Validation of a quality of life questionnaire measuring the subjective fear of falling in nursing home residents

Predictors of fear of falling among community-dwelling older adults: Cross-sectional study from Palestine

Introduction

Fear of falling has serious implications for health and is an important threat to autonomy. The purpose of this cross-sectional study was to investigate risk factors for fear of falling among Palestinian older adults in Hebron district.

Methods

A cross-sectional study was conducted among Palestinians > 60 years living in Hebron, West Bank. The Falls Efficacy Scale-International was used to predict falls among Palestinian older adults. Moreover, socio-demographic data, medical history, lifestyle habits, body composition, nutritional status, cognitive status (using the Montreal cognitive assessment tool), and functional status (using activities of daily living and instrumental activities of daily living scale), the presence of depressive symptoms (using geriatric depression scale), and physical fitness performance (using senior fitness test) were collected through an interview-based questionnaire. Data were analyzed using univariate and multivariate approach.

Results

A total of 200 participants were included in the study; 137 (68.5%) females and 63 (31.5%) males. Mean age was 70.5 ± 5.7 years, ranged from 65 to 98 years old. Fear of falling was significantly higher among older adults with advanced aged, living in villages or camps, low educational level, and being married (p < 0.05). Functional status (ADL and IADL), physical fitness status (timed up and go), and depression symptoms were significantly related to fear of falling (p < 0.05).

Conclusion

High concern of falling is significantly associated with advanced age, low education level, being married, and living in villages or camps. ADLs were among the factors that had a significant relationship with increased fear of falling. Predictors of fear of falling among Palestinian older adults were IADL scores, body fat percentage, rapid gait speed, timed up and go test. Future studies could investigate further correlates of fear of falling among older adults.

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

Maintaining or improving quality of life (QoL) is a key outcome of clinical interventions in older people. Fear of falling (FoF) is associated with activity restriction as well as with poorer physical and cognitive functions and may be an important contributor to a diminished QoL. The objectives of this systematic review were to determine i) the effect of FoF on QoL in older people, ii) whether the association between these two constructs depends on the use of specific conceptualizations and measurement instruments, and iii) the role of fall events as mediating factor in this relationship. Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Library) were searched from their inceptions to February 2018. Thirty mostly cross-sectional studies in nearly 30.000 people (weighted mean age 75.6 years (SD =6.1); 73% women) were included. FoF was associated with QoL in most studies, and this association appeared to be independent of the conceptualization of FoF. Moreover, this relationship was independent of falls people experienced which seemed to have a lower impact. FoF should be considered not only as by-product of falls and targeted interventions in parts different from those to reduce falls are likely required. Studies are needed showing that reducing FoF will lead to increased QoL.

Falls Self-Efficacy in German Nursing Home Residents: Assessment of Validity and Determination of a Cutoff Point

Approximately one in every two German nursing home residents falls at least once in a 1-year period and just as many report a fear of falling. It has been hypothesized that falls self-efficacy mediates the relationship between fear of falling and functional ability. The aim of the current study was to develop the German Nursing Home Falls Self-Efficacy Scale, examine its validity, and estimate a cutoff point to differentiate nursing home residents with low or high falls self-efficacy. Nursing home residents were assessed at baseline (n = 178, mean age = 83.7 years) and 6-month follow up (n = 115, mean age = 83.9 years). Factorial and construct validity analyses provided preliminary support for the validity of the scale. A cutoff point of 11.5 was generated by receiver operating characteristic curve analysis. This scale may assist health care professionals in differentiating between nursing home residents with low and high falls self-efficacy and supporting residents in providing appropriate interventions. [Res Gerontol Nurs. 2016; 9(3):134-144.].

Falls and EQ-5D rated quality of life in community-dwelling seniors with concurrent chronic diseases: a cross-sectional study

Background

Although recommended for use in studies investigating falls in the elderly, the European Quality of Life Group instrument, EQ-5D, has not been widely used to assess the impact of falls on quality of life. The aim of this study was to investigate the association of single and frequent falls with EQ-5D rated quality of life in a sample of German community-dwelling seniors in primary care suffering a variety of concurrent chronic diseases and conditions.

Methods

In a cross-sectional study, a sample of community-dwelling seniors aged ≥ 72 years was interviewed by means of a standardised telephone interview. According to the number of self-reported falls within twelve months prior to interview, participants were categorised into one of three fall categories: no fall vs. one fall vs. two or more falls within twelve months. EQ-5D values as well as other characteristics were compared across the fall categories. Adjustments for a variety of concurrent chronic diseases and conditions and further variables were made by using multiple linear regression analysis, with EQ-5D being the target variable.

Results

In total, 1,792 participants (median age 77 years; 53% female) were analysed. The EQ-5D differed between fall categories. Participants reporting no fall had a mean EQ-5D score of 81.1 (standard deviation [s.d.]: 15.4, median: 78.3), while participants reporting one fall (n = 265; 14.8%) and participants with two or more falls (n = 117; 6.5%) had mean total scores of 77.0 (s.d.: 15.8, median: 78.3; mean difference to participants without a fall: -4.1, p < 0.05) and 72.1 (s.d.: 17.6, median: 72.5; mean difference: -9.0, p < 0.05), respectively. The mean difference between participants with one fall and participants with two or more falls was -4.9 (p < 0.05). Under adjustment for a variety of chronic diseases and conditions, the mean decrease in the total EQ-5D score was about -1.0 score point for one fall and about -2.5 points for two or more falls within twelve months. In quantity, this decrease is comparable to other chronic diseases adjusted for. Among the variables with the greatest negative association with EQ-5D ratings in multivariate analysis were depression and fear of falling.

Conclusions

The findings suggest that falls are negatively associated with EQ-5D rated quality of life independent of a variety of chronic diseases and conditions.

The Nursing Home Falls Self-Efficacy Scale

We examined a brief measure of falls self-efficacy in nursing home residents participating in a pilot randomized controlled trial to study the effects of hip protectors on the prevention of fractures ( N = 116, mean age 82 ± 8, 72% female). Internal consistency reliability was acceptable with Cronbach’s alpha of .79. Factor analysis supported two factors representing self-efficacy expectations and outcome expectancy. Contrasted groups comparisons and construct validity were examined. We found lower falls self-efficacy in participants who needed help with mobility, in people with lower executive function, and in participants who reported fear of falling. Scores were not associated with prospective falls or adherence with hip protector use. The findings of this study provide preliminary support for the reliability and validity of the scale for future research.

Increased Use of Hip Protectors in Nursing Homes: Economic Analysis of a Cluster Randomized, Controlled Trial

OBJECTIVES

To assess the cost-efficacy of an intervention program aimed at reducing hip fractures.

DESIGN

Economic evaluation within an 18-month cluster randomized trial.

SETTING

Forty-nine nursing homes in Hamburg, Germany.

PARTICIPANTS

Residents with a high risk of falling (intervention group (IG), n=459; control group (CG), n=483).

INTERVENTION

Education session for nurses, who subsequently educated residents, and provision of three hip protectors per resident. CG care was optimized by providing brief information to nurses about hip protectors and providing two protectors per nursing home for demonstration purposes.

MEASUREMENTS

Main outcomes were hip fractures, costs, and incremental cost-effectiveness ratio (ICER).

RESULTS

The intervention was effective in reducing hip fractures (21 in the IG vs 42 in the CG) and resulted in a cost difference of 51 dollars per participant in favor of the CG (95% confidence interval covering cost saving of 242 dollars to cost expense of 325 dollars). Costs per additional hip fracture avoided were 1,234 dollars. Sensitivity analyses aimed at investigating robustness of the results to a real practice implementation scenario resulted in ICERs varying from 439 dollars to 1,693 dollars. Taking into account lower hip protector reimbursement levels, the intervention program would be cost saving (break-even point within the base case analysis=22 dollars per hip protector).

CONCLUSION

A program consisting of education and provision of hip protectors might produce a slight increase in costs or might even be cost saving if the price of the hip protector could be decreased.