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

Abstract

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.

Concerns About Falling in Parkinson’s Disease: Associations with Disabilities and Personal and Environmental Factors

“…Regular controls of blood pressure to evaluate and treat orthostatic hypotension could be recommended for people with PD who are concerned about falling. The significance of orthostatism is a novel finding; no prior PD study included orthostatism as an independent variable in multivariate analysis targeting FOF [10,12,[19][20][21]. However, a previous study that used univariate analyses showed no difference in the proportion of PD patients who experienced FOF among those with and without orthostatic hypotension [47].…”

“…Previous multivariate PD studies that have investigated associated factors to FOF have focused on FOF conceptualized as fall-related selfefficacy [10,12,19,20] or balance confidence [21]. Furthermore, a recent head-to-head comparison of four commonly used FOF rating scales showed that the FES-I and the modified Survey of Activities and Fear of Falling in the Elderly were the most favourable in terms of psychometric properties in people with PD [6].…”

“…It is a widely used umbrella term for that have targeted people with PD, FOF has been identified as a predictor of recurrent falls [15] and walking in the community [16], a barrier to physical exercise [17] and expressed as restricting participation in meaningful activities [18]. Furthermore, FOF has been shown to be negatively associated with quality of life [19] and a more important determinant of health-related quality of life than balance impairments and actual falling [13].…”

“…Several PD studies have investigated associated factors to FOF by using multivariate regression analyses [10,12,[19][20][21]. However, two of these studies were based on data collected by means of postal surveys and therefore lacked clinical data [12,19] and three studies included few (n = 4-6) potential independent variables [19][20][21], resulting in non-comprehensive analyses of contributors to FOF.…”

“…Prior multivariate PD studies on FOF have mainly focused on disabilities related to PD (such as difficulties in walking and activities of daily living) [10,12,[19][20][21]. Less is known about the associations between FOF and personal and environmental factors, as defined by the International Classification of Functioning, Disability and Health (ICF) [22].…”