Vulnerability in high-functioning persons aged 65 to 70 years: the importance of the fear factor

Seematter‐Bagnoud, Laurence; Santos-Eggimann, Brigitte; Rochat, Shékina; Martin, Estelle; Karmaniola, Athanassia; Aminian, Kamiar; Piot-Ziegler, Chantal; Büla, Christophe

doi:10.1007/bf03324799

Cited by 25 publications

(20 citation statements)

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“…Therefore, it has been suggested that poor balance confidence should rather be considered as a potential marker of frailty. For instance, in the study of well-functioning elderly subjects, those without any criteria of frailty according to Fried, but who reported some fear of falling, had similar gait performance than subjects with one or more frailty criteria but no fear [7] . In other terms, reporting some level of fear of falling was associated with a similar level of gait impairment, as observed in elderly persons already transitioning toward becoming frail.…”

Section: What Is the Epidemiological Rationale For Improving Balance mentioning

confidence: 99%

“…Moreover, some of these studies showed that even relatively young, wellfunctioning elderly persons report some level of fear and activity restriction. For instance, in a population-based study of 860 well-functioning elderly persons aged 65-70 years, about 30% reported a concern about falling in daily activities [7,8] .…”

Section: What Is the Epidemiological Rationale For Improving Balance mentioning

confidence: 99%

“…First, multiple epidemiological studies have shown the high prevalence of balance confidence impairment in older persons [1][2][3][4][5]7] . Initially, fear of falling was essentially considered as a psychological outcome of falls.…”

Section: What Is the Epidemiological Rationale For Improving Balance mentioning

confidence: 99%

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Interventions Aiming at Balance Confidence Improvement in Older Adults: An Updated Review

Büla

Monod²,

Hoskovec³

et al. 2010

Gerontology

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Background: Loss of balance confidence is a frequent condition that affects 20–75% of community-dwelling older persons. Although a recent fall is a common trigger, loss of balance confidence also appears independent of previous experience with falls. Maintaining or improving balance confidence is important to avoid unnecessary, self-imposed restrictions of activity and subsequent disability. Holding another person’s hand or using an assistive device while walking are simple interventions that are used naturally to address poor balance confidence in daily life. However, more complex interventions have also been developed and tested to achieve more sustained improvement in balance confidence. Objectives: This review describes interventions that have been tested to improve balance confidence in older community-dwelling persons. Methods: Based on 2 recent systematic reviews, an additional search for literature was performed to update current information on interventions aiming at balance confidence improvement. Interventions were classified as those directly aimed at increasing balance confidence or not, and further stratified into those using monofactorial or multifactorial approaches. Results: A total of 46 randomized controlled trials were identified. Five of the 8 interventions that directly targeted balance confidence showed benefits. Among those, multicomponent behavioral group interventions provided the most robust evidence of benefits in improving balance confidence and in decreasing activity avoidance. Among interventions not directly aiming at balance confidence improvement (11/21 studies with benefits), exercise (including tai chi) appears as the most promising monofactorial intervention. Nine of the 17 multifactorial fall prevention programs showed an effect on balance confidence, exercise being a main component in 7 of these 9 studies. Interventions that targeted elderly persons reporting poor balance confidence and/or those at risk for falls seemed more likely to be beneficial. Conclusions: Positive and sometimes sustained improvement in balance confidence can be achieved by various interventions among community-dwelling elderly persons. The effect of these interventions on activity restriction associated with poor balance confidence have been less well studied, but some studies also suggest potential benefits.

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Section: What Is the Epidemiological Rationale For Improving Balance mentioning

confidence: 99%

Section: What Is the Epidemiological Rationale For Improving Balance mentioning

confidence: 99%

See 1 more Smart Citation

Interventions Aiming at Balance Confidence Improvement in Older Adults: An Updated Review

Büla

Monod²,

Hoskovec³

et al. 2010

Gerontology

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“…Even among well-functioning older adults, the negative impact of concern about falling may be significant. For instance, previous work has shown that an increased level of concern about falling (assessed with Fall Efficacy Scale-International, FES-I) in robust community-dwelling older persons was associated with reduced mobility performance of similar magnitude than observed in the presence of a frailty criterion [4]. Therefore, the concern about falling and potential consecutive activity restrictions should be addressed early on to prevent these undesirable consequences [5].…”

Section: Introductionmentioning

confidence: 99%

Concern about Falling and Complexity of Free-Living Physical Activity Patterns in Well-Functioning Older Adults

et al. 2018

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Background: Fall-related psychological concerns are common among older adults, potentially contributing to functional decline as well as to restriction of activities and social participation. To effectively prevent such negative consequences, it is important to understand how even very low concern about falling could affect physical activity behavior in everyday life. We hypothesized that concern about falling is associated with a reduction in diversity, dynamics, and performance of daily activities, and that these features can be comprehensively quantified in terms of complexity of physical activity patterns. Methods: A sample of 40 community-dwelling older adults were assessed for concern about falling using the Falls Efficacy Scale-International (FES-I). Free-living physical activity was assessed using a set of metrics derived from data recorded with a chest-worn tri-axial accelerometer. The devised metrics characterized physical activity behavior in terms of endurance (total locomotion time, longest locomotion period, usual walking cadence), performance (cadence of longest locomotion period, locomotion periods with at least 30 steps and 100 steps/min), and complexity of physical activity patterns. Complexity was quantified according to variations in type, intensity, and duration of activities, and was considered as an adaptive response to environmental exigencies over the course of the day. Results: Based on FES-I score, participants were classified into two groups: not concerned at all/fully confident (n = 25) and concerned/less confident (n = 15). Demographic and health-related variables did not differ significantly between groups. Comparison of physical activity behavior indicated no significant differences for endurance-related metrics. In contrast, performance and complexity metrics were significantly lower in the less confident group compared to the fully confident group. Among all metrics, complexity of physical activity patterns appeared as the most discriminative feature between fully confident and less confident participants (p = 0.001, non-parametric Cliff’s delta effect size = 0.63). Conclusions: These results extend our understanding of the interplay between low concern about falling and physical activity behavior of community-dwelling older persons in their everyday life context. This information could serve to better design and evaluate personalized intervention programs in future prospective studies.

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“…Some experts have already shown that psychological aspects predict the onset of frailty in the elderly (Ostir et al, 2004); Ostir et al (2004) showed that a high positive affect reduced the risk of the onset of frailty in a 7-year prospective study. In the anthropological approach, fear of falling, for example, can also be a frailty deficit; this variable was already found to be a determinant of health vulnerability even after controlling for falls history and gait performance among older adults (Seematter-Bagnoud et al, 2010).…”

Section: Local Evaluations For a Micro-analysis Of Frailty: The Anthrmentioning

confidence: 99%

One Operational Definition by Population: The Need for Local Evaluations of Frailty

Barreto

2011

J Physiol Anthropol

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Frailty is a health problem that increases the probability of developing adverse health outcomes in the elderly. A frequently used way to operationalize frailty is the construction of a frailty index, which is built from the addition of several health deficits that describe biological aging. However, there is no consensus about the number of health deficits for building a frailty index and about which deficits must be chosen. This lack of a standardized frailty index is assumed to be an obstacle for the advancement of research on frailty. The focus of the present article is to propose a theoretically plausible alternative way of operationalizing frailty by means of frailty indexes composed of deficits selected at a local level. These deficits would therefore be different for each given population. This "anthropological approach" is on the opposite side from current trends in frailty research, which is characterized by the search for a standardized operational definition of frailty. The anthropological approach would generate more reliable data by taking into account the specificity of the population to be studied for selecting frailty deficits. In this approach, emotions, motives, and beliefs are as important to determine individuals' health vulnerability as chronic diseases and physical function. Physiological anthropologists are well positioned to contribute to research on frailty by carrying out studies on the selection of the best deficits to operationalize frailty in different populations, with different socio-cultural determinants of health, and living in different environmental life spaces.

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Vulnerability in high-functioning persons aged 65 to 70 years: the importance of the fear factor

Abstract: In high-functioning older persons, low falls efficacy was associated with vulnerability, even after controlling for gait performance and falls history. Whether low falls efficacy is a potential target on the pathway leading to frailty should be further examined prospectively.

Cited by 25 publications

References 20 publications

Interventions Aiming at Balance Confidence Improvement in Older Adults: An Updated Review

Interventions Aiming at Balance Confidence Improvement in Older Adults: An Updated Review

Concern about Falling and Complexity of Free-Living Physical Activity Patterns in Well-Functioning Older Adults

One Operational Definition by Population: The Need for Local Evaluations of Frailty

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