FUNCTIONAL DEFICIENCIES ASSOCIATED WITH FEAR OF FALLS IN THE OLDER ADULT

S. Dhavale^1,2, S. Singh², R.K. Parasher³

¹Amar Jyoti Institute of Physiotherapy, University of Delhi, Physiotherapy, New Delhi, India, ²Punjabi University, Patiala, Physiotherapy, Punjab, India, ³Venkateshwar Hospital, Physiotherapy, New Delhi, India

Background: Fear of falls (FOF) is a modifiable risk factor that has both psychological and physical consequences in terms of losing self-confidence and avoiding functional activities. Given an increasing population of community living elderly, an architecturally constrained urban landscape, the consequent economic and sociocultural impact, and a general paucity of literature, the phenomenon of FOF needs to be comprehensively studied as it has implications for the rehabilitation and quality of life of such individuals.

Purpose: To establish the prevalence of FOF in adults aged >50 years, and determine functional deficiencies associated with it.

Methods: Community-living adults were recruited, following informed consent, and the presence/absence of FOF was determined in >400 adults, aged 50 years and more. They were additionally measured on the following tests: Activities Based Confidence (ABC) scale, Unipedal Stance Test (UPST), Dynamic Gait Index (DGI), Berg Balance Scale (BBS), Beck’s Depression Inventory, and Quality of life (SF-36) scale.
Independent t-test, Spearman correlation test, and linear regression along with descriptive statistics were used to analyze the data at p< 0.05.

Results: 40% of participants reported a FOF, with a large percentage in the 50-60 age group, 58% were females, 14-45% had BMIs in the obese – overweight range, and importantly, 33% of participants had never experienced a fall.
Participants with FOF scored significantly lower, more in the older adult (interaction with age <0.05), than participants without FOF on UPST, BBS, ABC, BDI, and all subdomains of Rand SF-36. Also, only 19.66 % with FOF had normal depression scores compared to 80.34% of the participants having no FOFs.
ABC (ρ = 0.40) and BDI (ρ = - 0.30) were moderately correlated with FOF, but the correlations with UPST (ρ=0.13), BBS (ρ=0.28), DGI (ρ=0.28) were weak albeit significant. 60% with FOFs were at risk of falls as per the cut-off scores ofUPST, BBS, and DGI scores, while ABC predicted 70 % to be at the risk.
Regression analysis demonstrated that UPST, BBS, DGI, and ABC when included in the equation, significantly predicted the presence of FOF (R²= 0.15, p<0.05). However, partial correlations suggest that ABC was the strongest predictor, accounting for 36% of the variance.

Conclusions: Functional static and dynamic balance, confidence during functional activities, level of depression, and quality of life were significantly impacted by the presence of FOFs in adults above the age of 50 years, which increased with age. Overall, all functional parameters tested were significantly associated with FOFs, however, balance confidence during activities was the strongest predictor. Surprisingly, there were a significant number of participants in the 50-60 age group, and falls were a significant risk in people with FOFs.

Implications: FOF is a multidimensional construct, which significantly affects instability, and increases the probability of falls in older adults. Physical and psychological parameters associated with FOFs are modifiable, and their understanding within specific domains will help in the development of targeted and effective management strategies, and consequently in the prevention of falls.

Funding acknowledgements: Self Funded Research

Keywords:
Fear of falls
Older adult
Functional deficiencies

Topics:
Older people
Community based rehabilitation
Neurology

Did this work require ethics approval? Yes

Institution: Amar Jyoti Institute of Physiotherapy, University of Delhi, India

Committee: Amar Jyoti Institutional Review Board-Ethical Committee

Ethics number: AJIRB-EC/01/2018