Factors associated with fear of falling in community-dwelling older adults with and without diabetes mellitus: Findings from the Frailty in Brazilian Older People Study (FIBRA-BR)

Reduced Balance Confidence Significantly Mediates Fear of Falling Avoidance Behavior and Effectiveness of Balance Training in Older Adults With Type II Diabetes

BACKGROUND AND PURPOSE

Older adults with chronic diabetes have been shown to exhibit reduced balance function and increased fear of falling; however, the contextual inter-relationships between diabetes and its psychological consequences on physical functioning are not fully understood. This study examined the relationships between diabetes disease status, balance confidence, fear of falling avoidance behavior, and changes in performance and confidence after massed practice of a balance task in participants with and without diabetes (PWD and PWOD).

METHODS

Older adult PWD and PWOD were recruited for the pre-post control group study (n = 27 PWD, n = 26 PWOD). Participants underwent practice of a novel stabilometer-based balance task over a 2-day period (40 practice trials in 8 blocks). Changes in balance task performance and balance confidence were assessed pre- and post-training. Balance confidence and activity avoidance behavior associated with fear of falling were assessed using the Activities-Specific Balance Confidence Scale and Fear of Falling Avoidance Behavior Questionnaire, respectively. Repeated measures analysis of variance and mediation analyses were conducted to examine the effects of diabetes and training on balance performance and confidence, as well as how baseline balance confidence affects the training outcomes.

RESULTS AND DISCUSSION

Fifty-three participants (27 with type II diabetes, 29 men, 23 women, and 1 gender nonconforming, mean age = 63.8, range 50-89 years) were enrolled in the study. Of them, 48 (90.6%) successfully completed the balance training with significant balance task performance improvement of approximately 30% in both groups (PWD: 3.04 [95% confidence interval, 1.77-4.31], P < .001; PWOD: 4.39 [95% confidence interval, 3.04-5.74], P < .001). Activities-Specific Balance Confidence Scale score significantly mediated the effect of diabetes on balance confidence after training and fear of falling avoidance behavior.

CONCLUSIONS

Despite the physical and psychological deficits associated with diabetes, individuals with chronic diabetes are capable of improving balance confidence and performance through targeted training. Balance confidence was identified as an important mediating factor, explaining the relationship between diabetes disease status and activity-related psycho-physical outcomes. Future research should focus on the potentially self-reinforcing effects of psycho-physical gains induced by exercise training.

A multiple correspondence analysis of the fear of falling, sociodemographic, physical and mental health factors in older adults

Fear of falling (FoF) is a disabling condition due to different factors. The present study assessed potential FoF predictors, among sociodemographic, physical, and mental health domains, and explored their structural patterns. This cross-sectional study is part of the Physical Activity Promotion & Domestic Accidents Prevention (PAP & DAP) project, and was targeted to a sample of 229 independent older people (M 14.0%, F 86.0%) aged over 60 (mean 70.5 ± 5.96), both normal and overweight (median BMI 25.8 kg/m2, Interquartile Range 5.24). Standardized tools were used to assess the variables: the Short Falls Efficacy Scale International for the FoF; an information questionnaire for the socio-demographic variables, the presence of diseases, and previous falls; the International Physical Activity Questionnaire for the PA level; the Senior Fitness Test for physical fitness data; the Short Form 12 questionnaire for variables in the mental domain; and the Psychological Well-Being Scale 24 for the psychological well-being. Correlation/regression analyses were used to explore relationships between FoF and the considered variables. A Multiple Correspondence Analysis (MCA) was conducted to show graphical patterns projected into space dimensions. A percentage of 59.0 of the sample showed moderate/high concern of falling. The multiple regression model showed the following variables being significant predictors (p < 0.05) of the FoF: BMI (coeff 0.44, SE 0.104), musculoskeletal disease (1.55, 0.681), upper body strength (0.33, 0.117), mobility and balance (0.76, 0.320), perceived physical health (- 0.21, 0.047), and self-acceptance (- 0.52, 0.190). MCA evidenced two dimensions: the first one explained 41.8% of the variance and was described mostly by FoF (square residuals 0.721), gender (0.670), leg strength (0.617), perceived mental health (0.591), musculoskeletal diseases (0.572), and PA level (0.556); the second dimension (12.3% of the variance), was characterized mainly by perceived physical health (0.350), life objectives (0.346), education (0.301), upper body strength (0.278), and living in family/alone (0.260). The pattern elicited by MCA was characterized by older subjects with moderate/high FoF having low education or no occupation, being overweight and inactive, suffering from different diseases, having low physical fitness, and declaring low perceived physical and mental health. These results suggest that interventions aimed at reducing FoF should be addressed to this specific profile of older people.

Is frailty associated with increased concerns about falling and activity restriction in community-dwelling older adults? A systematic review

PURPOSE

Concerns about falling (CaF) are common in older adults. They are associated with increased risk of falls, activity restriction, social isolation, and physical deconditioning. This systematic review assessed if frailty is a risk factor for CaF.

METHODS

Searches of cross-sectional and prospective studies exploring associations between frailty and CaF were conducted across five databases (Medline, CINAHL, Embase, Psychinfo and Scopus). The Risk of Bias in Non-randomised Studies of Exposure (ROBINS-E) was used to determine risk of bias.

RESULTS

The search identified 2492 articles, 12 were included for data extraction: 8 cross-sectional and 4 prospective studies. Participants' mean ages across the different studies ranged from 67.5 - 81.7 years. All adjusted analyses reported a significant association between increasing frailty and CaF, except for one cross-sectional paper. Significant adjusted Odd Ratios (ORs) ranged from 1.79 (CI = 1.18-2.71) to 144.78 (CI = 13.86 - 1512.60) for cross-sectional studies, and from 1.33 (CI = 1.04-1.69) to 12.4 (CI = 7.6-20.1) for prospective studies. Three studies (one cross-sectional and two prospective) explored the association between frailty and concern-related activity restriction: A significant association was reported in two prospective studies (adjusted OR = 1.58 (CI=1.09-2.30) and adjusted RRR = 3.91 (2.61-5.85)), but not the cross-sectional study (adjusted OR = 1.31 (CI=0.62-2.78)).

CONCLUSION

This review identifies strong associations between increasing frailty and both CaF and associated activity restriction. This expands previous work describing the opposite association (that CaF can lead to frailty), suggesting a bi-directional relationship. Clinicians working with pre-frail and frail older adults should consider screening for CaF.

PROSPERO

CRD42023371899.

The Effect of Frailty on Balance, Fear of Falling, and Dual-Task Performance in Individuals with Type 2 DM

The aim of this study was to compare balance, fear of falling, and dual-task performance in frail, pre-frail, and non-frail individuals with type 2 DM. The study included 110 voluntary individuals diagnosed with type 2 DM. Individuals with type 2 DM were divided into three groups according to the FRAIL Scale: frail (n = 26), pre-frail (n = 52), and non-frail (n = 32). The FRAIL Scale evaluated individuals' frailty levels, Timed Up and Go Test evaluated dual-task performance (cognitive and motor), and Tinetti Balance and Gait Scale evaluated balance and risk of falls. Considering the Fall Efficacy Scale, Tinetti Balance and Gait Scale, TUGstandard (sec), TUGcognitive (sec), and TUGmotor (sec) results of frail, pre-frail, and non-frail individuals with type 2 DM, a statistically significant difference was found between the groups (p < 0.05). This difference originated from the frail group. Considering the increase in old age and chronic syndromes, such as DM, it brings about, it was concluded that the early evaluation of older adults for frailty and balance was essential and that individually planned intervention could improve prognosis, reduce falls that might occur due to a loss of balance and muscle strength, and enhance the quality of life in older adults.

Optimal cutoff score of the circular tandem walk test for determining the risk of falls in older community-dwelling individuals with type 2 diabetes

Patients with chronic diabetes may have a physical performance decline, which significantly increases the risk of falling. The study aimed to assess the validity of the Circular Tandem Walk Test (CTWT) in determining fall risk among older community-dwelling Thais with type 2 diabetes mellitus (T2DM). This is a cross-sectional diagnostic study of 71 older participants with T2DM from various communities. The participants were divided into "faller" (who had experienced one or more fall events) and "non-faller" groups based on 6-month fall history data. They were then interviewed about their fear of falling (FOF) using a single question and the Falls Efficacy Scale International (FES-I), followed by the CTWT. Thirty-five participants reported having fallen in the past six months. Significant differences were in the fallers and non-fallers CTWT, FOF, and FES-I scores (p < 0.001). CTWT results were significantly correlated with FOF (rpb = 0.605, p < 0.001), FES-I (rho = 0.837, p < 0.001), and number of falls (rho = 0.736, p < 0.001). The study suggested that the cutoff score for CTWT is 15.2 s, with a sensitivity = 80.00, specificity = 86.11, and AUC = 0.915. This study demonstrated the validity of the CTWT for determining the risk of falls in older community-dwelling individuals with T2DM. Implementing this tool in a community setting would be helpful in the initial screening and referral of data by concerned healthcare professionals. However, further studies may be needed to explore the reliability of CTWT and ensure the appropriate clinical use of CTWT by healthcare professionals.

Prevalence and outcomes of fear of falling in older adults with falls at the emergency department: a multicentric observational study

PURPOSE

Fear of falling (FOF) may result in activity restriction and deconditioning. The aim of the study was to identify factors associated with FOF in older patients and to investigate if FOF influenced long-term outcomes.

METHODS

Multicentric, observational, prospective study including patients 65 years or older attending the emergency department (ED) after a fall. Demographical, patient- and fall-related features were recorded at the ED. FOF was assessed using a single question. The primary outcome was all-cause death. Secondary outcomes included new fall-related visit, fall-related hospitalisation, and admission to residential care. Logistic regression and Cox regression models were used for statistical analyses.

RESULTS

Overall, 1464 patients were included (47.1% with FOF), followed for a median of 6.2 years (2.2-7.9). Seven variables (age, female sex, living alone, previous falls, sedative medications, urinary incontinence, and intrinsic cause of the fall) were directly associated with FOF whereas use of walking aids and living in residential care were inversely associated. After the index episode, 748 patients (51%) died (median 3.2 years), 677 (46.2%) had a new fall-related ED visit (median 1.7 years), 251 (17.1%) were hospitalised (median 2.8 years), and 197 (19.4%) were admitted to care (median 2.1 years). FOF was associated with death (HR 1.239, 95% CI 1.073-1.431), hospitalisation (HR 1.407, 95% CI 1.097-1.806) and institutionalisation (HR 1.578, 95% CI 1.192-2.088), but significance was lost after adjustment.

CONCLUSION

FOF is a prevalent condition in older patients presenting to the ED after a fall. However, it was not associated with long-term outcomes. Future research is needed to understand the influence of FOF in maintenance of functional capacity or quality of life.

Factors associated with fear of falling in older women with knee osteoarthritis: A cross-sectional study

Knee instability in patients with knee osteoarthritis (KOA) is associated with fear of falling (FoF). This study aimed to investigate the prevalence and the factors associated with FoF in older women with KOA. A cross-sectional study was conducted with 93 older women with KOA. Sociodemographic variables, medical conditions, handgrip strength, and anthropometric and body composition measurements were assessed. The Short Physical Performance Battery was used to measure functional performance. The Western Ontario and McMaster Universities Osteoarthritis Index was applied to assess pain, stiffness, and disability. FoF was assessed by the Falls Efficacy Scale-International. The prevalence of FoF was high (88.2 %). Disability, history of falls, handgrip strength, obesity, number of medications, and pain were independently associated with FoF. Our findings suggest that health professionals should investigate FoF when evaluating older women with KOA and address these risk factors when developing strategies to prevent or minimize FoF in this population.

Examining the factors associated with functional capacity of community-dwelling older adults using the ICF framework: a cross-sectional study from the Frailty in Brazilian Older Adults Study (FIBRA)

BACKGROUND

There are many factors associated with functioning and disability in older adults and these relationships are not clear.

OBJECTIVE

To explore the factors associated with functional capacity of older adults using the framework of the International Classification of Functioning, Disability, and Health (ICF).

METHODS

This is a cross-sectional study with a dataset from a survey of 1 377 community-dwelling older adults (≥ 65 years) in a middle-income country. Three functional outcomes were selected to represent the functioning domains: 1) muscle strength for body function; 2) walking speed for activity; and 3) advanced activities of daily living (ADL) for participation. Demographic, clinical, and social information was selected to represent the domains of health conditions and contextual factors (i.e. personal and environmental factors). Multivariate models tested the impact of these factors on each outcome.

RESULTS

Depressive symptoms, age, and physical activity were associated with the three outcomes. Muscle strength was also associated with urinary incontinence, visual deficits, female sex, and employment. Walking speed was also associated with urinary incontinence, obesity, fractures due to falls, female sex, health professionals' visits, and walking aid devices. Advanced ADL were also associated with stroke, visual deficits, education, employment, health perception, social support, and walking aid devices.

CONCLUSION

Functional capacity of older adults is associated with some non-modifiable factors, such as age and sex. The modifiable factors must be addressed by health professionals and policymakers in the geriatric area, especially depression, obesity, physical inactivity, and social support.

Falls, fear of falling, and related factors in patients with diabetic foot disease

BACKGROUND

Falls and fear of falling (FOF) are common in patients with diabetic foot disease (DFD).

PURPOSE

To understand the relationship between falls, FOF, and related factors in patients with DFD.

METHOD

We recruited 70 patients being treated for DFD at two hospitals in Korea. A structured questionnaire was used in investigating fall experience, FOF, and related factors.

RESULTS

Among the participants, 42.8 % fell in the past year, and FOF was reported in 57.1 %. Rates of "no caregiver," "DFD duration (>1 year)," and "burning pain" were higher in fallers than non-fallers. The rates of "older adults (≥65 years of age)," "unemployed," "not using assistive devices," "visual impairment," and "hearing impairment" were higher in patients with FOF than in those without FOF. However, the level of balance confidence was lower in patients with FOF.

CONCLUSIONS

The fall experience of patients with DFD was associated with the presence of their caregiver, disease-related factors, and foot pain symptoms, while FOF was related to age and fall-related factors.

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.

Association of falls and fear of falling with objectively-measured driving habits among older drivers: LongROAD study

OBJECTIVE

Falls in older adults are associated with increased motor vehicle crash risk, possibly mediated by driving behavior. We examined the relationship of falls and fear of falling (FOF) with subsequent objectively measured driving habits.

METHODS

This multi-site, prospective cohort study enrolled 2990 active drivers aged 65-79 (53% female). At enrollment, we assessed falls in the past year and FOF (Short Falls Efficacy Scale-International). Driving outcomes included exposure, avoidance of difficult conditions, and unsafe driving during one-year follow-up, using in-vehicle Global Positioning System devices.

RESULTS

Past-year falls were associated with more hard braking events (HBE). High FOF was associated with driving fewer days, miles, and trips, driving nearer home and more HBE. Differences were attenuated and not significant after accounting for health, function, medications and sociodemographics.

DISCUSSION

Differences in objectively measured driving habits according to past-year fall history and FOF were largely accounted for by differences in health and medications. Rather than directly affecting driving, falls and FOF may serve as markers for crash risk and reduced community mobility due to age-related changes and poor health.

Classification of Center of Mass Acceleration Patterns in Older People with Knee Osteoarthritis and Fear of Falling

(1) Background: The preoccupation related to the fall, also called fear of falling (FOF) by some authors is of interest in the fields of geriatrics and gerontology because it is related to the risk of falling and subsequent morbidity of falling. This study seeks to classify the acceleration patterns of the center of mass during walking in subjects with mild and moderate knee osteoarthritis (KOA) for three levels of FOF (mild, moderate, and high). (2) Method: Center-of-mass acceleration patterns were recorded in all three planes of motion for a 30-meter walk test. A convolutional neural network (CNN) was implemented for the classification of acceleration signals based on the different levels of FOF (mild, moderate, and high) for two KOA conditions (mild and moderate). (3) Results: For the three levels of FOF to fall and regardless of the degree of KOA, a precision of 0.71 was obtained. For the classification considering the three levels of FOF and only for the mild KOA condition, a precision of 0.72 was obtained. For the classification considering the three levels of FOF and only the moderate KOA condition, a precision of 0.81 was obtained, the same as in the previous case, and finally for the classification for two levels of FOF, a high vs. moderate precision of 0.78 was obtained. For high vs. low, a precision of 0.77 was obtained, and for the moderate vs. low, a precision of 0.8 was obtained. Finally, when considering both KOA conditions, a 0.74 rating was obtained. (4) Conclusions: The classification model based on deep learning (CNN) allows for the adequate discrimination of the acceleration patterns of the moderate class above the low or high FOF.

Fear of Falling, Cognition, and Physical Function in Community-Dwelling Older Adult

BACKGROUND

Fear of falling (FOF) might be associated with physical and cognitive function, but there is a lack of understanding of the specific relationship between the three variables.

OBJECTIVES

To accurately investigate the association of FOF with cognitive and physical function in community-dwelling older adults.

METHODS

A total of 669 older adults (> 60 years) participated in this study. A self-report questionnaire collected information about demographic characteristics, lifestyle, and behavioral habits. FOF was evaluated through the Shortened Version of the Falls Efficacy Scale International. Global cognitive function and the subdomains of cognitive function (including memory, visual-spatial, language, attention, and executive function) were assessed using the Montreal Cognitive Assessment (MoCA) scale, the Auditory Verbal Learning Test (AVLT), the Clock-Drawing Test (CDT), the Verbal Fluency Test, and the Trail Making Test. Subjective memory complaints were assessed using the Subjective Memory Complaints Questionnaire (SMCQ). Physical function was evaluated by measuring muscle strength and balance ability, and muscle strength was indicated by hand grip strength. In contrast, balance was assessed using the Timed Up and Go (TUG) Test.

RESULTS

After adjustment for potential confounding factors, the linear or ordinal regression analysis showed that the values of hand grip strength, MoCA, AVLT, and CDT were significantly and negatively correlated with the score of FOF. On the other hand, SMCQ and TUG Test values showed significant positive correlations with FOF scores. Moreover, compared with other cognitive or physical measures, the CDT and TUG Test values showed a greater association with the FOF scores.

DISCUSSION

Low subjective or objective cognitive ability and low physical function, especially low visuospatial and balance ability, were positively associated with the risk of FOF in a community-dwelling older population.

Perceived neighborhood and fall history among community-dwelling older adults living in a large Brazilian urban area: a multilevel approach

Few studies have examined the neighborhood features related to falls in the older population in low-and-middle-income countries, including Brazil. This study aimed to evaluate if perceived neighborhood features are related to falls among older Brazilian adults living in a large urban area. This cross-sectional study was conducted using data from 834 participants (≥60 years) from a multistage household survey in Belo Horizonte, Brazil. The association between fall history in the previous year and perceived neighborhood features (quality of services, physical and social disorder, and safety) was examined using multilevel logistic regression. The fall prevalence was 13.6%. Older adults living in neighborhoods with a higher physical disorder were more likely to report fall in the previous year, even after controlling for demographic, clinical and social variables (OR = 2.59; 95% CI = 1.14-5.87). The other neighborhood features investigated were not associated with a fall history. Our findings suggest that improving the physical environment represents an important strategy to prevent falls in the Brazilian urban older population.

Can Social Resources Explain the Limitations in the Activities of Daily Living of Older Adults Classified by the Phenotype of Physical Frailty?

The objective is to investigate the mediating roles of living alone and personal network in the relationship between physical frailty and activities of daily living (ADL) limitations among older adults. 2271 individuals were classified as vulnerable (pre-frail or frail) or robust. Mediating variables were living alone and personal network. Katz Index and Lawton-Brody scale were used to assess ADL. Mediating effects were analyzed with beta coefficients from linear regression models using the bootstrapping method. Mediation analysis showed significant mediating effects of living alone (β = .011; 95% CI = .004; .018) and personal network (β = .005; 95% CI = .001; .010) on the relationship between physical frailty and basic ADL limitations. Mediation effects of living alone and personal network on the relationship between physical frailty and instrumental ADL limitations were β = -.074 (95% CI=-.101; -.046) and β = -.044 (95% CI = -.076; -.020), respectively. Physically vulnerable older adults who lived alone or had poor personal network were more dependent on basic and instrumental ADL.

Fear of Falling in Older Adults: A Scoping Review of Recent Literature

BACKGROUND

Fear of falling (FOF) is prevalent among older adults and associated with adverse health outcomes. Over recent years a substantial body of research has emerged on its epidemiology, associated factors, and consequences. This scoping review summarizes the FOF literature published between April 2015 and March 2020 in order to inform current practice and identify gaps in the literature.

METHODS

A total of 439 articles related to FOF in older adults were identified, 56 selected for full-text review, and 46 retained for data extraction and synthesis.

RESULTS

The majority of included studies were cross-sectional. Older age, female sex, previous falls, worse physical performance, and depressive symptoms were the factors most consistently associated with FOF. Studies that measured FOF with a single question reported a significantly lower prevalence of FOF than those using the Falls Efficacy Scale, a continuous measure. FOF was associated with higher likelihoods of future falls, short-term mortality, and functional decline.

CONCLUSIONS

Comparisons between studies were limited by inconsistent definition and measurement of FOF, falls, and other characteristics. Consensus on how to measure FOF and which participant characteristics to evaluate would address this issue. Gaps in the literature include clarifying the relationships between FOF and cognitive, psychological, social, and environmental factors.

Factors associated with fear of falling among frail older adults

Some factors increase the fear of falling in frail older adults. Our aim is to quantify the influence of these factors. This cross-sectional study involved 229 community-dwelling prefrail and frail older adults aged 70 years and older. Fear of falling was moderate in 38.9% of our sample and high in 12.2%. Higher values were observed in women, those living alone, and those meeting criteria for slowness and feelings of exhaustion. A linear regression showed that being a woman, a history of falls, and depressive symptoms were related to higher fear of falling, while high levels of independence in basic and instrumental activities of daily living, along with good gait and balance, were associated with lower fear of falling. Screening for depressive symptoms and fear of falling in the comprehensive geriatric assessment of frail community-dwelling older adults could help to support preventive strategies.

Associations between fear of falling and activity restriction and late life depression in the elderly population: Findings from the Irish longitudinal study on ageing (TILDA)

BACKGROUND

The effect of Fear of Falling (FOF) and fear-related Activity Restriction (AR) on Late Life Depression (LLD) remains unstudied in older adults. In this study, we aimed to clarify associations between FOF, AR and the prevalence and incidence of LLD in a large cohort of community-dwelling older adults.

METHODS

In this prospective study, participants (n = 4230; 52.1% female) aged ≥50 years completed the survey on whether they had FOF and AR at baseline. In addition, the Centre for Epidemiological Studies Depression (CESD) scale was used to evaluate LLD at baseline and after 2 years of follow-up. Moreover, LLD was defined by a CES-D score ≥ 16, at follow-up.

RESULTS

The results showed that the prevalence and incidence of LLD were 6.9% (n = 293) and 4.2% (n = 167), respectively. In addition, most of the respondents with LLD were female (64.9% vs 55.4%) and 50-59 years of age (50.9% vs 42.8%, all P < 0.05). Analysis of data from Wave 1 and 2 using logistic regression also demonstrated that the levels of FOF/AR was associated with 82.2% and 62.7% higher odds of prevalence [OR = 1.822, 95%CI: 1.272-2.612] and incidence [OR = 1.627, 95%CI: 1.085-2.440] of LLD, respectively in the fully adjusted models.

CONCLUSION

FOF and AR may be associated with the prevalence and incidence of LLD. Additionally, the study highlighted the importance of assessing LLD in older adults with FOF and AR.

Prospective Associations of Physical Frailty With Future Falls and Fear of Falling: A 48-Month Cohort Study

OBJECTIVE

The present study aimed to examine the prospective associations of physical frailty with future falls and fear of falling (FOF) among community-dwelling older adults.

METHODS

A prospective cohort study with a 48-month follow-up was conducted in a Japanese community. Participants were 2469 community-dwelling older adults aged 65 years or older who completed baseline and follow-up assessments at intervals of 48 ± 2 months. Primary outcomes were recent falls (defined as at least one fall within the past year) and FOF (determined by response to "Are you afraid of falling?") at follow-up survey. Physical frailty, operationalized by the frailty phenotype (slowness, weakness, exhaustion, weight loss, and low activity) based on the criteria of the Japanese version of the Cardiovascular Health Study (J-CHS), was also assessed as a predictor of future falls and FOF.

RESULTS

Multivariable logistic regression showed that prefrailty or frailty increase the risk of not only future falls (odds ratio [OR]: 1.57; 95% CI = 1.20-2.05) but also FOF (OR: 1.33; 95%CI = 1.05-1.69). In addition, the relationship between baseline frailty status and future falls remained significant after adjusting for baseline FOF (OR: 1.55; 95% CI = 1.19-2.02), and the relationship between baseline frailty status and future FOF also remained significant after adjusting for baseline falls (OR: 1.32; 95% CI = 1.04-1.68).

CONCLUSIONS

Frailty status may predict future falls and FOF among community-dwelling older adults. Strategies to prevent frailty may be beneficial to prevent not only future falls but also future FOF in a community setting.

IMPACT

Falls and FOF have a close relationship but a different clinical meaning. Older adults with physical frailty may require monitoring as high risk not only for falls but also for FOF.

Influence of the Amazonian context on the frailty of older adults: A population-based study

The study aimed to identify the prevalence of frailty syndrome and its associated factors in older adults residents in an urban area in the interior of Amazonas, Brazil. This is a population-based cross-sectional study with a sample of 265 older adults (60 years or older), representative of the urban area of Coari-AM. Using the adapted Fried phenotype, those with 3 criteria or more were considered frail. Socio-demographic, health, and functionality information was collected. Multivariate analysis was used through Poisson regression with robust variance, using a hierarchical method for the dichotomous outcome of frailty. The prevalence of frailty was 9.4 % and in the final multivariate analysis model the factors associated with frailty were: advanced age (PR: 4.1; 95 % CI: 1.8-9.3), income less than one minimum wage (PR: 3.4; 1.7-6.9), masonry housing (PR: 3.3; 1.3-8.2), never having lived in a riverside community (PR: 2.7; 1.4-5.4), use of 3 medications or more (PR: 3.1; 1,4-6.9), history of falling (PR: 2.3; 1.1-4.9), and fear of falling (PR: 4.1; 1.3-13.0). The study concluded that the prevalence of frailty in Coari-AM was lower than other Brazilian cities with a similar HDI. In addition to factors associated with frailty already well described in the literature, the influence of the Amazonian culture and environment during the course of life was shown to have a possible protective effect on health outcomes in later life.

Evaluation of Fear of Falling in Patients with Primary Open-Angle Glaucoma and the Importance of Inferior Visual Field Damage

Purpose

To evaluate fear of falling using the Fall Efficacy Scale-International (FES-I) in glaucoma patients and investigate its association with glaucomatous visual field loss.

Methods

This study included 273 patients (160 men and 113 women, average age 64.2 years) with primary open-angle glaucoma. Participants were requested to answer the FES-I questionnaire, translated into Japanese, in a face-to-face interview. The relationship between total FES-I score and the following variables was analyzed using multivariable linear regression: age, sex, better and worse best corrected visual acuity, total deviation (TD) in four visual field areas, body mass index (BMI), minutes walked per day, history of diabetes mellitus, history of systemic hypertension, number of previous falls.

Results

Univariate analysis suggested that total FES-I score increased with age and in woman, whereas other variables were not significantly associated with total FES-I score. However, age (coefficient, 0.23; standard error [SE], 0.04; P < 0.001), sex (coefficient, 1.79 for women; SE, 0.84; P = 0.034), mean TD in the inferior central area (coefficient, 0.92; SE, 0.22; P <0.001), and mean TD in the inferior peripheral area (coefficient, –0.86; SE, 0.21; P < 0.001) were included in the optimal model for total FES-I score.

Conclusions

Inferior peripheral visual field damage and preserved inferior central visual field sensitivity were associated with increased fear of falling assessed with FES-I in glaucoma.

Cross-cultural adaptation and reliability of the Functional Gait Assessment in older Brazilian adults

BACKGROUND

The Functional Gait Assessment (FGA) is a standardized instrument for assessing postural stability during various walking tasks. It was developed to increase the reliability and to decrease the potential ceiling effect observed with the Dynamic Gait Index (DGI).

OBJECTIVE

To translate and cross-culturally adapt the FGA into Portuguese-Brazilian, and to evaluate its reliability in community-dwelling Brazilian older adults.

METHODS

The process of translation and cross-cultural adaptation followed the recommendations of international guidelines. The pre-final version was applied to a sample of 55 older adults of both sexes living independently in the community. For the assessment of reliability (i.e. inter- and intra-rater reliability, standard error of measurement (SEM), and internal consistency), 70 older adults aged 60-87 years were evaluated.

RESULTS

There was a conceptual equivalence between the original and the translated versions. All FGA items that used measurements in inches and feet were modified to use matching values in centimeters to reflect the measurement unit used in Brazil. The FGA-Brazil showed excellent inter- and intra-rater reliability (ICC_2,1 > 0.90), low SEM (ranging from 1.03 to 1.52), and good internal consistency (Cronbach's alpha = 0.858).

CONCLUSION

The FGA-Brazil is a semantically and linguistically valid and reliable instrument to assess walking balance among community-dwelling older adults.

Declínio da velocidade da marcha e desfechos de saúde em idosos: dados da Rede Fibra

RESUMO A velocidade da marcha (VM) tem sido considerada um marcador de saúde em idosos capaz de predizer desfechos adversos de saúde, mas a compreensão de fatores associados a ela ainda é limitada e controversa. O objetivo deste trabalho é identificar desfechos adversos de saúde relacionados ao declínio da velocidade de marcha em idosos comunitários. Trata-se de estudo transversal e multicêntrico, que avaliou o autorrelato de doenças crônicas e de hospitalização no último ano, polifarmácia e velocidade de marcha. Utilizou-se análise de regressão logística para estimar os efeitos de cada variável independente na chance de os idosos apresentarem declínio na velocidade de marcha inferior (VM<0,8m/s) (α=0,05). Participaram da pesquisa 5.501 idosos. A menor velocidade da marcha mostrou-se associada a portadores de doenças cardíacas (OR=2,06; IC: 1,67-2,54), respiratórias (OR=3,25; IC: 2,02-5,29), reumáticas (OR=2,16; IC: 1,79-2,52) e/ou depressão (OR=2,51; IC: 2,10-3,14), hospitalizados no último ano (OR=1,51; IC: 1,21-1,85) e polifarmácia (OR=2,14; IC: 1,80-2,54). Assim, os resultados indicaram que idosos com velocidade de marcha menor que 0,8m/s apresentam maior risco de eventos adversos de saúde. Dessa forma, sugere-se que a velocidade de marcha não seja negligenciada na avaliação de idosos comunitários, inclusive na atenção básica.

Gait profile score identifies changes in gait kinematics in nonfaller, faller and recurrent faller older adults women

BACKGROUND

Quantification of differences in gait kinematics between young and older adults provides insight on age-related gait changes and can contribute to the investigation of risk of falls. Gait Profile Score (GPS) is an index that indicates gait quality, using kinematic gait data, but so far it has not been used in an elderly population without neurological conditions.

RESEARCH QUESTION

Is the Gait Profile Score (GPS) an index that shows reliability for use in old adults? Does this index detect changes in gait quality observed by kinematic data between nonfaller, faller and recurrent faller older adults?

METHODS

Forty-nine women (mean age 72,43 ± 6,44; 27 faller and 22 nonfaller) were included in the study. Intra-session reliability was obtained from the intraclass correlation coefficient (ICC) between the five strides of each session.

RESULTS

Overall value of GPS shows no difference between nonfaller (6.65 ± 1.59º), faller (6.67 ± 2.05º) and recurrent faller (6.62 ± 0.86º) older adult. In all groups larger values of Gait Variable Scores (GVS) were observed in the hip and knee joints. Intra-session ICC values the GVS and GPS presented high stability, ranging from 0.80 to 0.99. MDC lower values in GPS were observed in the faller (0.39; ICC - 0.97) and recurrent faller (0.69; ICC - 0.90).

SIGNIFICANCE

Due to the high reliability, GPS has proven to be a valid method to analyze the gait quality of faller and nonfaller older woman. The most sensitive indexes (GPS and GVS) are the gear changes in fallers and recurrent fallers.

The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies

AIMS

Depression is a common co-morbidity in patients with type 2 diabetes mellitus (T2DM). Untreated depression in these patients adversely affects self-care activities and other diabetes complications. The aim of this study is to estimate the prevalence of depression among patients with T2DM by conducting a meta-analysis of observational studies.

METHODS

MEDLINE, Web of Science, Science Direct, and Google Scholar databases were searched for all observational studies that assessed depression in T2DM. Relevant articles were searched using the combination of Medical Subject Heading (MeSH) terms of "depression", "depressive disorder", and "diabetes mellitus" published between January 2007 and July 2018. Random effects model was used to estimate the weighted prevalence rates and 95% CI using "metaprop program in STATA 11".

RESULTS

In total, the 248 included studies (with 273 reported prevalence) identified 83,020,812 participants; of them, 23,245,827 (28%; 95% CI 27, 29) suffered from different severity levels of depressive disorders. The prevalence of depression was separately reported in 137,372 males and 134,332 females. Of them, 31,396 males (23%, 95% CI: 20, 26) and 45,673 females (34%, 95% CI: 31, 38) were depressed. Compared with global estimate, depression prevalence was lower in Europe (24%) and Africa (27%), but higher in Australia (29%) and Asia (32%). The prevalence in America was equal to the estimated prevalence in the world (28%). Depression was more common in subjects younger than 65 compared with elderlies (31% vs. 21%).

CONCLUSION

Our findings demonstrated that almost one in four adults with T2DM experienced depression. Given the high prevalence of depressive disorders in diabetic patients, screening these patients for co-morbid depression and its relevant risk factors is highly recommended.

Fear of Falling Contributing to Cautious Gait Pattern in Women Exposed to a Fictional Disturbing Factor: A Non-randomized Clinical Trial

Objective: This study aimed to investigate the gait pattern of elderly women with and without fall-history, with high and low fear of falling, when exposed to a disturbing factor. Materials and Methods: Forty-nine elderly women without cognitive impairment agreed to participate. Participants were divided into four groups, considering the history of falls and fear of falling. Three-dimensional gait analysis was performed to assess gait kinematics before and after exposure to the fictional disturbing factor (psychological and non-motor agent). Results: After being exposed to the perturbation, all showed shorter step length, stride length and slower walking speed. Those without fall-history and with high fear of falling showed greater changes and lower Gait Profile Score. Conclusion: The gait changes shown in the presence of a fear-of-falling causing agent led to a cautious gait pattern in an attempt to increase protection. However, those changes increased fall-risk, boosted by fear of falling. Clinical Trial Registration: www.residentialclinics.gov.br, identifier: RBR-35xhj5.

Fear of Falling and Balance Confidence in Older Adults With Type 2 Diabetes Mellitus: A Scoping Review

Type 2 diabetes mellitus is highly prevalent in older adults (≥65 years of age) and increases fall risk. Fear of falling and low balance confidence are reported in both fallers and nonfallers and can potentially be more debilitating than a fall itself. Therefore, the objective of this scoping review was to examine and map the current research evidence of balance confidence and fear of falling in older adults with type 2 diabetes. A search of CINAHL, EMBASE and PubMed was conducted. The search included MeSH terms and the key terms diabet* AND fear OR falls AND self-efficacy OR balance confidence. Inclusion criteria were 1) population: older adults (≥65 years of age) with type 2 diabetes; and 2) outcome measure: balance confidence or fear of falling. We included 21 studies: fear of falling (n=14); balance confidence (n=7). We categorized them into 4 themes: prevalence, severity, determinants and interventions. Determinants were further categorized into physical, psychosocial and health-related domains. Fear of falling and low balance confidence were highly prevalent and more severe in older adults with type 2 diabetes. Determinants of fear of falling and balance confidence occurred beyond the physical domain and the presence of diabetic peripheral neuropathy. Targeted group-based interventions (e.g. gait and balance training, tai chi, yoga) appear to be beneficial in reducing fear of falling and improving balance confidence. Future work is needed to generate best practices related to fear of falling and low balance confidence in older adults with type 2 diabetes.

Both psychological factors and physical performance are associated with fall-related concerns

BACKGROUND

Fall-related concern strongly correlates to activity avoidance in older people. In this complex phenomenon, different terminology and instruments are often used interchangeably. Three main concepts make up fall-related concerns: fear of falling, consequence concern, and falls self-efficacy. It is suggested that fall-related concerns are mediated by psychological and physical factors.

AIMS

Our aims were to describe the prevalence of fall-related concerns and find explanatory factors for its most studied concept-falls self-efficacy-in an older population.

METHODS

We executed a cross-sectional study on a random sample of 153 community-dwelling older people (70 years or older). We used validated and reliable instruments as well as structured interviews to gather data on the three concepts of fall-related concerns and possible mediating factors. We then calculated descriptive statistics on prevalence and regression models for the total group, and men and women, separately.

RESULTS

70% of the total sample (80% of women and 53% of men) reported at least one of the three concepts of fall-related concern. For the total sample, fear of falling, morale, and physical performance were associated factors with falls self-efficacy. For women, the number of prescription medications was added. For men, physical performance and concerns for injury were associated.

CONCLUSION

Fall-related concern is prevalent in large proportions with higher prevalence for women than for men. Important factors are fear of falling, morale, and physical performance. Gender differences in the emergence and variance of fall-related concern and the relation between physical performance and fall-related concern should be targeted in future research endeavors.

Frailty Status and Gait Parameters of Older Women With Type 2 Diabetes

OBJECTIVES

Gait decline in individuals with frailty status is associated with comorbidities, falls and reduced mobility, reflecting changes in gait. The prevalence of frailty in individuals with type 2 diabetes is higher compared to individuals without diabetes. However, the consequences of frailty status on gait in older women with diabetes are unclear. The objective of the study was to investigate gait changes in older women with diabetes who are classified as vulnerable, having 1 or more frailty conditions, or robust, having none of the conditions, according to the Fried phenotype.

METHODS

Participants included 203 older women: 112 without diabetes and 91 with diabetes. The nondiabetes robust group included 59 older women: nondiabetes, vulnerable, 53; diabetes, robust, 26; and diabetes, vulnerable, 65. Gait parameters were obtained by using the GAITRite system and included velocity, cadence, step length, stance time and double-support time. Multivariate analysis was conducted followed by post hoc analysis.

RESULTS

Older women with diabetes and vulnerable status used more drugs and had higher body mass indexes than the groups without diabetes who were vulnerable and robust; there was no difference between the diabetes, robust and diabetes, vulnerable groups. Falls history and fear of falling were similar in all groups. Vulnerable older women with diabetes walked with decreased velocity, cadence and step length and increased stance time compared to all groups and with increased double-support time compared to the nondiabetes robust and nondiabetes vulnerable groups.

CONCLUSIONS

Gait decline in vulnerable older women with diabetes is worsened by their frailty status. Our study reinforces the importance of screening older women with diabetes for frailty status.

Cross-cultural adaptation and measurement properties of the Brazilian Version of the Michigan Neuropathy Screening Instrument

BACKGROUND

The Michigan Neuropathy Screening Instrument is an easy-to-use questionnaire aimed at screening and detecting diabetic polyneuropathy.

OBJECTIVE

To translate and cross-culturally adapt the MNSI to Brazilian Portuguese and evaluate its measurement properties.

METHODS

Two bilingual translators translated from English into Brazilian Portuguese and made a synthetic version. The synthetic version was back translated into English. A committee of specialists and the translator checked the cultural adaptations and developed a pre-final questionnaire in Brazilian Portuguese (prefinal version). In pretesting, the prefinal version was applied to a sample of 34 subjects in which each subject was interviewed to determine whether they understood each item. For the later assessment of measurement properties, 84 subjects were assessed.

RESULTS

A final Brazilian Portuguese version of the instrument was produced after obtaining 80% agreement (SEM<0.01%) among diabetic patients and specialists. We obtained excellent intra-rater reliability (ICC_3,1=0.90), inter-rater reliability (ICC_2,1=0.90) and within-subject reliability ICC_3,1=0.80, excellent internal consistency (Cronbach's alpha>0.92), reasonable construct validity for the association between the MNSI and Neuropathy Symptom Score (r=0.46, p<0.05) and excellent association between the MNSI and Neuropathy Disability Score (r=0.79, p<0.05). We did not detect floor and ceiling effects (<9.5% of patients with maximum scores).

CONCLUSIONS

The Brazilian Portuguese version of the MNSI is suitable for application in the Brazilian diabetic population and is a reliable tool for the screening and detection of DPN. The MNSI can be used both in clinical practice and also for research purposes.