Association between Fear of Falling (FOF) and all-cause mortality

A pilot study to identify factors associated with frailty within the World Trade Center general responder cohort

BACKGROUND

Given the significant exposures experienced by the World Trade Center (WTC) general responders, there is increasing interest in understanding the effect of these exposures on aging in this population. We aim to identify factors that may be associated with frailty, a clinical syndrome characterized by a decrease in one's reserve that has been linked to poor health outcomes.

METHODS

WTC general responders enrolled in the WTC Health Program aged 50 and older provided informed consent. Validated frailty assessments, the Frailty Phenotype (with the Johns Hopkins Frailty Assessment Calculator) along with the FRAIL scale, categorized nonfrail from prefrail/frail. Fall risk, functional status, and cognition were also assessed. WTC variables, including an identified WTC-certified condition, were utilized. The risk of frailty was estimated using log binomial regression analysis. A 95% confidence interval (CI) was used to estimate the prevalence ratio (PR).

RESULTS

One hundred and six participants were included; 38 (35.8%) were classified as pre-frail or frail. More of the pre-frail/frail group were obese (57.9% vs. 25%; p = 0.004) and had a WTC-certified condition (78.9% vs. 58.8%; p = 0.036). Obesity (PR = 2.43, 95% CI = 1.31, 4.53), a WTC-certified condition (PR = 1.77, 95% CI = 1.09, 2.89), and risk of falling (PR = 1.97, 95% CI = 1.01, 3.84) were independently associated with frailty.

CONCLUSIONS

Obesity and having a WTC-certified condition were found to be risk factors for frailty in our pilot study. Future work may focus on further identifying risk factors for frailty in the larger WTC general responder population.

The association of cardiometabolic multimorbidity and fear of falling among older adults: Data from the national health and aging trends study

OBJECTIVES

Cardiometabolic diseases (CMDs) have been individually associated with fall-related outcomes, but their combined effect on fear of falling (FOF) has not been investigated. This study aims to examine the association between cardiometabolic multimorbidity and FOF in older adults.

METHODS

Data from the National Health and Aging Trends Study, 4,295 community-dwelling older adults ≥ 65 years were analyzed in this longitudinal study. CMDs were assessed at baseline, including heart disease, diabetes, stroke, and hypertension. FOF was evaluated by asking participants if they worried about falling in the past month. Data were analyzed using multi-adjusted logistic regression.

RESULTS

Cardiometabolic multimorbidity was associated with a higher risk of FOF. The combination of heart disease and diabetes showed the highest risk of FOF (OR = 3.47, 95 % CI: 1.63-7.40).

CONCLUSIONS

These findings underscore the need for targeted interventions to mitigate the combined impact of cardiometabolic multimorbidity on FOF in older adults.

Elective Foot and Ankle Procedures in the Patients Greater than 65 Years of Age: Worth the Mobility Gains

Chronic, non-traumatic pathologies of the foot and ankle can be mobility-limiting for patients of all ages. The objective of this study was to compare postoperative changes in LifeSpace Mobility Assessment (LSA) scores of adult and elderly patients following elective foot and ankle surgery. A prospective study of 184 patients undergoing elective ankle, hindfoot, and midfoot procedures conducted by one surgeon between 2015 and 2019 was undertaken. Patient-reported LSA scores were collected at preoperative, 6-month, and 12-month follow-up. Patient data was compared using an independent sample t-test for continuous, normally distributed data and a chi-squared or Fischer's exact test for categorical data. Alpha and beta were .05 and .8. Patients were divided based on age. 140 patients were observed in the younger (<65) group, 44 patients were observed in the elderly (≥65) group. The average LSA score of elderly patients at the preoperative visit was 58.3 (SD 38.0) vs 79.3 (SD 38.8) in the younger cohort (P = .041). Both patient cohorts saw decreased mobility at 3-month postoperative visits but surpassed preoperative mobility scores by 6 months and 1 year postop. No difference in average mobility score was observed between young (85.6, SD 36.1) and elderly (90.1, SD 34.3) cohorts at 1-year follow up. Given the increased rates of perioperative comorbidities and the heightened risks of intraoperative complications, physicians may be more inclined to manage elderly patients with longer periods of conservative treatment for similar pathologies. However, these results imply that elderly patients experience similar improvements after surgery to younger cohorts and should not be excluded from surgical consideration. Our results, in tandem with literature showing the deleterious effects of decreased mobility in the elderly, suggest that the discussion to pursue or hold surgical correction of chronic foot and ankle disease in patients over age 65 must consider the mobility benefits of surgery.

The association of fear of falling and physical and mental Health-Related Quality of Life (HRQoL) among community-dwelling older persons; a cross-sectional study of Urban Health Centres Europe (UHCE)

BACKGROUND

The share of people over 80 years in the European Union is estimated to increase two-and-a-half-fold from 2000 to 2100. A substantial share of older persons experiences fear of falling. This fear is partly associated with a fall in the recent past. Because of the associations between fear of falling, avoiding physical activity, and the potential impact of those on health, an association between fear of falling and low health-related quality of life, is suggested. This study examined the association of fear of falling with physical and mental Health-Related Quality of Life (HRQoL) among community-dwelling older persons in five European countries.

METHODS

A cross-sectional study was conducted using baseline data of community-dwelling persons of 70 years and older participating in the Urban Health Centers Europe project in five European countries: United Kingdom, Greece, Croatia, the Netherlands and Spain. This study assessed fear of falling with the Short Falls Efficacy Scale-International and HRQoL with the 12-Item Short-Form Health Survey. The association between low, moderate or high fear of falling and HRQoL was examined using adjusted multivariable linear regression models.

RESULTS

Data of 2189 persons were analyzed (mean age 79.6 years; 60.6% females). Among the participants, 1096 (50.1%) experienced low fear of falling; 648 (29.6%) moderate fear of falling and 445 (20.3%) high fear of falling. Compared to those who reported low fear of falling in multivariate analysis, participants who reported moderate or high fear of falling experienced lower physical HRQoL (β = -6.10, P < 0.001 and β = -13.15, P < 0.001, respectively). In addition, participants who reported moderate or high fear of falling also experienced lower mental HRQoL than those who reported low fear of falling (β = -2.31, P < 0.001 and β = -8.80, P < 0.001, respectively).

CONCLUSIONS

This study observed a negative association between fear of falling and physical and mental HRQoL in a population of older European persons. These findings emphasize the relevance for health professionals to assess and address fear of falling. In addition, attention should be given to programs that promote physical activity, reduce fear of falling, and maintain or increase physical strength among older adults; this may contribute to physical and mental HRQoL.

Bidirectional relationship between fear of falling and frailty among community-dwelling older adults: A longitudinal study

This study aims to examine the bidirectional association between fear of falling (FOF) and frailty among community-dwelling older adults. Longitudinal analyses were conducted over a representative sample of 5,829 community-dwelling individuals ≥65 years from the National Health and Aging Trends Study. FOF was ascertained by asking participants whether they worried about falling and if this worry ever limited their activities. Frailty status was assessed based on frailty phenotype. At baseline, 71.4% of participants reported no FOF, 16.7% reported FOF without fear-related activity restriction (FAR), and 11.9% reported FOF with FAR. The proportion of robust, pre-frail and frail respondents at baseline was 36.1%, 48.7% and 15.2%, respectively. Multinomial logistic regression models indicated FOF with and without FAR predicted pre-frailty and frailty. Pre-frailty predicted FOF with and without FAR, while frailty only predicted FOF with FAR. Tailored intervention strategies are needed for preventing adverse outcomes of FOF and frailty among the older population.

Investigating Factors Associated with Fear of Falling in Community-Dwelling Older Adults through Structural Equation Modeling Analysis: A Cross-Sectional Study

The scientific literature mentions the existence of factors associated with fear of falling in older adults. However, the direct and indirect paths of its predictors have not yet been fully explored. This study aimed to analyze the socioeconomic, clinical, and health factors directly and indirectly associated with fear of falling in community-dwelling older adults. This is a cross-sectional study conducted in older adults (n = 410 - 70.11 ± 7.22 years). Clinical and health-condition data were collected, as were data on fear of falling using the Falls Efficacy Scale International-Brazil (FES-I Brazil). It was found that being female and having a higher number of self-reported morbidities, worse physical performance, and a higher number of depressive symptoms were directly associated with greater fear of falling. Regarding indirect associations, physical inactivity, mediated by a greater number of morbidities, worse physical performance, and a greater number of depressive symptoms, was associated with greater fear of falling. In addition, worse self-rated health, mediated by a greater number of depressive symptoms, as well as older age, mediated by worse physical performance, were associated with the outcome. This study provides information on the predictors directly and indirectly associated with fear of falling, expanding current understanding of this relationship.

Exploring Mediation Effects of Gait Speed, Body Balance, and Falls in the Relationship between Physical Activity and Health-Related Quality of Life in Vulnerable Older Adults

The present study aimed to examine whether gait speed (GS), body balance (BB), and falls mediated the relationship between physical activity (PA) and health-related quality of life (HRQoL) in community-dwelling older adults. This is a cross-sectional study that included 305 men and 314 women (69.5 ± 5.6 years), residing in the Autonomous Region of Madeira, Portugal. HRQoL and PA were assessed using the SF-36 and Baecke Questionnaires, respectively. While BB was obtained by the Fullerton Advance Balance (FAB) scale, GS by the 50-foot (15 m) walk test, and the frequency of falls was obtained by self-report. According to the analyses, when GS and BB were placed concomitantly as mediators, the direct effect revealed by the model revealed a non-significant relationship between PA and falls. Thus, in the context of falls, GS and BB partially mediated the association between PA and HRQoL in approximately 29.7%, 56%, and 49.2%, respectively. The total HRQoL model explained a variance of 36.4%. The results can help to understand the role that GS, BB, and falls play in the relationship between PA and HRQoL of the vulnerable older adult population.

Associations of fall history and fear of falling with multidimensional cognitive function in independent community-dwelling older adults: findings from ORANGE study

BACKGROUND

Falls and fear of falling (FoF) inhibit healthy longevity and have been suggested to be associated with cognitive function. However, the domains of cognitive function that are associated with them remain controversial. It is speculated that clarifying this will help in the assessment of health status and interventions in the community.

AIM

To analyse the associations between fall history and FoF and multidimensional cognitive function in independent community-dwelling older adults.

METHODS

The data from 9759 (73.3 ± 5.4 years, 59.9% women) older individuals enrolled in the cross-sectional ORANGE study were analysed. Simple questions were used to assess fall history in the past year and current FoF. Assessments of multidimensional cognitive function were performed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT) to evaluate memory, attention, executive function, and processing speed. The independent associations of fall history and FoF with multidimensional cognitive function were assessed using multivariate linear regressions adjusted for potential confounding variables.

RESULTS

A total of 18.3% and 35.4% of participants presented with fall history and FoF, respectively. Fall history (p = 0.008) and FoF (p = 0.002) were significantly associated with memory. FoF, but not fall history was associated with attention (p = 0.004), executive function (p < 0.01), and processing speed (p < 0.01).

CONCLUSION

In independent community-dwelling older adults, fall history was associated only with the memory domain; in contrast, fear of falling was associated with multidimensional cognitive function. This study provides weak evidence suggesting the need to assess falls and FoF in all situations involving independent community-dwelling older adults.

Fear of falling and all-cause mortality among young-old community-dwelling adults: a 6-year prospective study

This study investigated whether fear of falling (FOF) measured by two different instruments, the Falls Efficacy Scale-International (FES-I) and the single question on FOF and activity restriction (SQ-FAR), is associated with mortality at 6-year follow-up. Participants (n = 1359, 58.6% women) were community-dwelling persons enrolled in the Lausanne cohort 65 + , aged 66 to 71 years at baseline. Covariables assessed at baseline included demographic, cognitive, affective, functional and health status, while date of death was obtained from the office in charge for population registration. Unadjusted Kaplan Meyer curves were performed to show the survival probability for all-cause mortality according to the degree of FOF reported with FES-I and SQ-FAR, respectively. Bivariable and multivariable Cox regression analyses were performed to assess hazard ratios, using time-in-study as the time scale variable and adjusting for variables significantly associated in bivariable analyses. During the 6-year follow-up, 102 (7.5%) participants died. Reporting the highest level of fear at FES-I (crude HR 3.86, 95% CI 2.37-6.29, P < .001) or "FOF with activity restriction" with SQ-FAR (crude HR 2.42, 95% CI 1.44-4.09, P = .001) were both associated with increased hazard of death but these associations did not remain significant once adjusting for gender, cognitive, affective and functional status. As a conclusion, although high FOF and related activity restriction, assessed with FES-I and SQ-FAR, identifies young-old community-dwelling people at increased risk of 6-year mortality, this association disappears when adjusting for potential confounders. As a marker of negative health outcomes, FOF should be screened for in order to provide personalized care and reduce subsequent risks.

Quantifying fear of falling by utilizing objective body sway measures: A 360° virtual video study

BACKGROUND

Fear of falling (FOF) is a psychological condition that can lead to increased morbidity and mortality in the elderly population. However, the subjective and multidimensional nature of FOF results in limitations of existing FOF measurement tools, which could influence the generalization of the findings from various studies. An objective measure of FOF could address those limitations. The present study aimed to identify the feasibility of using center of pressure (COP) parameters to quantify FOF.

RESEARCH QUESTION

(1) Are 360º roller coaster videos effective to induce FOF? And (2) Which COP parameter(s) is/are feasible to quantify FOF?

METHODS

Nineteen young, healthy adults (24 ± 2.47 years) were recruited in the present study. Subjects were required to watch three 360º videos: one control video and two roller coaster videos, through virtual reality goggles during standing and sitting. Six trials (3 during standing and 3 during sitting) with video were performed. Subjects were required to rate their FOF on a visual analogue scale after watching each video. COP mean power frequency, COP root mean square, and COP range were measured. The Friedman test was used to assess differences in COP parameters under different video conditions, and Spearman's correlation analysis was used to assess the relationship between FOF and COP parameters.

RESULTS

Similar COP changes were observed in sitting and standing conditions. With increased FOF, participants demonstrated decreased COP mean power frequency and increased COP root mean square in the medial-lateral direction during both sitting and standing.

SIGNIFICANCE

Our study provided evidence that 360º roller coaster videos are effective tools to induce FOF and change in COP parameters. The relationship between FOF and COP parameters suggests that the measurement of body sway may be an objective way to quantify FOF. More research are needed to solidify the evidence.

Association Between Fear of Falling and Frailty in Community-Dwelling Older Adults: A Systematic Review

Background/Objective

Fear of falling (FoF) and frailty are common problems in older adults. FoF can lead to self-imposed restriction of activities and then further decline in physical capacities that predispose older adults to frailty. Evaluating the association of these two geriatric syndromes may be the first step for understanding their complex relationship and might ultimately lead to establishing therapeutic goals and guiding treatments for older adults with frailty. This systematic review was conducted to provide evidence regarding the association between FoF and frailty.

Methods

All the articles that provided information on the association between FoF and frailty were selected from PubMed, Scopus, CINAHL, and EMBASE in search of relevant papers. Articles reporting information on the association between FoF (exposure) and frailty (outcome), with older adults (age ≥60 years) living in the community (ie, living either at home or in places of residence that do not provide nursing care or rehabilitation) were included. Only original articles with observational design (cross-sectional or longitudinal/cohort) were included. The methodological quality of included articles was evaluated independently by the two assessors through the Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) critical appraisal checklist for longitudinal and cross-sectional studies, respectively.

Results

The initial searches found 4,342 articles, of which 10 articles were included in this review: 7 cross-sectional and 2 longitudinal studies, and 1 study with cross-sectional and longitudinal analyses. The total sample was composed of 6,294 community-dwelling older adults (61.8% women). Among the longitudinal studies, adjusted odds ratios ranged from 1.18 (95% CI = 1.02; 1.36) to 9.87 (95% CI = 5.22; 18.68), while the adjusted odds ratios of the cross-sectional studies ranged from 1.04 (95% CI = 1.02; 1.07) to 7.16 (95% CI = 2.34; 21.89).

Conclusion

FoF increases the risk of frailty in community-dwelling older adults. The knowledge of this association is of utmost importance in clinical practice, since it can help health professionals in the development of rehabilitation, prevention, and health promotion protocols. In addition, these findings can contribute to the development of public health policies and actions aimed at reducing the FoF and consequently the frailty.

Prospero

CRD42021276775.

Association between activity restriction due to fear of falling and mortality: Results from the Korean longitudinal study of aging

AIM

To analyze the correlation between activity restriction due to fear of falling and mortality among Koreans aged ≥45 years.

METHODS

After excluding missing values, the data of 411 participants from the first to sixth waves of the Korean Longitudinal Study of Aging were analyzed using the χ² -test, log-rank tests and Cox proportional hazards model.

RESULTS

In model 1, which did not include activity restriction due to fear of falling as an independent variable, the death rate increased by 1.024-fold (hazard ratio 1.024, 95% confidence interval 1.000-1.050, P = 0.0498) as the number of falls increased by one. In model 2, which included activity restriction due to fear of falling as an independent variable, participants with experience of activity restriction showed 1.993-fold higher mortality (hazard ratio 1.993, 95% confidence interval 1.112-3.572, P = 0.0205) than those without such experience. In addition, as the number of falls in the group with chronic diseases increased by one, the mortality rate increased by 1.028-fold (hazard ratio 1.028, 95% confidence interval 1.001-1.057, P = 0.043).

CONCLUSIONS

There was a close relationship between activity restriction due to fear of falling and mortality. Therefore, this study can serve as the foundation for policies and institutional measures to reduce the mortality rate of groups with activity restrictions due to fear of falling. Geriatr Gerontol Int 2021; ••: ••-••.

How Much Time in Sedentary Behavior Should Be Reduced to Decrease Fear of Falling and Falls in Community-Dwelling Older Adults?

Fear of falling and history of falls are frequent situations in older adults, which can be aggravated by sedentary behavior (SB). The objective was to establish SB cutoff values which discriminate falls and fear of falling in older adults and verify the association between these conditions. This was a cross-sectional study including 308 community-dwelling older adults. The SB was assessed by International Physical Activity Questionnaire. The outcomes were history of falling in the last 12 months and fear of falling (higher or equal than 23 points in Falls Efficacy Scale International-Brazil). The cutoff points found were >4.14 (area under curve = 0.60, 95% confidence intervals [CIs] [0.54, 0.65]) and >3.90 hr per day (area under curve = 0.59, 95% CI [0.53, 0.64]) for fear of falling and history of falls, respectively. Older adults with SB had 1.71 (95% CI [1.03, 2.84]) and 1.75 (95% CI [1.06, 2.89]) greater odds of having greater fear of falling and suffering falls, respectively.

Experiences of falling and depression: Results from the Korean Longitudinal Study of Ageing

OBJECTIVE

This study estimates the association between fall experiences during the last two years and risk of depression.

METHODS

Data from 9,355 subjects of the Korean Longitudinal Study of Ageing from 2006 to 2016 were included with baseline at 2006. To analyze the association between fall experiences during the last two years and depression, a generalized estimating equation (GEE) model and chi-square tests were used.

RESULTS

At baseline 2006, the odds ratio (OR) of depressive symptoms in those with fall experiences was 1.36 times higher (p < .0001) than those with non-fall experience. In those 64 years or younger and 65 years or older, the OR of depressive symptoms in fall experience was 1.45 times higher (p =0.003) and 1.34 times higher (p =0.000) than those with non-fall experience, respectively. In males and females, the OR of depressive symptoms in those with fall experience was 1.47 times higher (p 0.008) and 1.34 times higher (p =0.000) than those with non-fall experience, respectively.

CONCLUSION

Fall experiences during the last two years are associated with depressive symptoms. Therefore, self-reported screening for fall experiences might aid in population-based prevention strategies for depressive symptoms.

[Prevalence of fear of falling and related factors in community-dwelling older people]

Objetivo

El objetivo general del estudio es conocer la prevalencia de la preocupación a caer en personas mayores, independientes para la deambulación, que viven en la comunidad, según la versión reducida del FES-I y los factores asociados que influyen en esta preocupación.

Diseño

Estudio descriptivo transversal.

Emplazamiento

Centro de Salud El Greco (Getafe), Gerencia Asistencial de Atención Primaria de Madrid.

Participantes

Ciento ochenta y nueve pacientes ≥ 70 años independientes o con dependencia funcional leve-moderada (índice de Barthel ≥ 60) e independientes para la deambulación (camina 45 min sin ayuda o con bastón). El estudio se ofreció a 328 personas: 217 aceptaron y rechazaron 111.

Mediciones principales

La variable dependiente, miedo a caerse (MC), fue evaluada mediante el cuestionario Short FES-I, considerando como punto de corte para el cribado positivo del MC una puntuación ≥ 11. Como variables independientes se consideraron: índice de Barthel, escala Downton, prueba de fragilidad Short Physical Performance Battery (SPPB), caídas en el último año, lesiones asociadas a las caídas, tiempo desde la última caída, déficit sensorial, uso de dispositivos de la marcha, comorbilidad y tratamiento farmacológico.

Resultados

La prevalencia del MC fue del 42,9% (IC 95%: 35,5-50,2). Los factores asociados al MC en el análisis multivariante final fueron: sexo femenino, vivir solo, alto riesgo de caídas, presencia de fragilidad, uso de hipotensores y lesiones asociadas a caídas previas.

Conclusiones

La prevalencia del miedo a caer en personas mayores es elevada. Los profesionales de atención primaria deben sistematizar el cribado de este problema de salud, priorizando especialmente en las personas que presentan los siguientes factores de riesgo: ser mujer, vivir solo, tener una puntuación baja en el SPPB (como indicador de fragilidad) o presentar un elevado riesgo de caídas.