Fear and Risk of Falling, Activities of Daily Living, and Quality of Life

Abstract

Older adults seeking care in the ED who have a higher risk of falling are more dependent in daily living activities and experience lower quality of life. Care seeking in the ED offers an opportunity to assess fall risk and fear of falling and provide guidance on prevention and management of falls in older adults.

<p>A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls?</p>

“…mean differences between FoF and no FoF in all domainsFoF associated with PCS (β=−2.04, SE=0.24) and MCS (β=−2.46, SE=0.24), p <0.001 Chang et al 201646 N=3824;Age: 65+73.9 (5.8)Setting: CD% female: 44No dementia or severe cognitive impairment; 13.6% fallerSingle question (2 response options)53.4% afraid of fallingSF-36; SRH (5 response options)Sig. mean differences between FoF and no FoF in all domains for men and women (SF-36 & SRH)Only included SRH; SRH associated with FoF: reference excellent/very goodvs good/fair all OR 1.35 (1.13–1.62), ♂ OR 1.40 (1.11–1.76), ♀ OR 1.32 (1.00–1.75);vs poor all OR 2.52 (1.75–3.64), ♂ OR 2.44 (1.54–3.86), ♀ OR 3.12 (1.69–5.76) Cinarli et al 201737 N=151;Age: 65+;72.7 (6.3)Setting: ED% female: 48No major cognitive impairment; 37% walking aid; 48.3% fallerFES (cut point 70); activity restriction (not specified)63.6%; 46.9% limited activities because of FoFNottingham Health ProfileFoF sig. correlated with QoL(rs=0.64) Davis et al 201130 N=135;Age: 65–75;69.6 (3)Setting: CD% female: 100Healthy; no major cognitive impairments; no neurodegenerative disease, stroke or depression; mean PPA 0.12 (1.28)ABC Scale (no cut point applied)ABC mean score - 87.9 (12.9) at baselineEQ-5DFoF sig.…”

“…Most participants resided in the community. Exceptions were few studies recruiting participants from nursing homes,33–35 retirement villages/senior housing,4,36 emergency department,37 and day services 38Table 1Sample sizes, age ranges, mean age (standard deviations), population characteristics, measurements, and main results of fear of falling and quality of life of the included studiesReferencePopulationcharacteristicsHealth and fallsFoF measureFoF estimate/ prevalenceQoL measureUnivariate/unadjusted analysesMultivariate/adjusted analyses Akosile et al 201440 N=261;Age: 65+;72.27 (7.72)Setting: CD% female: 50Healthy;conditions affecting fall risk excludedmFES (cut point 8)23.4%SF-36FoF sig.…”

“…Apart from one study that included people from 58 to 96 years (mean age 78),39 all studies had participants’ minimum ages of 60 years. Thirteen publications included only participants of 65 years and older15,30,31,37,40–48 and 6 studies only adults above 70 years 32,33,35,49–51. Overall, the weighted mean age of 25 studies reporting on this outcome was 75.6 years ( SD =6.1 (22 studies)).…”

“…Study populations consisted of numerous cultures from all inhabited continents and 16 countries, ie, Nigeria,40 Brasil,48 Canada,30,36 USA,4,15,39,49,52 China/HK,34,47 Iran,53 Japan,35,38 Taiwan,41–44,46 Thailand,54 Vietnam,55 New Zealand/Australia,51 Finland,50 Germany,33,43 Greece,56 Turkey,31,37 and UK 32,45,57…”

“…Most studies utilized standard FoF questionnaires related to self-efficacy including the FES and its variations (FES-I and MFES, translations)3,4,37,40,43,44,47,48,50–53,55,56 and the ABC scale 30,57. The SAFE, measuring the activity restrictions due to FoF was used in three studies 4,34,49.…”