The Impact of Falls and Fear of Falling on Health-Related Quality of Life in Taiwanese Elderly

Comparative study of Baduanjin and brisk walking on balance and stability in older adults

OBJECTIVE

To investigate the impact of practicing the health Qigong-Baduanjin exercise on lower limb balance among elderly individuals.

METHODS

Two intervention methods, Baduanjin and brisk walking, were applied to study the effect of exercise on senior balancing. Sixty elderly individuals aged 65 to 79 were selected and randomly divided into the Baduanjin group, the brisk walking group, and the control group that did not engage in exercise. There were a total of 20 individuals in each group, 10 males and 10 females. The first two groups participated in a 16-week exercise regimen. The balance tests for members of all three groups were conducted.

RESULTS

(1) For the eyes-open two-legged standing posture, the center of pressure (COP) was more centralized in the Baduanjin group; the swaying range of the body, forward and backward displacement, and left and right displacement among the elderly individuals in this group were significantly lower than those of the other two groups. (2) In the tests for two-legged standing, one-legged standing, and tandem feet stance, the elderly in the Baduanjin group had significantly lower swaying trajectory of the center of gravity, body swaying ellipse area, and maximum vibration parameters than those in the brisk walking and control groups. (3) The 2nd pose of Baduanjin, which involves a considerable amount of knee bending and semi-squatting exercises for the lower limbs, proved to be beneficial for the lower limb joints and body balance among the elderly.

CONCLUSION

Long-term practice of health Qigong-Baduanjin can exert a beneficial impact on improving the muscle strength of the lower limb joints and ankle joint flexibility, improving the static balance ability of the elderly, and consequently reducing their risk of falling.

Translation, cross-cultural adaptation, and measurement properties of the Traditional Chinese version of the Fear of Falling Avoidance Behavior Questionnaire in Taiwanese community-dwelling adults

PURPOSE

This study aimed to translate the Fear of Falling Avoidance Behavior Questionnaire (FFABQ) into Traditional Chinese (FFABQ-TC) and to evaluate the psychometric properties of FFABQ-TC in Taiwanese adults.

METHODS

We translated and culturally adapted the FFABQ into Traditional Chinese, ensuring linguistic accuracy and cultural relevance. A total of 230 Taiwanese community-dwelling adults participated in the study. Test-retest reliability was assessed in 30 participants, while 200 participants were included in the validity analysis. Known-groups validity was investigated by comparing the FFABQ-TC scores between fallers and non-fallers. Convergent validity was examined by correlating FFABQ-TC scores with Activities-specific Balance Confidence Scale (ABC), Geriatric Fear of Falling Measure (GFFM), and Timed-Up-and-Go (TUG) test.

RESULTS

The FFABQ-TC demonstrated excellent test-retest reliability (Intraclass Correlation Coefficient = 0.884) and excellent internal consistency (Cronbach's alpha = 0.930). Known-groups analysis revealed that FFABQ-TC significantly differentiated between fallers and non-fallers. Convergent validity was examined and showed significant correlations of FFABQ-TC with the ABC, the GFFM, and TUG.

CONCLUSION

The psychometric properties of FFABQ-TC was established in Taiwanese adults for assessing FOF-related avoidance behaviors. The translated and adapted FFABQ-TC is a reliable and valid clinical tool for evaluating fall risk in this population.

Association of fear of falling and low physical activity with fall risk among older Taiwanese community-dwellers

BACKGROUND AND PURPOSE

Fear of falling and low physical activity become prevalent in an aged society, but their association with fall risk warrants further investigation.

METHODS

Our study involved 600 individuals aged 70.8-96.1 years who completed two rounds of community surveys. During the second survey, we analyzed the correlations between fall incidents and a range of factors, including age, sex, gait maneuverability, vision, comorbidity count, depressive symptoms, cognitive function, history of falls, fear of falling, and physical activity level. The chi-square test and univariate and multivariate logistic regression models were used, with further analyses either adjusted for or stratified by the full-factor combinations of fear of falling (with versus without) and low physical activity (low versus moderate-to-high).

RESULTS

Falls exhibited a prevalence rate of 13.8%. A fall risk gradient by the full-factor combinations was observed. Multivariate logistic regression modeling identified independent risk predictors for falls, including the number of comorbidities, depressive symptoms, a history of falls, and fear of falling. Fear of falling and low physical activity presented a synergistic effect to increase the fall risk by two- and one-third times (adjusted odds ratio: 2.35, 95% confidence interval: 1.12-4.91). Depressive symptoms, cognitive impairment, and a history of falls remained as significant risk predictors for older adults with both factors, those with fear of falling only, and those with neither, respectively, when the models were further stratified.

CONCLUSION

Fear of falling and low physical activity presented likely synergism to increase the fall risk. Those older community-dwellers with both risk factors warrant fall prevention resources as a priority over those with either or neither.

The impact of fear of falling on health-related quality of life in community-dwelling older adults: mediating effects of depression and moderated mediation effects of physical activity

BACKGROUND

The fear of falling is a common issue among older adults that negatively affects physical and psychological aspects of health-related quality of life, regardless of actual fall events. Interventions aimed at reducing fear of falling, independent of falls, may improve older adults' quality of life. This study examined the moderated mediation effect of physical activity in how fear of falling affects health-related quality of life through depression in community-dwelling older adults.

METHODS

This study used secondary data from the Korea Centers for Disease Control and Prevention's 2019 Community Health Survey. The study included 73,738 adults aged 65 years or older. The researchers used the fear of falling scale, International Physical Activity Questionnaire, Patient Health Questionnaire-9, and EuroQol 5 Dimension as research tools, and performed descriptive statistics, Pearson's correlation coefficient, and SPSS PROCESS macro analysis. The study used the bootstrapping method to assess the adjusted mediating effect by resampling 5,000 times, and determined statistical significance with a 95% confidence interval.

RESULTS

In the model in which fear of falling affects health-related quality of life by mediating depression, the moderated mediation effect of physical activity was statistically significant, as the bootstrapping result did not include 0 in the 95% confidence interval (Index of moderated mediation [95% CI] = 0.006 [0.004-0.007], 0.008 [0.006-0.009]). Depression and health-related quality of life impairment decreased as the level of physical activity increased through inactivity, minimal activity, and health promotion activities, as the negative mediating effects decreased.

CONCLUSION

Physical activity reduces depression and improves health-related quality of life by influencing older adults' fear of falling. Community-based programs are needed to encourage and support older adults in maintaining moderate physical activity to manage the depression caused by fear of falling, which is common among older adults, and to improve their health-related quality of life.

Relationship between Social Participation, Children's Support, and Social Frailty with Falls among Older Adults in Colombia

BACKGROUND

There is limited research on social factors related to falls among older adults. This study assessed the association between falls during the past year with social participation, children's support, relationship with children, and social frailty.

METHODS

Participants were 17,687 community-dwelling older adults from the 2015 Survey on Health, Well-being, and Aging (SABE) in Colombia. Covariates included sociodemographic characteristics, environmental barriers, psychotropic intake, vision problems, memory loss, multimorbidity, and fear of falling.

RESULTS

In multivariate logistic regression analyses, being socially frail (vs. no-frail) was associated with higher odds of falls (odds ratio [OR]=1.20; 95% confidence interval [CI] 1.10-1.32). Participating in groups (OR=1.07; 95% CI 1.03-1.11), helping others (OR=1.04; 95% CI 1.02-1.06), or volunteering (OR=1.09; 95% CI 1.01-1.17) were also associated with higher odds of falls. These findings were partly explained because most group participants reside in cities where they are more exposed to environmental barriers. In contrast, receiving help, affection, and company from children (OR=0.95; 95% CI 0.93-0.97) was associated with lower fall odds than not receiving it. Moreover, having a good relationship with children was associated with lower odds of falls (OR=0.75; 95% CI, 0.66-0.85) compared to an unsatisfactory relationship.

CONCLUSION

Support from children and having a good relationship with them were associated with fewer falls; however, social frailty and participation in social groups were associated with more falls.

Fear of Falling: Exploring Associated Factors among Elderly Residents in the Rural Communities of Vietnam

This research aimed to explore factors associated with the fear of falling (FOF) among community-dwelling older adults in Vietnam. A cross-sectional study was conducted in five communes in Soc Son, Hanoi, Vietnam, from March to June 2017. We recruited a total of 487 participants, which provided sufficient data for analysis. The outcome variable was fear of falling. Several covariates, including demographics, medical history, general health status, geriatric syndromes, eye diseases, assessment of fall risk environment, timed up-and-go test, and number of standing up in 30 s, were collected. A multivariable logistic regression model was performed to determine predictors associated with FOF. The results showed that 54.6% of the participants had FOF. Furthermore, the logistic multivariable regression model revealed several factors associated with FOF among participants in the research sites, including polypharmacy status (OR: 1.79; 95%CI 1.07-2.99), higher scores in quality of life according to the EQ-5D-5L index (OR:6.27; 95%CI: 2.77-14.17), and having fallen during the past 12 months (OR:4.4; 95%CI: 2.39-8.11). These findings contribute to a comprehensive understanding of the intricate relationship between FOF and several associated factors, notably polypharmacy status, quality of life, and having a fall during the past 12 months.

The global prevalence of and risk factors for fear of falling among older adults: a systematic review and meta-analysis

BACKGROUND

As a common psychological problem among older adults, fear of falling was found to have a wide range prevalence in different studies. However, the global prevalence of it was unknown and a lack of the large sample confirmed its risk factors.

OBJECTIVES

To report the global prevalence of fear of falling and to explore its risk factors among older adults for further developing precise interventions to systematically manage FOF.

DESIGN

A systematic review and meta-analysis was conducted by PRISMA guidelines.

METHODS

Searches were conducted in PubMed, Web of Science, EMBASE, the Cochrane Library and the manual search in August 20, 2022, updated to September 2, 2023. Observational studies published in English were included and two researchers independently screened and extracted the data. Fixed or random effects mode was used to estimate the pooled prevalence of and risk factors for fear of falling. Heterogeneity resources were analyzed by subgroup and sensitivity analysis. Publication bias was assessed through funnel plots, Egger's test and Begg's test.

RESULTS

A total of the 153 studies with 200,033 participants from 38 countries worldwide were identified. The global prevalence of fear of falling was 49.60%, ranging from 6.96-90.34%. Subgroup analysis found the estimates pooled prevalence of it was higher in developing countries (53.40%) than in developed countries (46.7%), and higher in patients (52.20%) than in community residents (48.40%). In addition, twenty-eight risk factors were found a significant associations with fear of falling, mainly including demographic characteristics, physical function, chronic diseases and mental problems.

CONCLUSION

The global prevalence of FOF was high, especially in developing countries and in patients. Demographic characteristics, Physical function, chronic diseases and mental problems were a significant association with FOF. Policy-makers, health care providers and government officials should comprehensively evaluate these risk factors and formulate precise intervention measures to reduce FOF.

TRIAL REGISTRATION

The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD42022358031.

Social factors of health-related quality of life in older adults: a multivariable analysis

PURPOSE

The objective of the analysis was to examine the relationships between sociodemographic, socioeconomic, psychosocial, and behavioural factors and both physical and mental health-related quality of life (HRQOL) in older adults.

METHODS

The analysis was based on recent cross-sectional data of 1687 community residents from a whole population postal survey of German adults aged 65 years and older (33% response rate, 52% female, mean age 76 years). HRQOL was assessed using the 36-Item Short Form Survey (SF-36v2). For a differentiated analysis, hierarchical multiple linear regressions were performed.

RESULTS

An internal health locus of control, physical activity, social support, and income were positively associated with physical HRQOL (Adj. R2 = 0.34; p < 0.001) and mental HRQOL (Adj. R2 = 0.18; p < 0.001), whereas an external health locus of control and age were negatively associated with both. Alcohol use and educational level were positively associated only with physical HRQOL, whilst female gender was negatively associated only with mental HRQOL.

CONCLUSION

Sociodemographic, socioeconomic, psychosocial, and behavioural factors were associated with physical and mental HRQOL. These results highlight the importance of social factors in HRQOL and provide approaches for policy and practice to develop and implement tailored health interventions for older adults. Our findings may be transferable to municipalities in metropolitan areas of high-income European countries.

CLINICAL TRIAL REGISTRATION

Not applicable.

Prevalent falls, fall frequencies and health-related quality of life among community-dwelling older Chinese adults

PURPOSE

Fall is a serious health hazard to older adults. The aim of our study was to investigate the relationship between falls and health-related quality of life (HRQOL) in mainland China.

METHODS

Data from 4579 Chinese community-dwelling older adults was analyzed. Data of falls was self-reported by participants, the HRQOL of older adults was measured by the 3-Level EQ-5D (EQ-5D-3L, 3L). Regression models were built to explore the associations of falls (experience and frequency) with the 3L data (index score, EQ-VAS score and health problems). The potential interaction effects between falls and gender on HRQOL were assessed using a likelihood ratio test, sex-stratified analysis was also performed to separately investigate the associations in men and women.

RESULTS

A total of 368 (8.0%) participants had the experience of fall during the last year. Falls (experience and frequency) were significantly related to EQ-5D-3L index and EQ-VAS scores, fall experience contributed to pain/discomfort and anxiety/depression problems, while fall frequency was associated with physical-related problems and pain/discomfort. Significant interactions between falls and sex in several EQ-5D measures were also observed, and men had lager magnitude of associations than women.

CONCLUSION

Falls were negative associated with overall HRQOL as well as separate HRQOL dimensions among older adults. It also appears that the HRQOL influence on older men is more evident than older women.

Fear of falling as a mediator in the association between social frailty and health-related quality of life in community-dwelling older adults

BACKGROUND

Social frailty is associated with Fear of Falling (FoF) and health-related quality of life (HrQoL). However, how social frailty simultaneously influences FoF and HrQoL remains unclear. The study aims to understand the links between social frailty, FoF, and HrQoL in older adults and the mediating role of FoF in the relations between social frailty and HrQoL.

METHODS

In this cross-sectional survey, 1,933 community-dwelling older adults from Changhua County, Taiwan, were interviewed using a self-administrated questionnaire. In total, 1,251 participants with complete data were included for analysis. Data were analyzed using the SPSS PROCESS macro. A simple mediation was employed using social frailty as the independent variable, FoF as the mediator variable, and HrQoL as the outcome variable.

RESULTS

Social frailty was associated with HrQoL and indirectly with HrQoL through FoF, and FoF was directly associated with HrQoL. Of the 5-item social frailty index, "going out less frequently" was correlated with HrQoL and indirectly with HrQoL through FoF. Individuals who felt unhelpful toward family or friends had the worst physical HrQoL and did not talk to someone daily had the most negative influence on mental HrQoL.

CONCLUSIONS

Social frailty can directly and indirectly, through FoF decrease HrQoL. It also emphasizes the importance of social connectivity in reducing the risk of falls. This study points to the need for social connectivity and fall prevention programs as essential components of strategies to enhance the health and well-being of community-dwelling older adults.

Neuromuscular electrical stimulation enhances the ability of serum extracellular vesicles to regenerate aged skeletal muscle after injury

Exercise promotes healthy aging of skeletal muscle. This benefit may be mediated by youthful factors in the circulation released in response to an exercise protocol. While numerous studies to date have explored soluble proteins as systemic mediators of rejuvenating effect of exercise on tissue function, here we showed that the beneficial effect of skeletal muscle contractile activity on aged muscle function is mediated, at least in part, by regenerative properties of circulating extracellular vesicles (EVs). Muscle contractile activity elicited by neuromuscular electrical stimulation (NMES) decreased intensity of expression of the tetraspanin surface marker, CD63, on circulating EVs. Moreover, NMES shifted the biochemical Raman fingerprint of circulating EVs in aged animals with significant changes in lipid and sugar content in response to NMES when compared to controls. As a demonstration of the physiological relevance of these EV changes, we showed that intramuscular administration of EVs derived from aged animals subjected to NMES enhanced aged skeletal muscle healing after injury. These studies suggest that repetitive muscle contractile activity enhances the regenerative properties of circulating EVs in aged animals.

Balance Confidence and Balance Performance, But Not Fall History Are Associated With Quality of Life in Community-Dwelling Older Adults: A Cross Sectional Study

BACKGROUND AND PURPOSE

Fear of falling (FoF) is highly prevalent in community-dwelling older adults and is associated with low health-related quality of life (QoL). Low QoL is associated with increased health care utilization and is a predictor of future falls, but few studies have examined the relationship between high-level balance and dynamic gait performance and QoL in community-dwelling older adults. The purpose of this cross-sectional study was to determine whether there is a relationship between FoF avoidance behaviors, balance confidence, performance on measures of high-level mobility, and QoL in community-dwelling older adults. The secondary purpose was to determine whether older adults who fall have a different QoL than older adults who have not fallen in the past year.

METHODS

Eighty-nine community-dwelling older adults (76.33 ± 6.84 years, 54 female, 34 fallers) completed the World Health Organization Quality of Life-BREF (WHOQOL-BREF), Activities-specific Balance Confidence Scale (ABC), Fear of Falling Avoidance Behavior Questionnaire (FFABQ), Functional Gait Assessment (FGA), and Community Balance and Mobility Scale (CB&M). Correlation and multiple regression analyses were calculated to determine the relationship between the outcome measures and domains on the WHOQOL-BREF.

RESULTS AND DISCUSSION

Significant correlations were observed between the WHOQOL-BREF physical health domain and the ABC, FFABQ, FGA, and CB&M (ρ= 0.524, -0.509, 0.348, and r = 0.423, respectively), the WHOQOL-BREF psychological domain and the ABC (ρ= 0.284) and FFABQ (ρ=-0.384), and the WHOQOL-BREF environment domain and the ABC (ρ= 0.343) and FFABQ (ρ=-0.406). No correlations were found between WHOQOL-BREF domain scores and a history of falls.

CONCLUSIONS

Performance-based outcome measures that measure high-level mobility such as the CB&M and FGA, and patient-reported outcome measures for balance confidence and FoF avoidance behavior such as the ABC and FFABQ, are correlated with the physical health QoL domain on the WHOQOL-BREF. The ABC and FFABQ are correlated with psychological and environment QoL. Fall history was not correlated with QoL. Interventions to decrease FoF or improve high-level mobility may improve QoL in community-dwelling older adults.

Improvement of lower-extremity stability by rotational leg press training

BACKGROUNDS

Previous reports revealed that balance and stability are essential for human physical activity. The present study aimed to evaluate the comparative outcome of a novel beginning movement load training (BMLT) versus conventional leg press training in terms of improvement of lower-extremity stability.

RESEARCH QUESTION

Does the leg press training improve the stability of lower extremities?

METHODS

Twenty adult, asymptomatic and active amateur basketball players were enrolled in this study and randomized in equal numbers into a BMLT group (study group) and a conventional leg press training group (control group).

RESULTS

The results after eight-week course of training showed that conventional leg press training had an opposite effect on dynamic stability in the left leg (p = 0.015) and backward movement of the right leg (p = 0.038). The athletes in the study group revealed superior dynamic stability maintenance in both legs backwards (p = 0.001), the left leg (p = 0.013), the right leg backwards (p = 0.022) and overall stability (p = 0.002).

SIGNIFICANCE

The study group showed better postural stability in terms of the medial/lateral index (p = 0.017), and the athletes in the control group exhibited a significant inability to maintain postural stability in the medial/lateral aspect after the training (p = 0.016). Rotational BMLT lower-extremity press training yielded superior enhancement of dynamic stability and maintenance of center of gravity and postural stability.

Baseline health-related quality of life predicts falls: a secondary analysis of a randomized controlled trial

PURPOSE

Among older adults, health-related quality of life (HRQoL) and falls are associated. Generic patient-reported outcomes measures (PROMs) assess individual's HRQoL. The role for PROMs, a potential tool for predicting subsequent falls, remains under-explored. Our primary aim was to determine whether a baseline PROMs assessment of HRQoL may be a useful tool for predicting future falls.

METHODS

A secondary analysis of a 12-month randomized clinical trial (RCT) of a home-based exercise program among 344 adults (67% female), aged ≥ 70 years, with ≥ 1 falls in the prior year who were randomized (1:1) to either a home-based exercise program (n = 172) or usual care (n = 172). A negative binomial regression model with total falls count as the dependent variable evaluated the main effect of the independent variable-baseline HRQoL (measured by the Short-Form-6D)-controlling for total exposure time and experiment group (i.e., exercise or usual care) for the total sample. For the usual care group alone, the model controlled for total exposure time.

RESULTS

For the total sample, the rate of subsequent total falls was significantly predicted by baseline HRQoL (IRR = 0.044; 95% CI [0.005-0.037]; p = .004). For the usual care group, findings were confirmed with wider confidence intervals and the rate of prospective total falls was significantly predicted by baseline HRQoL (IRR = 0.025; 95% CI [0.001-0.909]; p = .044).

CONCLUSION

These findings suggest the ShortForm-6D should be considered as part of falls prevention screening strategies within a Falls Prevention Clinic setting. Trial Registrations ClinicalTrials.gov Protocol Registration System. Identifier: NCT01029171; URL: https://clinicaltrials.gov/ct2/show/NCT01029171 . Identifier: NCT00323596; URL: https://clinicaltrials.gov/ct2/show/NCT00323596 .

A Collaborative Implementation Strategy to Increase Falls Prevention Training Using the Age-Friendly Health Systems Approach

Falls in the home and in community environments are the leading cause of injuries and long-term disabilities for the aging population. The purpose of this study was to examine outcomes of a partnership among an academic institution, government agency, community organizations, and emergency management services to implement a falls prevention training program using an Age-Friendly Health Systems approach. In this prospective study, partners identified gaps in services and targeted and non-targeted delivery areas for implementation of an evidence-based falls prevention intervention addressing the 4Ms of Age-Friendly Health Systems—Mobility, Medications, Mentation, and What Matters. Descriptive statistics were calculated for program implementation and participant demographic variables, and paired t-test analysis compared scores for self-assessed general health and falls efficacy prior to and after program participation. Twenty-seven falls prevention classes were implemented, with over half (52%) in targeted areas. A total of 354 adults aged 50 and older participated, with N = 188 participants (53%) completing the program by attending at least five of eight sessions. Of completers, 35% resided in targeted areas. The results showed a statistically significant improvement in falls efficacy by program completers in targeted and non-targeted areas. However, there was no statistically significant difference in self-rated health. Overall, the findings of this study indicate that collaboration to deliver falls prevention training can be effective in reaching at-risk older adults. By mobilizing collaborative partnerships, limited resources can be allocated towards identifying at-risk older adults and improving community-based falls prevention education.

Impact of COVID-19 Stay-At-Home Restrictions on Falls in One Community of High-Risk Older Adults

Aim: To examine the relationship between falls among high-risk older adults at one Program of All-Inclusive Care for the Elderly (PACE) and the COVID-19 closure of its Day Health Center (DHC), which provides participants with social and rehabilitative services and contributes to their weekly physical activity. Methods: Self-reported falls during the 3 months before the DHC’s closure (“pre–COVID-19”) were compared in number and in character to falls during its closure (“COVID-19”). Results: One thirty five participants were enrolled during the entire 6-month period; 37% (n = 50) fell during this time. These participants experienced fewer falls during COVID-19 (mean = 0.64) than they did pre–COVID-19 (mean=1.24, p = .0003). Conclusions: In this population of high-risk, community-dwelling older adults, an abrupt reduction in activity levels may have reduced falls. Physical activity has been shown to both increase and protect against falls in older adults. The long-term consequences of a comparably prolonged period of inactivity merit further study.

[Falls and health-related quality of life: influence of frequency and location type of falls]

This article aims to evaluate health-related quality of life (HRQOL) according to the frequency and characteristics of falls in the elderly. A cross-sectional study was carried out with data from a household health survey conducted in 2014 and 2015, in Campinas, SP. The dependent variables were the SF-36 domains and, the independent ones, the occurrence and the characteristics of the falls. The mean and mean differences of the SF-36 scores were estimated by simple and multiple linear regression. The study reveals that the impact on HRQOL depends significantly on the characteristics of falls. Larger declines and a greater number of SF-36 domains were observed in the elderly who suffered three or more falls (compared to those with one or two falls), reporting falls from fainting/dizziness (compared to falls due to tripping), those who fell at home (versus falls occurring elsewhere) and reported falling limitation in daily activities. Only in the falls with these characteristics did the domain of emotional aspects be affected. The impact on HRQoL, including emotional aspects, depends on the characteristics of the falls that need to be considered in prevention actions and in the control of the consequences of falls in the quality of life of the elderly.

Estimating Health-Related Quality of Life Based on Demographic Characteristics, Questionnaires, Gait Ability, and Physical Fitness in Korean Elderly Adults

The elderly population in South Korea accounted for 15.5% of the total population in 2019. Thus, it is important to study the various elements governing the process of healthy aging. Therefore, this study investigated multiple prediction models to determine the health-related quality of life (HRQoL) in elderly adults based on the demographics, questionnaires, gait ability, and physical fitness. We performed eight physical fitness tests on 775 participants wearing shoe-type inertial measurement units and completing walking tasks at slower, preferred, and faster speeds. The HRQoL for physical and mental components was evaluated using a 36-item, short-form health survey. The prediction models based on multiple linear regression with feature importance were analyzed considering the best physical and mental components. We used 11 variables and 5 variables to form the best subset of features underlying the physical and mental components, respectively. We laid particular emphasis on evaluating the functional endurance, muscle strength, stress level, and falling risk. Furthermore, stress, insomnia severity, number of diseases, lower body strength, and fear of falling were taken into consideration in addition to mental-health-related variables. Thus, the study findings provide reliable and objective results to improve the understanding of HRQoL in elderly adults.

Risk Factors Associated with Fall Awareness, Falls, and Quality of Life Among Ethnic Minority Older Adults in Upper Northern Thailand

Background

Falls are a major public health issue and one of the leading causes of morbidity and mortality among the older adults in many countries. Falls and their consequences have an impact on people’s quality of life, particularly the older adults. However, there have been very few studies on falls among ethnic minority groups living in rural areas. The aim of this study was to examine factors related to fall awareness, falls, and quality of life among ethnic minority older adults living in northern Thailand.

Methods

A cross-sectional study was conducted among 462 older adults from ethnic minority groups living in rural communities in Phayao and Lamphun provinces of northern Thailand using a multi-stage sampling technique. The data were collected through face-to-face interviews, with structured questionnaires covering health information, fall awareness, and quality of life (WHOQOL-OLD). The factors were determined using simple linear regression and binary logistic regression.

Results

The mean age of the participants was 68.2, Karen (35.5%), Mien (24.2%), indigenous (20.8%), and Hmong (19.5%). In the previous 12 months, 20.6% of elders had experienced a fall, and 4.5% of them had experienced multiple falls. More than half of the elders had moderate fall awareness and quality of life (71.6% and 68.6%, respectively). Univariate analysis revealed that minority group, sociodemographic characteristics, sleep duration, and fear of falling were all found to be associated with fall awareness, falls, and quality of life score (p<0.001). There was a significant relationship among fall awareness, falls, and quality of life score (p<0.001). Compared to those who had not fallen in the previous year, the quality of life of the older adults who had fallen was about 11 points lower.

Conclusion

Several independent variables were discovered to be fall risk factors and quality of life indicators. It is critical to recognize the risk factors to promote fall prevention programs that are appropriate for the older adults among ethnic minorities. Therefore, public health agencies and local government should be aware of the problem and initiate an implementation program and policy to prevent falls and improve the quality of life among ethnic minority older adults.

Cognitive performances better identify fallers than mobility assessment among older adults with fear of falling

BACKGROUND

Half of the people with fear of falling (FoF) are non-fallers, and the reason why some people considered non-fallers are afraid of falling is unknown, but reduced mobility or cognition, or both concurrently must be considered as potential risk factors.

AIM

The study aimed to determine if mobility and/or cognitive abilities could identify people with a history of falls in older adults with FoF.

METHODS

Twenty-six older adults with FoF participated in this study. Full cognitive and mobility assessments were performed assessing global cognitive impairments (MoCA score < 26), executive functions, memory, processing speed, visuospatial skills, mobility impairment (TUG time > 13.5 s), gait, balance and physical capacity. Information about falls occurring during the year prior to the inclusion was collected. Logistic regression analyses were performed to explore the association between falls and cognitive and mobility abilities.

RESULTS

No significant differences in age, sex, level of education or body mass index were detected between fallers and non-fallers. Cognitive impairments (MoCA score < 26) distinguished between fallers and non-fallers (p = 0.038; R² = 0.247). Among specific cognitive functions, visuospatial skills distinguished between fallers and non-fallers (p = 0.027; R² = 0.258). Mobility impairments (TUG time > 13.5 s), gait, balance and physical capacity were not related to past falls.

DISCUSSION/CONCLUSION

In older adults with FoF, global cognitive deficits detected by the MoCA are important factors related to falls and more particularly visuospatial skills seem to be among the most implicated functions. These functions could be targeted in multifactorial interventions.

A novel model to quantify balance alterations in older adults based on the center of pressure (CoP) measurements with a cross-sectional study

Background

The timely detection of fall risk or balance impairment in older adults is transcendental because, based on a reliable diagnosis, clinical actions can be taken to prevent accidents. This study presents a statistical model to estimate the fall risk from the center of pressure (CoP) data.

Methods

This study is a cross-sectional analysis from a cohort of community-dwelling older adults aged 60 and over living in Mexico City. CoP balance assessments were conducted in 414 older adults (72.2% females) with a mean age of 70.23 ± 6.68, using a modified and previously validated Wii Balance Board (MWBB) platform. From this information, 78 CoP indexes were calculated and analyzed. Multiple logistic regression models were fitted in order to estimate the relationship between balance alteration and the CoP indexes and other covariables.

Results

The CoP velocity index in the Antero-Posterior direction with open eyes (MVELAPOE) had the best value of area under the curve (AUC) to identify a balance alteration (0.714), and in the adjusted model, AUC was increased to 0.827. Older adults with their mean velocity higher than 14.24 mm/s had more risk of presenting a balance alteration than those below this value (OR (Odd Ratio) = 2.94, p<0.001, 95% C.I.(Confidence Interval) 1.68–5.15). Individuals with increased age and BMI were more likely to present a balance alteration (OR 1.17, p<0.001, 95% C.I. 1.12–1.23; OR 1.17, p<0.001, 95% C.I. 1.10–1.25). Contrary to what is reported in the literature, sex was not associated with presenting a balance alteration (p = 0.441, 95% C.I. 0.70–2.27).

Significance

The proposed model had a discriminatory capacity higher than those estimated by similar means and resources to this research and was implemented in an embedded standalone system which is low-cost, portable, and easy-to-use, ideal for non-laboratory environments. The authors recommend using this technology to support and complement the clinical tools to attend to the serious public health problem represented by falls in older adults.

Validation of the short falls efficacy scale-international for Taiwanese community-dwelling older adults: Associations with fall history, physical frailty, and quality of life

The FES-I is widely used to measure the fear of falling. However, studies linking the Chinese version of the FES-I to frailty and quality of life among older adults are still limited. Thus, this study examined the association of the full 16-item FES-I and the 7-item short FES-I with fall history, physical frailty, and quality of life among older Taiwanese adults. A total of 751 community-dwelling older adults in Taipei City participated in this study. Data analyses included logistic and linear regression models. The 16-item and the short FES-I were strongly correlated (Spearman rho = 0.963), and both scales are reliable. The 7-item FES-I was positively associated with fall history and physical frailty and negatively associated with the physical (b = -0.65, p < 0.001) and mental (b = -0.59, p < 0.001) components of health-related quality of life, independent of physical frailty. Thus, the short FES-I can be used to increase the feasibility of health screenings of older adults in Chinese-speaking contexts.

Relationship between fall behavior and quality of life of elderly individuals

The aim of this study was to examine the association between the quality of life and the fall behavior in elderly individuals. The study was conducted as a descriptive and correlational study design. Data were collected with the Patient Information Form, The Fall Behavior Scale for the Elderly and the World Health Organization Quality of Life module for the elderly. There were 110 older people included in study. When the relationship between the Fall Behavior Scale for the Elderly and the World Health Organization Quality of Life Module for the Elderly sub-scale and total scores were examined, there was a statistically significant negative correlation between the Fall Behavior Scale for the Elderly safe movement sub-scale and the World Health Organization Quality of Life Module social participation sub-scale scores (p < .01).

Quality of Life of Older People Receiving Home Health Care Services: An Example From Turkey

Advanced age, restrictions on daily life activities, increased disability, and chronic diseases negatively affect the quality of life of older individuals. The aim of the present study was to investigate the quality of life of older patients receiving home health care services (HHCS) in Samsun province, Turkey. The population of this cross-sectional study comprised 489 individuals aged 65 years and older. Patient selection was performed using the stratified randomized sampling method. A total of 183 patients were included in the study. Data were collected using a questionnaire and face-to-face interviews. The Mann-Whitney U and Kruskal–Wallis tests were used in the statistical evaluation of data, and significance was regarded as p < .05 for all tests. Some 75.4% of the patients were women, and the average age was 82 years. Eighty-three percent of the participants were semi-dependent or completely dependent in the activities of daily living (ADL); however, in the instrumental activities of daily living (IADL), 96.0% were semi-dependent or completely dependent. The quality of life of the older people receiving HHCS was identified as low both in the physical and mental health components. However, physical quality of life was statistically higher in men, in graduates of primary school or above, and in patients with no decubitus ulcers compared with the others. We found that the older individuals receiving HHCS had a lower quality of life due to their chronic diseases and high dependency compared with the general population and their contemporaries.

Effects of a resistance training community programme in older adults

Ageing is associated with reduced muscle mass, strength, flexibility and balance, resulting in a poor quality of life (QOL). Past studies have occurred in highly controlled laboratory settings which provide strong support to determine whether similar gains can be made in community programmes. Twenty participants were enrolled in an eight-week community-based resistance training programme (mean age = 61.3 (standard error (SE) = 0.9) years); Body Mass Index = 32.0 (SE = 1.3) kg/m2). All participants completed surveys to assess outcomes associated with QOL. Given the relationship between muscle function and nerve health, nerve conduction studies (NCS) were also conducted in a separate group of participants (mean age = 64.9 (SE = 2.0) years; Body Mass Index = 32.6 (SE = 1.9) kg/m2). This community-based training programme significantly improved QOL measures in older adults (p< 0.001). Although weight loss was not the primary outcome of the study, participants reduced their body weights (p< 0.001), by primarily reducing fat mass (p= 0.007) while maintaining muscle mass. Significant improvements were observed in muscle strength (2.2%), flexibility and balance (3.2–464.2%,p⩽ 0.05 for all). Improvements were also observed in plasma glucose (p= 0.05), haemoglobin A1C (p= 0.06) and aldolase enzyme levels (p< 0.001). Scores for surveys on memory and sleep improved (p< 0.05). Improved QOL was associated with increased lean mass (r= −0.714,p= 0.002), decreased fat mass (r= −0.702,p= 0.003) and improved flexibility and balance (r= −0.627,p= 0.008). An eight-week, community-based resistance training programme significantly improved QOL in older adults. Influence on the lipid profile and NCS still needs further investigation.

Fear of Falling, Community Participation, and Quality of Life Among Community-Dwelling People Who Use Wheelchairs Full Time

OBJECTIVES

To examine the differences in community participation and quality of life (QOL) among individuals who use wheelchairs full time with and without fear of falling (FOF).

DESIGN

Cross-sectional study design.

SETTING

University research laboratory.

PARTICIPANTS

Individuals (N=85) who use a manual or power wheelchair full time who are living with various health conditions and have a history of at least 1 fall in the past 12 months (age, 45.4±15.8y; disability duration, 21.5±13.6y) were included. Forty-six (54%) were manual wheelchair users.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

To quantify FOF, participants responded (yes/no) to the question: "Are you worried or concerned that you might fall?" Community participation and QOL were indexed by the Community Participation Indicator (CPI) and the World Health Organization Quality of Life-Brief version (WHOQOL-BREF), respectively. A multivariate analysis of variance (MANOVA) was performed to examine the differences in CPI and WHOQOL-BREF scores among wheelchair users who reported FOF and no FOF.

RESULTS

A total of 54 participants (63.5%) reported that they were worried or concerned about falling. The MANOVA revealed significant differences in overall CPI (F_2,82=4.714; P=.012; Wilks' λ=0.897) and WHOQOL-BREF (F_4,63=3.32; P=.016; Wilks' λ=.826) scores. Participants who reported FOF demonstrated significantly lower CPI and WHOQOL-BREF scores compared with those who did not report FOF.

CONCLUSIONS

FOF and associated activity curtailment are prevalent and may be a factor influencing full time wheelchair users' community participation and QOL. Prospective research is needed to better understand how FOF influences community participation and QOL among individuals who use wheelchairs full time. Findings would support the development of interventions, specifically for individuals who use wheelchairs full time, to reduce FOF and improve community participation and QOL.

Mediating factors on the association between fear of falling and health-related quality of life in community-dwelling German older people: a cross-sectional study

Background

Previous research has shown that not only falls, but also fear of falling (FoF) influences health-related quality of life (HrQoL) negatively. The EQ-5D (consisting of an index and a visual analogue scale [EQ-VAS]) is a frequently used instrument to determine HrQoL in clinical studies and economic evaluations, but no previous study compared the association between FoF and the EQ-5D index with the association between FoF and the EQ-VAS. Moreover, factors that influence the association between FoF and HrQoL are rarely examined. Thus, this study aimed to examine the association between FoF and HrQoL and to examine factors that mediate the association.

Methods

FoF (Short Falls Efficacy Scale International) and HrQoL (EQ-5D descriptive system, EQ-5D index, and EQ-VAS) were assessed in a sample of community-dwelling older persons (≥70 years) participating in the baseline assessment of a randomized controlled trial (N = 309). Linear and logistic regression analyses were performed, adjusting for sociodemographic variables, frequency of falls, number of chronic conditions, functional mobility (Timed up-and-go test), and subjective functional capacity (LLFDI function and disability scales). Multiple regression models were used to test the mediating effects.

Results

Moderate or high FoF was prevalent in 66% of the sample. After adjusting for covariates, FoF was negatively associated with the EQ-5D index, but not with the descriptive system or the EQ-VAS. Subjective functional capacity partly mediated the association between FoF and the EQ-5D index and completely mediated the association between FoF and the EQ-VAS.

Conclusion

FoF was negatively associated with the EQ-5D index. As subjective functional capacity mediated the association between FoF and HrQoL, future interventions should account for subjective functional capacity in their design.

Social inequalities in the impact of falls on health-related quality of life among older adults

The aim of the present study was to determine the association between falls and health-related quality of life (HRQoL) among older adults considering different demographic and socioeconomic characteristics. This study was developed with data from the Household Health Survey conducted in the city of Campinas, Brazil, in 2014 and 2015. HRQoL was investigated using the eight domains and two components of the SF-36 questionnaire. Simple and multiple linear regression analyses were performed with the aid of the Stata 15.0 program to determine the association between falls and HRQoL according to sex, age, income and schooling. Significant declines in the scores of the physical functioning, role physical and bodily pain domains as well as the physical component were found among women (not men) and individuals with a lower income. Among individuals aged 75 years or older and those with less schooling, declines occurred in these same domains as well as in the role emotional and mental health domains. The results reveal that the impact of falls on HRQoL differs depending on the socioeconomic and demographic characteristics of older adults, indicating that specific care strategies should target more vulnerable subgroups, with attention given to emotional aspects.

Risk Factors and Number of Falls as Determinants of Quality of Life of Community-Dwelling Older Adults

BACKGROUND AND PURPOSE

In older adults, the psychological impact and effects related to the loss of functional capacity are directly related to perceived quality of life (QOL). The predictors of better QOL are increased physical activity, lower prevalence of overweight, lower cases of depression, and lower rate of reported alcohol abuse. On the contrary, the predictors of decreased QOL are female gender, comorbidity, deficient nutritional condition, polypharmacy, loss of mobility, depression and dependency, poor economic conditions, and social isolation and loneliness. Furthermore, QOL in older adults is more dependent on the number of falls than comorbidity. The objective was to investigate the determinants of perceived QOL among independent community-dwelling older adults and to quantify the influence of number of falls and number of risk factors on QOL.

METHODS

This is a cross-sectional study of 572 older adults (>70 years of age) seen in 10 primary care centers in La Ribera, Valencia, Spain. Comprehensive geriatric assessment was done by 4 nurses in primary care centers. Functional status and sociodemographic and clinical variables were collected. Quality of life was assessed with the EQ-5D scale.

RESULTS

Females predominated (63.3%). Mean age (standard deviation) was 76.1 (3.9) years. The male gender (β = .09; 95% confidence interval [CI]: 0.05-0.13) was found to be predictive of better QOL, together with physical activity (β = .04; 95% CI: 0.02-0.06), while the use of drugs affecting the central nervous system (β = -.08; 95% CI: -0.12 to -0.03), overweight (β = -.06; 95% CI: 0.1 to - 0.02), comorbidity (β = -.09; 95% CI: -0.13 to -0.05), the presence of fall risk factors (β = -.02; 95% CI: -0.03 to 0.01), and the number of previous falls (β = -.03; 95% CI: -0.06 to 0.01) had a negative impact upon the EQ-5D Index score.

CONCLUSIONS

If perceived QOL is used as an indicator of the success of intervention programs, certain factors accompanying the adoption of measures for the prevention of falls may mask the results (failure or success) of the intervention. Because most determinants of QOL are modifiable and physical activity has the potential to improve QOL, this research suggests that physical activity programs should be a component of health care for 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.

Geriatric syndromes and quality of life in older adults with diabetes

AIM

To describe geriatric syndromes and their relationships with quality of life in older adults with diabetes.

METHODS

Community-dwelling older adults (aged >60 years) with diabetes (n = 316) participated in the present study. Eight geriatric syndromes, including polypharmacy (number of medications), pain (Brief Pain Inventory), urinary incontinence (International Consultation on Incontinence Questionnaire), sleep disturbance (hours of sleep), lower cognitive level (Mini-Mental State Examination), falls, depressive symptoms (Geriatric Depression Scale short form) and functional limitation (Barthel Index and Instrumental Activity of Daily Living), were assessed. The WHOQOL-BREF Taiwan version was used to measure physical, psychological, social and environmental domains of quality of life.

RESULTS

Polypharmacy was the most common geriatric syndrome (46.6%), followed by pain (41.5%). Participants with any of the geriatric syndromes, except for polypharmacy and sleep disturbance, had significantly poorer quality of life than those without. The Geriatric Depression Scale score was the only common and significant contributor to all four domains of quality of life, explaining 16~29% of the variance. Number of medications, pain level and cognitive level were also significant contributors, although they explained a small amount (<5%) of the variance. The number of geriatric syndromes (mode = 2) was significantly correlated with all four domains of quality of life (partial correlation r = -0.278~0.460, all P < 0.001).

CONCLUSIONS

Geriatric syndromes, especially polypharmacy and pain, were common among older adults with diabetes. A greater number of geriatric syndromes or a higher Geriatric Depression Scale score were associated with poorer quality of life. Further studies focusing on combinations of different geriatric syndromes or comorbidities are required. Geriatr Gerontol Int 2019; 19: 518-524.

Cross-cultural adaptation and psychometric properties of the Falls Efficacy Scale - International in Filipino community-dwelling older adults

Purpose: The Falls Efficacy Scale - International is universally used in assessing the level of concern about falling in older adults. The objectives of this study were to conduct a cross-cultural adaptation and to establish psychometric properties of Falls Efficacy Scale - International in Filipino (FES-I F).Methods: The standardized 10-step translation protocol of the Prevention of Falls Network Europe was followed. Community-dwelling older adults aged 60 or above (N = 211) from Manila, Philippines were recruited. The internal consistency and test-retest reliability of the translated tool was assessed. Convergent validity was compared with fall-related factors. The receiver operating characteristics were used to determine the cutoff score.Results: The FES-I F has high internal consistency (α = 0.91) and good test-retest reliability (intraclass correlation coefficient = 0.86). Overall scores were significantly higher among those with subjective report of fear of falling (p < 0.001), lower timed up and go test scores (p = 0.014), slower gait speed (p = 0.003), and lower perceived well-being scores (p = 0.003) indicating acceptable convergent validity. The cutoff score of FES-I F was 22 points.Conclusions: The FES-I F has high internal reliability and acceptable validity, and can be a practical tool to measure the concern about falling in Filipino older adults. Future research is necessary to establish its utilization as an outcome measure in intervention studies.Implications for rehabilitationThe psychometric properties of the Filipino version of the Falls Efficacy Scale - International were good when assessed in older adults living in the community.The cutoff score to demarcate those with fear of falling from those without is 22 points.Falls Efficacy Scale - International in Filipino is recommended for the assessment of fear of falling for research and clinical purposes.

Effect of the Living Environment on falls among the Elderly in Urmia

BACKGROUND:

The living environment has an impact on the health of the elderly, and the safety of the house is one of the concerns of the elderly. Disregarding the safety concerns increases the falling.

AIM:

This research was conducted with the aim of influencing the living environment on falls among elderly people in Urmia city.

METHODS:

This is a cross-sectional (descriptive-analytic) study which 200 elderly people were selected by random cluster sampling. Data were collected by using a two-part questionnaire including demographic information, and home safety assessment checklist. Data were analysed by using chi-square test and logistic regression in SPSS v. 21 software.

RESULTS:

The incidence of falling in the elderly was 30%. There was a significant statistical association with age, sex, marital status and history of chronic disease. Results of logistic regression showed non-safe stairs (OR = 1.1, p = 0.002), unsafe toilet/bath (OR = 1.3, p = 0.001), unsafe bedrooms (OR = 1.7, p = 0.05) unsafe living room (OR = 1.4, p = 0.02) increase the falls in the elderly, as well as male gender (OR = 1.14, p < 0.001) and living with other people (OR = 0.19, p = 0.002) reduce the falls in the elderly.

CONCLUSION:

By identifying the risk factors of the physical space of the home, we can plan for implementing necessary interventions according to the risk factor or risk factors to prevent and reduce the falls in the elderly community.

Associations between health-related quality of life, physical function and fear of falling in older fallers receiving home care

BACKGROUND

Falls and injuries in older adults have significant consequences and costs, both personal and to society. Although having a high incidence of falls, high prevalence of fear of falling and a lower quality of life, older adults receiving home care are underrepresented in research on older fallers. The objective of this study is to determine the associations between health-related quality of life (HRQOL), fear of falling and physical function in older fallers receiving home care.

METHODS

This study employed cross-sectional data from baseline measurements of a randomised controlled trial. 155 participants, aged 67+, with at least one fall in the previous year, from six Norwegian municipalities were included. Data on HRQOL (SF-36), physical function and fear of falling (FES-I) were collected in addition to demographical and other relevant background information. A multivariate regression model was  applied.

RESULTS

A higher score on FES-I, denoting increased fear of falling, was significantly associated with a lower score on almost all subscales of SF-36, denoting reduced HRQOL. Higher age was significantly associated with higher scores on physical function, general health, mental health and the mental component summary. This analysis adjusted for sex, education, living alone, being at risk of or malnourished, physical function like balance and walking speed, cognition and number of falls.

CONCLUSION

Fear of falling is important for HRQOL in older fallers receiving home care. This association is independent of physical measures. Better physical function is significantly associated with higher physical HRQOL. Future research should address interventions that reduce fear of falling and increase HRQOL in this vulnerable population.

TRIAL REGISTRATION

ClinicalTrials.gov. NCT02374307 . First registration, 16 February 2015. First enrolment of participants, February 2016.

Effect of a Matter of Balance programme on avoidance behaviour due to fear of falling in older adults

BACKGROUND

Fear of falling (FOF) is associated with restricted activities, increased risk of falling, and decreased quality of life. A Matter of Balance (AMOB) is an evidence-based programme designed to decrease FOF. The current study investigated the influence of the AMOB on activity avoidance caused by FOF in older adults using the Fear of Falling Avoidance Behavior Questionnaire (FFABQ), health-related quality of life, and a question regarding concerns about falling.

METHODS

Participants of this quasi-experimental, one-group, pretest-post-test study design were older adults from community sites in the Phoenix, Arizona, metropolitan area. Participants attended the AMOB programme, which consisted of one weekly 2-h session for 8 weeks. At the beginning and end of the programme, participants completed the standard AMOB assessments, the FFABQ, the Centers for Disease Control Core Healthy Days Measure (CDC HRQOL-4), and a question regarding concerns about falling.

RESULTS

Sixty-three participants completed the study; their mean ± SD age was 75.3 ± 7.1 years (range: 60.0-90.0 years), and 84.1% were women. The FFABQ scores decreased from baseline (24.4 ± 12.7 points) to post-AMOB (20.1 ± 11.9 points; t = 2.62, P = 0.01). No changes in any of the CDC HRQOL-4 questions were noted (CDC HRQOL-4 question (Q)1 (z = -1.41, P = 0.16), CDC HRQOL-4 Q2 and Q3 summary index (z = -1.60, P = 0.11), and CDC HRQOL-4 Q4 (z = -0.97, P = 0.33)). Concerns about falling decreased from baseline (3.4 ± 0.9 points) to post-AMOB (2.8 ± 0.8 points; z = -4.09, P < 0.001).

CONCLUSION

Avoidance behaviour caused by FOF, as measured by the FFABQ, and concerns about falling decreased in community-dwelling older adults who participated in the AMOB. Findings support the efficacy of the AMOB for reducing both avoidance behaviour caused by FOF and concerns about falling through an approach that combines education and exercise.

Relationship between muscle strength and fall episodes among the elderly: the Yilan study, Taiwan

Background

Fall episodes are not unusual among community residents, especially the elderly, and lower muscle strength is an important issue to address in order to prevent falls.

Methods

A community health survey was conducted in a suburban area of Taiwan, and 1067 older adults were selected for enrollment in the present study. All the enrolled subjects had been visited at their homes; the subjects’ strength of both hands and muscle mass of both legs were measured and well-established questionnaires were finished by certificated paramedic staffs.

Results

The incidence of fall episodes in the previous 1 year in the Yilan elderly population was 15.1%, and the female predominance was significant. A significantly higher prevalence of cataracts was found in group who experienced a fall in the past year (64% vs. 54.9% in the non-fall group). Mild or more severe dementia was much more prevalent in the group who experienced a recent fall (33.8% vs. 25.7% in the non-fall group). The strength of both hands tested as the physical function was 17.6 ± 8.0 kg in the recent fall group, significantly weaker than that in the non-fall group (20.7 ± 8.7 kg). Multivariate regression analysis revealed a greater weekly exercise duration and greater strength of both hands reduced the occurrence of falls among the whole and the female population. The standardized effect sizes of hand grip strength between both groups, not trivial, were 0.29 and 0.37 for the total population and the female subpopulation respectively.

Conclusions

Less weekly exercise duration and weaker muscle strength were f ound to be independent risk factors of fall episode(s) in an elderly Taiwanese population, especially in the female sub-population. Muscle strength, measured by average of both hands grip strength, was the most significantly factor of one-year fall episode(s) accessed retrospectively.

Fear of falling and its predictors among community-living older adults in Korea

OBJECTIVES

To explore the prevalence and predicting factors of fear of falling (FOF) among community-living older adults in Korea.

METHODS

Secondary data analysis of the 2011 Korean National Elderly Living Conditions and Welfare Desire Survey was used. Logistic regression analysis was conducted to examine the predictors of FOF.

RESULTS

In total, 75.6% of older adults with normal cognition have FOF. Factors associated with an increased risk of FOF in older adults are previous experience with falling (OR = 3.734, 95% CI = 2.996-4.655), limitations in the performance of exercise involving lower extremities (OR = 2.428, 95% CI = 2.063-2.858), being female (OR = 2.335, 95% CI = 2.023-2.694), having more than three chronic diseases (OR = 1.994, 95% CI = 1.625-2.446), limitations in instrumental activities of daily living (IADLs) (OR = 1.745, 95% CI = 1.230-2.477), limitations in the performance of exercise involving upper extremities (OR = 1.646, 95% CI = 1.357-1.997), living without a spouse (OR = 1.626, 95% CI = 1.357-1.948), having poor self-rated health (OR = 1.571, 95% CI = 1.356-1.821), limitations in muscle strength (OR = 1.455, 95% CI = 1.150-1.841), age (≥75 years) (OR = 1.320, 95% CI = 1.150-1.516), lower levels of education (0-6 years) (OR = 1.231, 95% CI = 1.075-1.409), and life satisfaction (OR = 1.104, 95% CI = 1.065-1.114).

CONCLUSION

A multidimensional construct of general characteristics, physical, and psychosocial variables act as risk factors for FOF. Preventive intervention should be developed to decrease the FOF among Korean older adults.

Ethnic Differences in Fall Risk Among Community-Dwelling Older People in the Netherlands

OBJECTIVE

This study measures the prevalence of falls and fear of falling among a population sample aged ≥65 years from different ethnic minorities living in the Netherlands, and examines whether ethnicity contributed to the differences in fall risk.

METHOD

We analyzed data from 8,892 Dutch, Moroccan, Turkish, and Surinamese participants. Descriptive statistics and multiple regression analyses were conducted with falls and fear of falling as the dependent variable and ethnicity as the independent variable.

RESULTS

Moroccan, Turkish, and Surinamese older adults had a significantly higher odds ratio (OR) for fear of falling than their Dutch counterparts (OR = 2.13, 95% confidence interval [CI] = [1.05, 4.31]; OR = 2.09, 95% CI = [1.07, 4.09]; and OR = 2.49, 95% CI = [1.53, 4.03], respectively). The association between ethnicity and falling disappeared after controlling for socio-demographic and health characteristics.

DISCUSSION

Dutch minority older adults were at higher risk for fear of falling than their Dutch counterparts. The study underlines the need for targeting culture-sensitive interventions.

Impact of falling on social participation and social support trajectories in a middle-aged and elderly European sample

Whereas falls are frequent and traumatic events for the elderly, their long-term consequences in terms of the social lives of older fallers are understudied. This study aimed to identify the impact of falling on the trajectories of social participation and social support of older people in Europe. Our sample consisted of 16,583 people aged 50–95 years from 10 European countries who responded to the waves 1, 2 and 4 of the Survey of Health Ageing and Retirement in Europe. The impact of falling on the trajectories of social participation and social support was examined using generalised estimating equation (GEE) models. The effect of the interactions between falling and frailty and between falling and social support on social participation was assessed. Falls were negatively associated with social participation (OR=0.73, p<0.001) and positively associated with social support (OR=2.20, p<0.001). For social participation, this effect was moderated by frailty; the interaction term between frailty and fall highlighted the finding that frailty better explained the global trajectory of social participation compared with falling. Social support did not buffer the negative impact of falling on social participation. Falls can be considered stressful events that have implications beyond the health context. Frail people who have fallen should be targeted in prevention and rehabilitation programmes; specific attention should also be paid to the relatives of fallers, who appeared to be more intensively solicited after a fall.

•

Fall events were independent and direct predictors of increased social support.

•

Falls indirectly decreased social participation.

•

Frail people exhibited the lowest odds of social participation after a fall and should be targeted in fall prevention programmes.

•

Specific attention should be paid to informal caregivers, who provided increasing support after a fall.

Balance Confidence and Fear of Falling Avoidance Behavior Are Most Predictive of Falling in Older Adults: Prospective Analysis

BACKGROUND

Evidence suggests that there are several fall predictors in the elderly population, including previous fall history and balance impairment. To date, however, the role of psychological factors has not yet been thoroughly vetted in conjunction with physical factors as predictors of future falls.

OBJECTIVE

The purpose of this study was to determine which measures, physical and psychological, are most predictive of falling in older adults.

DESIGN

This was a prospective cohort study.

METHODS

Sixty-four participants (mean age=72.2 years, SD=7.2; 40 women, 24 men) with and without pathology (25 healthy, 17 with Parkinson disease, 11 with cerebrovascular accident, 6 with diabetes, and 5 with a cardiovascular diagnosis) participated. Participants reported fall history and completed physical-based measures (ie, Berg Balance Scale, Dynamic Gait Index, self-selected gait speed, Timed "Up & Go" Test, Sensory Organization Test) and psychological-based measures (ie, Fear of Falling Avoidance Behavior Questionnaire, Falls Efficacy Scale, Activities-specific Balance Confidence Scale). Contact was made 1 year later to determine falls during the subsequent year (8 participants lost at follow-up).

RESULTS

Using multiple regression, fall history, pathology, and all measures were entered as predictor candidates. Three variables were included in the final model, explaining 49.2% of the variance: Activities-specific Balance Confidence Scale (38.7% of the variance), Fear of Falling Avoidance Behavior Questionnaire (5.6% additional variance), and Timed "Up & Go" Test (4.9% additional variance).

LIMITATIONS

Falls were based on participant recall rather than a diary.

CONCLUSIONS

Balance confidence was the best predictor of falling, followed by fear of falling avoidance behavior, and the Timed "Up & Go" Test. Fall history, presence of pathology, and physical tests did not predict falling. These findings suggest that participants may have had a better sense of their fall risk than with a test that provides a snapshot of their balance.

Association of falls with health-related quality of life (HRQOL) in older cancer survivors: A population based study

OBJECTIVE

To examine the association between falls and health-related quality of life (HRQOL) in older cancer survivors.

MATERIALS AND METHODS

Using the 2006-2011 Surveillance, Epidemiology, and End Results cancer registry system and the Medicare Health Outcomes Survey (SEER-MHOS) linkage database, a cross-sectional analysis was performed including 17,958 older cancer survivors. Multivariable regression models were used to evaluate the association of falls with HRQOL measured by the physical component summary (PCS) and mental component summary (MCS) scores on the Veteran RAND 12-item health survey after controlling for demographic, health- and cancer-related factors. A longitudinal analysis using the analysis of covariance (ANCOVA) models was also conducted comparing changes in HRQOL of older cancer survivors who fell with HRQOL of older patients with cancer who did not fall.

RESULTS

In the cross-sectional analysis, 4524 (25%) cancer survivors who fell reported a significantly lower PCS (-2.18; SE=0.16) and MCS (2.00; SE=0.17) scores compared to those who did not (N=13,434). In the longitudinal analysis, after adjusting for baseline HRQOL scores and covariates, patients who fell reported a decline in mean HRQOL scores of both PCS (-1.54; SE=0.26) and MCS (-1.71; SE=0.27). Presence of depression, functional impairment and comorbidities was significantly associated with lower HRQOL scores.

CONCLUSION

Falls are associated with lower HRQOL scores and are associated with a significant prospective decline in HRQOL in older cancer survivors. Further research is necessary to determine if assessment and intervention programs can help improve HRQOL by reducing the likelihood of falls.

Age-associated declines in muscle mass, strength, power, and physical performance: impact on fear of falling and quality of life

This 3-year longitudinal study among older adults showed that declining muscle mass, strength, power, and physical performance are independent contributing factors to increased fear of falling, while declines of muscle mass and physical performance contribute to deterioration of quality of life. Our findings reinforce the importance of preserving muscle health with advancing age.

INTRODUCTION

The age-associated loss of skeletal muscle quantity and function are critical determinants of independent physical functioning in later life. Longitudinal studies investigating how decrements in muscle components of sarcopenia impact fear of falling (FoF) and quality of life (QoL) in older adults are lacking.

METHODS

Twenty-six healthy older subjects (age, 74.1 ± 3.7; Short Physical Performance Battery (SPPB) score ≥10) and 22 mobility-limited older subjects (age, 77.2 ± 4.4; SPPB score ≤9) underwent evaluations of lower extremity muscle size and composition by computed tomography, strength and power, and physical performance at baseline and after 3-year follow-up. The Falls Efficacy Scale (FES) and Short Form-36 questionnaire (SF-36) were also administered at both timepoints to assess FoF and QoL, respectively.

RESULTS

At 3-year follow-up, muscle cross-sectional area (CSA) (p < 0.013) and power decreased (p < 0.001), while intermuscular fat infiltration increased (p < 0.001). These decrements were accompanied with a longer time to complete 400 m by 22 ± 46 s (p < 0.002). Using linear mixed-effects regression models, declines of muscle CSA, strength and power, and SPPB score were associated with increased FES score (p < 0.05 for each model). Reduced physical component summary score of SF-36 over follow-up was independently associated with decreased SPPB score (p < 0.020), muscle CSA (p < 0.046), and increased 400 m walk time (p < 0.003).

CONCLUSIONS

In older adults with and without mobility limitations, declining muscle mass, strength, power, and physical performance contribute independently to increase FoF, while declines of muscle mass and physical performance contribute to deterioration of QoL. These findings provide further rationale for developing interventions to improve aging muscle health.

Quality of Life and Gait in Elderly Group

Introduction

 The process of aging could lead to seniors being more prone to falls, which affects their quality of life.

Objective

 The objective of this study is to investigate the relationship between quality of life and gait in the elderly.

Methods

 We used World Health Organization Quality of Life-Brief (WHOQOL-Brief) Brazilian version and the Dynamic Gait Index to assess fifty-six volunteers from the northeast of Brazil. Ages ranged from 60 to 85 years.

Results

 The Dynamic Gait Index, which indicates the probability of falls, resulted in 36.3% of the sample presenting abnormal results. There was correlation between domain 2 (psychological) and domain 4 (environment) with domain 1(Physical) and domain 3 (Social); a negative correlation between age and Domain 2; correlation between Question 1 (How would you rate your quality of life?) and domains 1, 2, and 4 and no correlation between questions 1 and 2 (How satisfied are you with your health?). Question 2 was correlated with all of the domains. There was negative association between question 1 and falls, and a slight correlation between the Dynamic Gait Index scores and Question 1.

Conclusion

 The self-perception of the study group about their quality of life was either good or very good, even though a considerable percentage of individuals had suffered falls or reported gait disturbances.

Relationship among health-related quality of life, depression and awareness of home care services in elderly patients

AIMS

The present descriptive study was carried out to determine the relationship between health-related quality of life, depression and awareness of home care services among elderly patients.

METHODS

Patients aged 65 years or older staying at the surgery and internal medicine clinics were included in the study. The "Patient Introduction Form," "Short Form-36 Quality of Life Questionnaire" and "Geriatric Depression Scale" were utilized in the collection of data.

RESULTS

In the present study, it was determined that only approximately half of elderly patients (54.9%) knew the concept of home care, most of them had not previously received home care and requested home care related to medical care. The mean scores were lower in some areas of the quality of life questionnaire in some factors that could influence home care awareness. These factors were determined as: female sex, history of falling, chronic illness, functionally, moderately or severely dependent, no previous receipt of home care and wishing to receive home care.

CONCLUSIONS

The home care requirement of elderly patients can be influenced by many physiological, psychological and social factors that can affect their quality of life. Thus, it is of utmost importance that medical professionals evaluate the quality of life of elderly individuals and its influencing factors. Geriatr Gerontol Int 2016; 16: 1211-1219.

Mobility predicts change in older adults' health-related quality of life: evidence from a Vancouver falls prevention prospective cohort study

Background

Older adults with mobility impairments are prone to reduced health related quality of life (HRQoL) is highly associated with mobility impairments. The consequences of falls have detrimental impact on mobility. Hence, ascertaining factors explaining variation among individuals’ quality of life is critical for promoting healthy ageing, particularly among older fallers. Hence, the primary objective of our study was to identify key factors that explain variation in HRQoL among community dwelling older adults at risk of falls.

Methods

We conducted a longitudinal analysis of a 12-month prospective cohort study at the Vancouver Falls Prevention Clinic (n = 148 to 286 depending on the analysis). We constructed linear mixed models where assessment month (0, 6, 12) was entered as a within-subjects repeated measure, the intercept was specified as a random effect, and predictors and covariates were entered as between-subjects fixed effects. We also included the predictors by sex and predictor by sex by time interaction terms in order to investigate sex differences in the relations between the predictor variable and the outcome variable, the EQ-5D.

Results

Our primary analysis demonstrated a significant mobility (assessed using the Short Performance Physical Battery and the Timed Up and Go) by time interaction (p < 0.05) and mobility by time by sex interaction (p < 0.05). The sensitivity analyses demonstrated some heterogeneity of these findings using an imputed and a complete case analysis.

Conclusions

Mobility may be an important predictor of changes in HRQoL over time. As such, mobility is a critical factor to target for future intervention strategies aimed at maintaining or improving HRQoL in late life.

A theoretical and empirical review of psychological factors associated with falls-related psychological concerns in community-dwelling older people

BACKGROUND

Four constructs are encompassed by the term "falls-related psychological concerns" (FrPC); "fear of falling" (FOF), "falls-related self-efficacy" (FSe), "balance confidence" (BC) and "outcome expectancy" (OE). FrPC are associated with negative consequences including physical, psychological, and social. Identifying factors associated with FrPC could inform interventions to reduce these concerns.

METHODS

Sixty-two empirical papers relating to psychological factors associated with FrPC in community-dwelling older people (CDOP) were reviewed. Four levels of evidence were used when evaluating the literature: good, moderate, tentative, and none.

RESULTS

Evidence that anxiety predicted FOF, BC, and OE was tentative. Moderate evidence was found for anxiety predicting FSe. Good evidence was found for depression predicting FSe. Moderate evidence was found for depression predicting both FOF and BC. No evidence was found for depression predicting OE. Tentative evidence was found for FSe predicting depression. Good and moderate evidence was found for quality of life (QoL) being predicted by FOF and BC respectively. Tentative evidence was found for FSe predicting QoL. Moderate evidence was found for QoL predicting both FSe and BC. No evidence was found for QoL predicting FOF. Good and moderate evidence was found for activity avoidance/restriction (AA/AR) being predicted by FOF and FSe respectively. Tentative evidence was found for BC and OE predicting AA/AR, as well as for AA/AR predicting FOF. Moderate evidence for activity level (AL) predicting FOF was identified, however the evidence of this predicting FSe and BC was tentative. Evidence for FOF, FSe, and BC predicting AL was tentative as was evidence to suggest FOF predicted coping.

CONCLUSIONS

Mixed evidence has been found for the association of psychological factors in association with FrPCs. Future research should employ theoretically grounded concepts, use multivariate analysis and longitudinal designs.