of fear of falling, this study analyzed associations between psychological and physical aspects related to fear of falling and falls efficacy in hip/pelvic fracture patients. Design: Baseline data of a randomized controlled trial. Setting: Geriatric inpatient rehabilitation hospital. Subjects: In all, 115 geriatric patients with hip/pelvic fracture (mean age: 82.5 years) reporting fear of falling within first week of inpatient rehabilitation. Interventions: None. Main measures: Falls efficacy (Short Falls Efficacy Scale–International; Perceived Ability to Manage Falls), fear of falling (one-item question), fall-related post-traumatic stress symptoms (six items based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria), physical performance (Short Physical Performance Battery) and psychological inflexibility (Acceptance and Action Questionnaire-II) were assessed. Results: Path analyses demonstrated that low falls efficacy (Short Falls Efficacy Scale International) was significantly related to poor physical performance ( β* = –.277, P ⩽ .001), but not to psychological inflexibility and fall-related post-traumatic stress symptoms ( P ⩾ .05.). Fear of falling was directly associated with fall-related post-traumatic stress symptoms ( β*= .270, P = .007) and indirectly with psychological inflexibility ( β*= .110, P = .022). Low perceived ability to manage falls was significantly related to previous falls ( β* = –.348, P ⩽ .001), psychological inflexibility ( β* = –.216, P = .022) and female gender ( β* = –.239, P ⩽ .01). Conclusion: Falls efficacy and fear of falling constitute distinct constructs. Falls efficacy measured with the Short Falls Efficacy Scale International reflects the appraisal of poor physical performance. Fear of falling measured by the single-item question constitutes a fall-specific psychological construct associated with psychological inflexibility and fall-related post-traumatic stress symptoms.

Fraturas de fêmur em idosos nas diferentes regiões do Brasil de 2015 a 2020: análise dos custos, tempo de internação e total de óbitos

“…8,29 Este estudo ressalta a necessidade de ações de saúde que devem também ser direcionadas à médio e longo prazo, pois após a ocorrência da fratura e com o processo de envelhecimento, há um aumento da propensão a quedas acrescida com o medo de cair, fatores que repercutem na capacidade funcional e sintomas de estresse pós-traumático relacionados à queda. 30,31 Dentre as limitações do estudo, os dados não permitem realizar a associação de causa-efeito, o maior número de casos e os maiores custos na região Sudeste pode ser inferido da maior densidade populacional na região.…”

An Evaluation of the Fear of Falling, Balance Levels, and Prognostic Blood Parameters Among the Geriatric Population With Hip Fractures

“…Fear of falling is common among patients with hip fractures, worsening treatment outcomes [1][2][3][7][8][9][10]. The literature has offered different opinions on the cause of this fear of falling, and the most frequently investigated factors include neuropsychiatric causes, obesity, postural balance disorder, decreased muscle strength, and metabolic causes [1,3,[7][8][9][10].…”

“…Therefore, preventative methods are important. Due to high fear-of-falling rates after a hip fracture among the geriatric population (21-85%), decreased physical activity levels and worsening functional results have been observed among these patients [1][2][3][7][8][9][10]. Studies have also reported that the fear of falling affects functional recovery more than pain [11].…”

“…Different opinions have been suggested in the literature regarding what causes the fear of falling, and the most frequently investigated factors are neuropsychiatric causes, namely, obesity, postural balance disorder, decreased muscle strength, and metabolic causes [ 1 , 3 , 7 - 10 ]. Post-traumatic symptoms, especially after falling, are common among geriatric patients.…”

“…Post-traumatic symptoms, especially after falling, are common among geriatric patients. Neuropsychiatric symptoms, such as anxiety, depression, and delirium, are thought to be the most important factor in the fear of falling, causing post-traumatic symptoms after a fall [ 7 ].…”