Fear of Falling Is Prevalent in Older Adults with Diabetes Mellitus But Is Unrelated to Level of Neuropathy

Abstract

Background Patients with diabetic peripheral neuropathy (DPN) demonstrate gait alterations compared with their nonneuropathic counterparts, which may place them at increased risk for falling. However, it is uncertain whether patients with DPN also have a greater fear of falling. Methods A voluntary group of older adults with diabetes was asked to complete a validated fear of falling questionnaire (Falls Efficacy Scale International [FES-I]) and instructed to walk 20 m in their habitual shoes at their habitual speed. Spatiotemporal parameters of gait (eg, stride velocity and gait speed variability) were collected using a validated body-worn sensor technology. Balance during walking was also assessed using sacral motion in the mediolateral and anteroposterior directions. The level of DPN was quantified using vibration perception threshold from the great toe. Results Thirty-four diabetic patients (mean ± SD: age, 67.6 ± 9.2 years; body mass index, 30.9 ± 5.7; hemoglobin A1c, 7.9% ± 2.3%) with varying levels of neuropathy (mean ± SD vibration perception threshold, 34.6 ± 22.9 V) were recruited. Most participants (28 of 34, 82%) demonstrated moderate to high concern about falling based on their FES-I score. Age (r = 0.6), hemoglobin A1c level (r = 0.39), number of steps required to reach steady-state walking (ie, gait initiation) (r = 0.4), and duration of double support (r = 0.44) were each positively correlated with neuropathy severity (P < .05). Participants with a greater fear of falling also walked with slower stride velocities and shorter stride lengths (r = −0.3 for both, P < .05). However, no correlation was observed between level of DPN and the participant’s actual concern about falling. Conclusions Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy.

Diabetes and Risk of Frailty and Its Potential Mechanisms: A Prospective Cohort Study of Older Adults

“…Similarly, although in our study diabetes was associated with decreased walking speed, we observed no significant association between diabetes and hand-grip weakness. In addition to loss of lower-limb strength, the following mechanisms have been proposed as potential contributors to the decline in walking speed observed among diabetic individuals: poor sensory and motor peripheral nerve function (46), lower cerebral vasoreactivity (47), poor balance(46) and fear of falls (48).…”

Balance performance and fear of falling in older patients with diabetics: a comparative study with non-diabetic elderly

“…[8,11] Additionally, the significant effect of neuropathic pain on FOF and balance was also found in patients with DM by univariate analysis, but peripheral neuropathy was not a factor on balance and FOF. Many studies suggest that peripheral neuropathy significantly influences FOF and balance [8,26,28] On the contrary, Kelly et al [29] and IJzerman et al [6] demonstrated that FOF was prevalent in older adults with DM but it is unrelated to peripheral neuropathy. Lalli et al [30] demonstrated that the presence of neuropathic pain in patients with DM might impair gait and stability resulting in increased falls.…”

Using Plantar Electrical Stimulation to Improve Postural Balance and Plantar Sensation Among Patients With Diabetic Peripheral Neuropathy: A Randomized Double Blinded Study

“…8 Furthermore, DPN has also been found to be one of the independent risk factors for increased risk of falls and fear of falls in older adults with diabetes. [16][17][18][19] Furthermore, fall-related injuries in diabetes are often assumed to trigger a vicious circle as they have potentially detrimental influence on the physical activity levels. This vicious circle of low physical activity, functional deficits and high fall risk further increases health care and economic costs.…”

“…42 In this scale, scores are treated as continuous variables ranging from 16-64, where 16 indicates no concern and 64 indicates severe concern for falling. Participants in our study were further classified as having low concern (score between [16][17][18][19], moderate concern (score between 20 and 27), or high concern (score ≥28) for falling according to the prior works. 19,43 Balance was measured using two wearable sensors (BalanSens™, BioSensics, Watertown, MA, USA) attached to dominant leg and the lower back.…”

“…Participants in our study were further classified as having low concern (score between [16][17][18][19], moderate concern (score between 20 and 27), or high concern (score ≥28) for falling according to the prior works. 19,43 Balance was measured using two wearable sensors (BalanSens™, BioSensics, Watertown, MA, USA) attached to dominant leg and the lower back. Participants were instructed to stand for 30 seconds with feet close together (without touching), with eyes open (EO), and eyes closed (EC).…”