Cross-sectional and longitudinal risk factors for falls, fear of falling, and falls efficacy in a cohort of middle-aged African Americans

Clinical practice in nursing homes as a key for progress

With the aging of the world's population there has become a major need for the development of nursing homes throughout the world. While some countries provide high quality care for the disabled elderly, in others this is not the case. Education of a medical director has been shown to improve the quality of the nursing home. Physicians need to have knowledge of how to implement continuous quality improvement and culture change. Key medical issues include moving to a restraint free environment, subsyndromal delirium, behavioral disturbances, weight loss, pain management, pressure ulcers, falls, hip fractures, polypharmacy, depression and frailty.

Neighborhood conditions, diabetes, and risk of lower-body functional limitations among middle-aged African Americans: a cohort study

Background

The relationship between presence of diabetes and adverse neighborhood and housing conditions and their effect on functional decline is unclear. We examined the association of adverse neighborhood (block face) and housing conditions with incidence of lower-body functional limitations among persons with and those without diabetes using a prospective population-based cohort study of 563 African Americans 49-65 years of age at their 2000-2001 baseline interviews.

Methods

Participants were randomly sampled African Americans living in the St. Louis area (response rate: 76%). Physician-diagnosed diabetes was self reported at baseline interview. Lower-body functional limitations were self reported based on the Nagi physical performance scale at baseline and the three-year follow-up interviews. The external appearance of the block the respondent lived on and five housing conditions were rated by study interviewers. All analyses were done using propensity score methods to control for confounders.

Results

109 (19.4%) of subjects experienced incident lower-body functional limitations at three-year follow-up. In adjusted analysis, persons with diabetes who lived on block faces rated as fair-poor on each of the five conditions had higher odds (7.79 [95% confidence interval: 1.36-37.55] to 144.6 [95% confidence interval: 4.45-775.53]) of developing lower-body functional limitations than the referent group of persons without diabetes who lived on block faces rated as good-excellent. At least 80 percent of incident lower-body functional limitations was attributable to the interaction between block face conditions and diabetes status.

Conclusions

Adverse neighborhood conditions appear to exacerbate the detrimental effects on lower-body functioning associated with diabetes.

Socio-demographic, health-related and psychosocial correlates of fear of falling and avoidance of activity in community-living older persons who avoid activity due to fear of falling

Background

Fear of falling and avoidance of activity are common in old age and are suggested to be (public) health problems of equal importance to falls. Earlier studies of correlates of fear of falling and avoidance of activity did hardly differentiate between severe and mild levels of fear of falling and avoidance of activity which may be relevant from clinical point of view. Furthermore, most studies focused only on socio-demographics and/or health-related variables and hardly incorporated an extensive range of potential correlates of fear of falling including psychosocial variables. This study analyzes the univariate and multivariate associations between five socio-demographic, seven health-related and six psychosocial variables and levels of fear of falling and avoidance of activity in older persons who avoid activity due to fear of falling.

Methods

Cross-sectional study in 540 community-living older people aged ≥ 70 years with at least mild fear of falling and avoidance of activity. Chi-squares, t-tests and logistics regression analyses were performed to study the associations between the selected correlates and both outcomes.

Results

Old age, female sex, limitations in activity of daily living, impaired vision, poor perceived health, chronic morbidity, falls, low general self-efficacy, low mastery, loneliness, feelings of anxiety and symptoms of depression were identified as univariate correlates of severe fear of falling and avoidance of activity. Female sex, limitations in activity of daily living and one or more falls in the previous six months correlated independently with severe fear of falling. Higher age and limitations in activity of daily living correlated independently with severe avoidance of activity.

Conclusion

Psychosocial variables did not contribute independently to the difference between mild and severe fear of falling and to the difference between mild and severe avoidance of activity due to fear of falling. Although knowledge about the unique associations of specific variables with levels of severe fear of falling and avoidance of activity is of interest for theoretical reasons, knowledge of univariate association may also help to specify the concepts for developing interventions and programmes to reduce fear of falling and avoidance of activity in old age, particularly in their early stages of development.

Feelings of anxiety and symptoms of depression in community-living older persons who avoid activity for fear of falling

OBJECTIVES

The objectives of this cross-sectional study were to assess the presence of feelings of anxiety and symptoms of depression among older persons who avoid activity for fear of falling and to assess whether feelings of anxiety and symptoms of depression are independently associated with the severity of fear of falling and fear-related activity avoidance.

DESIGN

This is a cross-sectional study.

SETTING

Data were collected at two urban areas south of The Netherlands.

PARTICIPANTS

Participants included 540 community-living people aged 70 years or older who reported fear of falling and associated activity avoidance.

MEASUREMENTS

Data were collected by means of self-administered questionnaires.

RESULTS

This study shows that 28.2% and 26.1% of the persons with severe fear of falling had feelings of anxiety and symptoms of depression, respectively. These rates were 28.5% and 22.6% for participants with severe fear-related activity avoidance. Multivariate analyses revealed that participants with severe fear of falling were more likely to have feelings of anxiety and symptoms of depression than those with mild fear of falling. Furthermore, persons who reported severe fear-related activity avoidance were more likely to have feelings of anxiety than mild avoiders.

CONCLUSIONS

Feelings of anxiety and symptoms of depression are common in persons with severe fear of falling and fear-related activity avoidance. Professional care providers should be alert to underlying anxiety disorders and depression in this category of older persons in the interests of providing optimum treatment.

Self-rated health: changes, trajectories, and their antecedents among African Americans

OBJECTIVE

Little is known about changes in self-rated health (SRH) among African Americans.

METHOD

We examined SRH changes and trajectories among 998 African Americans 49 to 65 years old who we reinterviewed annually for 4 years, using multinomial logistic regression and mixed effect models.

RESULTS

Fifty-five percent had the same SRH at baseline and 4 years later, 25% improved, and 20% declined. Over time, men were more likely to report lower SRH levels, individuals with hypertension were less likely to report lower SRH levels, and those with congestive heart failure at baseline were more likely to report higher SRH levels. Lower SRH trajectory intercepts were observed for those with lower socioeconomic status, poorer health habits, disease history, and worse functional status. Those with better cognitive status had higher SRH trajectory intercepts.

DISCUSSION

The decline in SRH levels among 49- to 65-year-old African Americans is comparable to that of Whites.

Rating neighborhoods for older adult health: results from the African American Health study

Background

Social theories suggest that neighborhood quality affects health. Observer ratings of neighborhoods should be subjected to psychometric tests.

Methods

African American Health (AAH) study subjects were selected from two diverse St. Louis metropolitan catchment areas. Interviewers rated streets and block faces for 816 households. Items and a summary scale were compared across catchment areas and to the resident respondents' global neighborhood assessments.

Results

Individual items and the scale were strongly associated with both the catchment area and respondent assessments. Ratings based on both block faces did not improve those based on a single block face. Substantial interviewer effects were observed despite strong discriminant and concurrent validity.

Conclusion

Observer ratings show promise in understanding the effect of neighborhood on health outcomes. The AAH Neighborhood Assessment Scale and other rating systems should be tested further in diverse settings.

Fear of Falling in Older Women: A Longitudinal Study of Incidence, Persistence, and Predictors

OBJECTIVES

To determine longitudinal predictors of incident and persistent fear of falling (FOF) in older women.

DESIGN

Longitudinal study.

SETTING

Clinical research center based at a university hospital.

PARTICIPANTS

One thousand two hundred eighty-two community-dwelling women aged 70 to 85.

MEASUREMENTS

FOF at baseline and after 3 years of follow-up; a range of baseline demographic and clinical variables, including mobility, balance, and depression.

RESULTS

FOF was present in 418 subjects (33%) at baseline, developed in 30% of women who had been free of the symptom at baseline, and was reported by a total of 46% of the sample after 3 years of follow-up. In cross-sectional multivariable analysis, baseline FOF was independently associated with a range of variables, including living alone, obesity, cognitive impairment, depression, and impairments in balance and mobility. Baseline predictors of FOF that persisted after 3 years were similar, whereas obesity and slower timed up and go test scores predicted new-onset FOF.

CONCLUSION

FOF in older women is a common and persistent complaint that is caused mainly by impairments of balance and mobility. A range of social, psychological, and physical risk factors for disability are associated with persistence of FOF. These results imply that early intervention may be important for the prevention of persistent FOF.