Postural control among older adults with fear of falling and chronic low back pain.

OBJECTIVE: Altered Postural control could increase the risk of falling in older adults. Factors such as low back pain and fear of falling can be contributing factors to postural control instability. This study aimed to investigate the effect of chronic low back pain (CLBP) and fear of falling (FOF) on postural control of older adults. METHOD: Forty-one older adults were included (27 LBP and 14 control). Among the participants, 22 people had high FOF, and 19 had low FOF based on Falls efficacy scale cut-off of ≥ 26. For postural control evaluation Center of pressure parameters (COP) of Standard deviation (Sd) of velocity, Sd of amplitude, path length and mean velocity in both Medial-lateral (ML) and Anterior-Posterior (AP) directions were measured. Mixed-model anova with two between group factor (Health status; with and without CLBP, and with high and low FES-I groups) and one within factor postural condition (four conditions with and without vision and Achill tendon vibration) was used. RESULT: No significant interaction between groups (health status and FES-I) and group with condition (health status and condition or FES-I and condition) was observed for all COP parameters in both AP and ML direction. There was main effect of FES-I for all COP parameters in ML direction, with greater Sd of velocity, Sd of amplitude, path length and mean velocity in older adults with high FES-I compared to low FES-I in the ML direction. CONCLUSION: High levels of FOF influenced static postural control in the ML direction. Therefore, paying attention to the lateral stability of older adults is of great importance.

Experiencing Cerebrovascular Diseases like Stroke and Fear of Falling: Longitudinal Results from the Survey of Health, Ageing and Retirement in Europe.

Objective: The aim of this study was to clarify the link between experiencing cerebrovascular diseases (strokes as an explicit example) and fear of falling (FOF) among middle-aged and older adults in Europe. Methods: Longitudinal data were used from wave 5 to wave 7 of the representative Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported tools were used to quantify the key variables. Fear of falling was similarly assessed using a dichotomous yes or no question, "For the past six months at least, have you been bothered by any of the health conditions on this card", with fear of falling being one of the options. It was adjusted for various sociodemographic and health-related factors. In particular, to account for unobserved heterogeneity, conditional fixed effect regressions (FE) were used. Accordingly, change in an individual's FOF status over the included waves was analysed and correlated with the reported change of all the included time-varying independent variables within the same individual, including experiencing stroke or other cerebrovascular diseases. The final analytical sample equalled n = 22.071 observations. Results: Conditional logistic FE regressions showed that the onset of a stroke or other forms of cerebrovascular disease was not associated with an increased likelihood of experiencing fear of falling (OR = 1.25, p = 0.095). However, stratified by sex, such an association was present in men (OR = 1.79, p = 0.006), though not in women (OR = 0.94, p = 0.732). Conclusions: The onset of a stroke or other cerebrovascular diseases was associated with an increased likelihood of experiencing FOF in men but not women. Efforts are required to assist older men in avoiding FOF after the onset of stroke or other cerebrovascular pathologies.

Standing on Elevated Platform Changes Postural Reactive Responses during Arm Movement.

Background/Objectives: This study investigated the behavior of postural adjustments throughout the entire action: from the preparatory phase (anticipatory postural adjustment, APA), the focal movement phase (online postural adjustments, OPA), to the compensatory phase (compensatory postural adjustment, CPA) while raising the arms in a standing position, both with eyes opened and closed. The goal was to analyze the effects of reduced sensorial information and different heights on postural muscle activity during these three phases. Methods: Eight young women performed rapid shoulder flexion while standing on the ground and on a 1-m elevated platform. The EMG activity of the trunk and lower limb muscles was recorded during all three phases. Results: Although average muscle activity was similar on the ground and the elevated platform, the pattern of postural muscle activation varied across the motor action. During OPA, all postural muscle activity was the highest, while it was the lowest during APA. On the elevated platform postural muscles have increased their activation during APA. In the most stable condition (standing on the ground with eyes opened), muscle activity showed a negative correlation between APA and OPA, but there was no correlation between OPA and CPA. Conclusions: Our results suggest postural control adapts to sensory, motor, and cognitive conditions. Therefore, the increased demand for postural control due to the height of the support base demands greater flexibility in postural synergies and alters muscle activity.

Concern about falling is related to threat-induced changes in emotions and postural control in older adults.

BACKGROUND: Concern about falling is reportedly related to mobility and balance in older adults. While increased concern about falling may be directly related to balance deficits, establishing a causal relationship remains limited. This study aimed to investigate whether concern about falling affects threat-induced changes in emotions and postural control in older adults. RESEARCH QUESTION: How does concern about falling affect threat-induced changes in emotions and postural control among older adults? METHODS: Sixty-two older adults (age; 78.8 ± 5.7 years, height; 152.7 ± 6.3 cm) were exposed to height-related fear while standing, leaning forward, and leaning backward on the floor and a higher surface. The mean position, root mean square, and mean velocity of the center of pressure (COP) displacement were measured during the standing task, as well as the forward and backward limits of stability (LOS) tasks. The degree of self-reported fear of falling (FoF) was also obtained during the standing and LOS tasks. The participants were categorized into lower and higher concerns about falling based on the short form of the Falls Efficacy Scale International (FESI). RESULTS: Lower and higher concern about falling groups scored 10.2 ± 2.2 and 17.3 ± 3.3 in the short FESI. Both groups experienced increased FoF during the standing and forward LOS tasks on a higher surface. Leaning away from the edge of the surface resulted in increased COP velocity, decreased COP amplitude while standing, and decreased forward LOS. Participants with higher concern about falling had increased FoF during the backward LOS task and decreased backward LOS on a higher surface, while those with lower concern about falling did not. SIGNIFICANCE: Concern about falling can directly affect emotions and balance control owing to the occurrence of threat-related changes.

Exploring Indoor Home Environment Factors Influencing Fear of Falling: A Systematic Review.

In-home falls and fear of falling (FOF) are significant concerns among older adults and people with disabilities (PwD), impacting independence in daily lives. The indoor home environment (IHE) plays an important role in influencing FOF, as it is influenced by barriers and facilitators within the home. This systematic review provides an evidence-based list of IHE factors and investigates their association with FOF, especially in older adults, PwD, and wheelchair users. Examining 24 studies, we found associations between IHE factors and FOF, suggesting the importance of home modifications to live in a supportive environment to reduce FOF. Most studies were experimental and intervened for either single or multiple IHE factors, indicating reasonably strong evidence. Our findings highlight the importance of considering psychological factors when evaluating home environments to reduce FOF. The list of barriers and facilitators we provide can help healthcare professionals conduct evidence-based home assessments.

Prevalence of concerns about falling in people with knee or hip osteoarthritis and the association with pain, function, and psychological factors-a cross-sectional study of 7442 patients treated in primary care.

BACKGROUND: Concerns about falling (CaF) are common in older people and can lead to avoidance of activities, social isolation and reduced physical function. However, there is limited knowledge about CaF in people with osteoarthritis (OA); yet, symptoms may increase CaF. We aimed to evaluate the prevalence of CaF and associated factors in people with knee or hip OA. METHODS: This cross-sectional study used data from the Good Life with osteoArthritis in Denmark registry including patients with OA treated in primary care. CaF was assessed with the Short Falls Efficacy Scale International (Short FES-I, range 7-28, low to high). Associations between CaF and pain, function and psychological factors were evaluated using multivariable linear Tobit regression. RESULTS: In total, 7442 patients were included [mean age 67 years (SD: 9.6), 67% females]. Mean Short FES-I was 9.8 [95% confidence interval (CI): 9.7; 9.8]. Moderate CaF was observed in 48.1% (95% CI: 46.7; 48.9) of participants, whilst 11.3% (95% CI: 10.7; 12.1) had a high level of CaF. CaF was more prevalent in the oldest participants and in females. Pain intensity [ß-value (95% CI): 0.52 (0.48; 0.55)], chair stand test [-0.21 (-0.22; -0.19)] and fear of movement [1.38 (1.19; 1.56)] were significantly associated with increased CaF across age groups and sex. CONCLUSIONS: CaF is common in people with OA, especially in the oldest participants and in females. Higher pain, lower function and psychological distress are associated with CaF; yet, the causality of the associations remain to be determined. Integrating CaF assessments and interventions into OA management in primary care seems highly relevant.

Digital music and movement intervention to improve health and wellbeing in older adults in care homes: a pilot mixed methods study.

BACKGROUND: Low physical activity among older adults is related to adverse health outcomes such as depression and loneliness, poor physical function and increased risk of falls. This study was designed to increase physical activity through a digital, group-based, physical activity and music intervention and to examine its effectiveness on social, mental and physical health outcomes. METHODS: Participants were 34 older adults (65 years +) recruited across four care homes in Scotland to a pilot study. Surveys were administered at baseline and post-intervention, comprising measures of fear of falling, depression and anxiety, loneliness, sleep satisfaction and quality of life. A battery of physical function tests and saliva sampling for cortisol and dehydroepiandrosterone hormone analysis were also conducted at each time point. Additionally, process evaluation measures (recruitment, intervention fidelity, attendance, retention rates and safety) were monitored. The intervention comprised 12 weeks of three prescribed digital sessions per week: movement and music (n = 2) and music-only (n = 1), delivered by an activity coordinator in the care home. Post-intervention interviews with staff and participants were conducted to gain qualitative data on the acceptability of the intervention. RESULTS: An average of 88% of prescribed sessions were delivered. Pre- to post-intervention intention-to-treat analysis across all participants revealed significant improvements in anxiety, salivary DHEA, fear of falling and loneliness. There were no significant improvements in health-related quality of life, perceived stress, sleep satisfaction or physical function tests, including handgrip strength. Qualitative analysis highlighted benefits of and barriers to the programme. CONCLUSIONS: The digital movement and music intervention was deemed acceptable and delivered with moderate fidelity, justifying progression to a full-scale trial. Although a proper control group would have yielded more confident causal relationships, preliminary psychosocial and biological effects were evident from this trial. To show significant improvements in physical function, it is likely that a bigger sample size providing sufficient power to detect significant changes, greater adherence, longer intervention and/or higher exercise volume may be necessary. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov, number NCT05601102 on 01/11/2022.

Topography of Cholinergic Nerve Terminal Vulnerability and Balance Self-Efficacy in Parkinson's Disease.

BACKGROUND: Postural instability and gait disturbances (PIGD) represent a significant cause of disability in Parkinson's disease (PD). Cholinergic system dysfunction has been implicated in falls in PD. The occurrence of falls typically results in fear of falling (FoF) that in turn may lead to poorer balance self-efficacy. Balance self-efficacy refers to one's level of confidence in their ability to balance while completing activities of daily living like getting dressed, bathing, and walking. Lower self-efficacy, or greater FoF during these activities is a function of motor, cognitive, and emotional impairments and may impact quality of life in PD. Unlike known cholinergic reduction, especially in the right lateral geniculate and caudate nuclei, little is known about the role of cholinergic transporters in FoF or mobility self-efficacy in PD. METHODS: [18F]fluoroethoxybenzovesamicol ([18F]FEOBV) positron emission tomography (PET) studies were conducted to assess vesicular acetylcholine transporter (VAChT) expression in 126 patients with PD (male (m) = 95, female (f) = 31). Participants had a mean age of 67.3 years (standard deviation (SD) = 7.1) and median Hoehn Yahr stage of 2.5. Patients also completed the Short Falls Efficacy Scale (sFES-I) as a survey measure of concerns about falling. [18F]FEOBV data were processed in Statistical Parametric Mapping (SPM) using a voxel-wise regression model with sFES-I scores as the outcome measure. RESULTS: Reduced [18F]FEOBV binding in tectum, metathalamic (lateral more than medial geniculate nuclei), thalamus proper, bilateral mesiotemporal (hippocampal, parahippocampal, fusiform gyri and fimbriae), and right cerebellar lobule VI significantly associated with higher sFES-I scores (p < 0.05, family-wise error (FWE) correction after Threshold-Free Cluster Enhancement (TFCE)). CONCLUSIONS: Unlike the more limited involvement of the brainstem-thalamic complex and caudate nuclei cholinergic topography associated with falls in PD, cholinergic reductions in the extended connectivity between the thalamic complex and the temporal limbic system via the fimbriae associates with FoF. Additional cholinergic changes were seen in the cerebellum. The temporal limbic system plays a role not only in episodic memory but also in spatial navigation, scene and contextual (e.g., emotional) processing. Findings may augur novel therapeutic approaches to treat poor mobility self-efficacy in PD. CLINICAL TRIAL REGISTRATION: No: NCT02458430. Registered 18 March, 2015, https://www. CLINICALTRIALS: gov/study/NCT02458430; No: NCT05459753. Registered 01 July, 2022, https://www. CLINICALTRIALS: gov/study/NCT05459753.

Study of knee pain, fear of falling, and quality of life among community-dwelling older adults, Northern Thailand.

Fall is the leading cause of disability and mortality due to unintentional injury in older adults. The aim of this study was to determine the prevalence and risk factors associated with knee pain, fear of falling, and quality of life among community-dwelling older adults in Northern Thailand. A cross-sectional study was conducted among older adults aged 60 and over. A total of 369 participants were enrolled from April to May 2024. Oxford knee score, a short version of the Falls Efficacy Scale International (FES-I) and World Health Organization quality of life-BREF-Thai, was measured. The results showed that the mean age was 69.4 years and 47 (12.7%) had a history of falls in the previous year. The prevalence of fear of falling was 39.3% for low, 22.5% for moderate, and 38.2% for high concern. Age, marital status, alcohol, history of falls, hypertension, arthritis, and osteoporosis were associated with fear of falling. After adjusting to age, gender, body mass index, education, marital status, smoking, alcohol, history of falls, and chronic disease, osteoarthritis of the knee was positively associated with increasing fear of falling (ß: 0.361; p<0.001), while quality of life was negatively associated with fear of falling (ß: -0.064; p<0.011). In conclusion, the identified determinants of fear of falling among the elderly indicated the need for fear of falling prevention programs targeting not only individual lifestyles but also chronic diseases. This study provides useful information that might help to develop and adopt effective policies for fear of falling control in Thailand.

Fear of falling and associated influencing factors in patients on maintenance hemodialysis.

INTRODUCTION: This cross-sectional study analyzed the fear of falling (FOF) and associated influencing factors in patients undergoing maintenance hemodialysis (MHD). METHODS: Patients on MHD (n = 131) were assessed using the short Falls Efficacy Scale International, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Perceived Social Support Scale, and Barthel Index questionnaires. RESULTS: The total FOF score was positively correlated with total anxiety and depression scores but negatively correlated with the total score of activities of daily living. There were significant differences in FOF among different age groups, employment status, the use of walkers, living arrangements (living alone), and having a history of falling in the past year. Age, employment status, history of falls in the past year, and anxiety score were significant risk factors for FOF in MHD patients. CONCLUSION: FOF in MHD patients is strongly associated with age, employment status, history of falls in the past year, and anxiety level.

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.

Characterizing Longitudinal Changes in Fear of Falling and Quality of Life in Patients with Varying Levels of Visual Field Damage.

PURPOSE: To investigate the relationship between baseline visual field (VF) severity and rates of visual field loss with changes in quality of life (QoL) and fear of falling (FoF) in adults with glaucoma. METHODS: Prospective cohort study, including participants from the Falls In Glaucoma Study. Quality of life and FoF were assessed annually using the Glaucoma Quality of Life-15 Questionnaire, and the University of Illinois at Chicago FoF Questionnaire, respectively, with higher Rasch-analyzed scores (in logits) indicating better QoL and greater FoF. Mean deviation (MD) values of each eye were collected, with better-eye MD taken as the primary exposure. Change rates in better-eye MD, QoL, and FoF were computed using linear regression. Separate regression models were employed to explore the relationship between baseline better-eye MD and its rate of change with rates of change in QoL and FoF. RESULTS: The mean (standard deviation) rate of change in better-eye MD was -0.08 dB/year (0.5), rate of QoL change was -0.08 logits/year (0.4), and rate of FoF change was 0.16 logits/year (0.7). At baseline, better-eye MD (per dB worse) was significantly associated with worse baseline QoL (ß = -0.10 logits [95% confidence interval [CI]: -0.13, -0.08]) and greater FoF (ß = 0.06 logits [95% CI: 0.01, 0.10]). Baseline better-eye MD was associated with no significant change in QoL ( -0.004 logits/year, 95% CI: -0.02, 0.01) or FoF (-0.0001 logits/year, 95% CI: -0.02, 0.02) over time. Change rates in better-eye MD showed significant associations with faster increases in FoF over time (ß = 0.26 logits/year [95% CI: 0.06, 0.45]; per dB loss/year), but not with changes in QoL (P = 0.79). CONCLUSIONS: Patients with glaucoma generally showed worsening of QoL and FoF over time, though the degree of change was modest and not related to the degree of damage at baseline. Faster rates of better-eye MD change alone were associated with faster increases in FoF. Further studies are needed to evaluate the reasons (visual and nonvisual) for changes in QoL and functionality over time and find ways in which QoL and mobility can be improved for those with VF damage. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Recreating Fall Risk Appraisal matrix using R to support fall prevention programs.

Objective: This study aimed to optimize Fall Risk Appraisal (FRA) graphing for use in intervention programs tailored toward reducing the fall risk of older adults by using computing graphic functions in the R language. Materials and Methods: We utilized RStudio, a free development environment for the R language, as well as the functions within the "ggplot2" and "grid" packages, to develop a code that would recreate the FRA matrix for use in data visualization and analysis, as well as feedback for older adults. Results: The developed code successfully recreates the FRA matrix in R and allows researchers and clinicians to graph participant data onto the matrix itself. Discussion: The use of an R code allows for a streamlined approach to manipulating the FRA matrix for use in data visualization and feedback for older adults, which improves upon the traditional paper-pencil method that has been previously used. Conclusions: The code presented in this study recreates the FRA matrix instrument in the R language and gives researchers the ability to instantaneously add, remove, or change different aspects of the instrument to improve its readability for researchers and older adults.

Development, reliability, and validity assessment of a fall concerns scale for people who use wheelchairs and scooters (FCS-WC/S).

PURPOSE: To evaluate the psychometric properties of a Fall Concerns Scale for people who use Wheelchairs and Scooters (FCS-WC/S). MATERIALS AND METHODS: Developed by fall prevention experts, FCS-WC/S underwent refinement through interdisciplinary reviews and focus groups with researchers, clinicians, and individuals who use WC/S full-time. The psychometric evaluation involved adults who used WC/S for ≥1 year and had ≥1 fall in the previous 3 years, recruited between April and September 2022. RESULTS: The FCS-WC/S evaluates fall concerns among people with various health conditions who use WC/S full-time across 33 daily activities. One hundred and twenty-four participants responded to the baseline survey. A subgroup of 63 people repeated the FCS-WC/S a week later. The FCS-WC/S demonstrated excellent internal and good test-retest reliability (α ≥ 0.90, ICC = 0.86-0.9), as well as concurrent validity (Spearman's rho = 0.72) with the Spinal Cord Injury Falls Concern Scale (SCI-FCS). It effectively differentiated fear of falling levels from an established measure (ORs 4.1, 25.8, 46.7). Factor and parallel analysis revealed three factors, two of which were retained for further analysis. CONCLUSIONS: Preliminary findings support FCS-WC/S validity and reliability for assessing fall concerns among individuals with various conditions who use WC/S. Further scale construction analysis is recommended.

Measuring concerns about falling among full-time wheelchair and scooter users is crucial due to its potential negative impact on activity curtailment, which in turn may affect community participation and quality of life.Most validated tools, except for the Spinal Cord Injury-Falls Concern Scale, designed for manual wheelchair users with spinal cord injury, are primarily tailored for individuals who ambulate, highlighting the need for assessment tools specifically designed for full-time wheelchair and scooter users.Using the Spinal Cord Injury-Falls Concern Scale as a foundation, the Fall Concerns Scale for people who use Wheelchairs and Scooters was developed to measure fall concerns among full-time wheelchair and scooter users, irrespective of their specific health conditions.The Fall Concerns Scale for people who use Wheelchairs and Scooters has a good potential to offer clinicians a valid and reliable tool to systematically screen fall concerns across various health conditions, with further large-scale studies needed to validate the tool across a wider range of health conditions.

Moving the needle on implementing fall prevention programs in Saudi Arabia: assessing knowledge and perceptions of fall risk among community-dwelling older women.

BACKGROUND: Saudi Arabia, like many nations globally, is experiencing a demographic shift towards an aging population. With this demographic shift, falls and the fear of falling (FOF) emerge as serious public health concerns among community-dwelling older adults. Addressing misconceptions and enhancing awareness regarding fall risks among older adults holds significant importance, offering insights for informing targeted interventions and enhancing well-being. This study aimed to examine knowledge and perceptions of fall risk among community-dwelling older women in Saudi Arabia. METHODS: A cross-sectional study was conducted with 150 Saudi older women, with a mean age (SD) of 63.98 (4.90) years. Participants completed questionnaires assessing fall history, fall knowledge, fall perception, the Falls Efficacy Scale-International (FES-I), Timed Up and Go (TUG), and the Barthel Index. Fall knowledge and perception were assessed using previously constructed statements translated into Arabic and carried out in interviewer-administered forms. RESULTS: Nearly half of the participants reported experiencing at least one fall in the previous 12 months. Despite good knowledge of falls, some gaps were identified, particularly regarding the awareness of social isolation as a consequence of falls. Participants demonstrated positive perceptions towards fall prevention programs but also highlighted misconceptions regarding aging and falls. FOF was prevalent, with higher levels identified among participants without a history of falls. CONCLUSION: Multidimensional strategies are needed to address falls and FOF among community-dwelling older women in Saudi Arabia. Leveraging existing knowledge and perceptions towards fall prevention and implementing evidence-based interventions can reduce the burden of falls and enhance health outcomes in older adults. Future research should focus on diverse samples and evaluate the feasibility of implementing fall prevention interventions within Saudi Arabia's healthcare systems.

Floor-hugging Intervention: A Perspective on Floor Exposure and After-Fall Contingency Intervention.

The fear of falling is a pressing public health issue, yet current interventions often fall short in addressing it effectively. As a result, there is a need for innovative interventions that go beyond symptom relief to address the underlying causes. From this standpoint, we propose that limited exposure to floors and a lack of post-fall contingencies may contribute to the uncertainty that amplifies the fear of falling, particularly in fall prone populations. We explore the theoretical underpinnings of this hypothesis and propose a framework based on the Uncertainty and Anticipation model to elucidate potential connections. Building upon this, we introduce the Floor-hugging intervention-a two-part strategy designed to confront these challenges. Firstly, we propose gradual exposure to different floor scenarios through guided imagery to diminish fear by familiarizing individuals with such situations. Secondly, we advocate for the adoption of evidence-based ways to get up from the floor for developing after fall contingencies. We delve into the theoretical framework supporting our approach and its potential to reduce the fear of falling while improving physical, social, and psychological well-being. Additionally, we outline prospective outcome measures to comprehensively assess the impact of the intervention across biopsychosocial domains. This perspective aims to stimulate discussion on the potential role of floor exposure and post-fall strategies in reducing the fear of falling, while also advocating for innovative interventions to empower and protect fall-prone populations.

The Effects of Exergaming on Fear of Falling and the Balance Function in Anxious and Non-Anxious Older Adults: A Pilot Study.

BACKGROUND: Anxiety can exacerbate fear of falling and balance issues, potentially affecting intervention efficacy. This study examines exergaming's impact on fear of falling and balance in anxious and non-anxious older adults. MATERIALS AND METHODS: Twenty older adults (10 anxious, 10 non-anxious) participated in six weeks of balance-oriented gaming. Fear of falling was assessed using the Falls Efficacy Scale and the Activities-specific Balance Confidence Scale. Balance was measured with the Berg Balance Scale and the Timed Up and Go Test before, after, and six weeks post-intervention. RESULTS: Both groups showed significant improvements in balance and mobility, sustained during follow-up. However, only the non-anxious group exhibited significant reductions in fear of falling and increased balance confidence. Anxiety was linked to reduced enjoyment, lower efficacy perception, and heightened tension during the intervention. CONCLUSION: Exergaming improves balance and reduces fear of falling in non-anxious older adults. Anxiety may diminish these benefits. CLINICAL IMPLICATIONS: Assessing anxiety levels is crucial when prescribing exergaming interventions. Tailoring treatments to address anxiety could enhance outcomes.

Association between Falls, Fear of Falling and Depressive Symptoms in Community-Dwelling Older Adults.

BACKGROUND: Longevity increases pose public health challenges, especially in managing falls and their psychological impacts on older adults. Limited evidence exists on the relationship between a fear of falling (FOF), previous falls, and depressive symptoms among community-dwelling older adults. OBJECTIVE: To evaluate the association between falls, FOF, and depressive symptoms in community-dwelling older adults. METHODS: This cross-sectional study, conducted in 2018, included 400 older adults from a Basic Health Unit in São Paulo, Brazil. The Geriatric Depression Scale (GDS-15) and the International Falls Efficacy Scale (FES-I) were used, along with self-report questionnaires on fall history. Linear and logistic regression were used to analyze the relationships between variables. RESULTS: The mean age was 75.2 (SD = 8.53) years, with 63.2% being female. Depressive symptoms were observed in 18.3% of the participants, while 90.5% reported a fear of falling (FOF). More than half (63.0%) experienced falls, with 49.5% occurring in the last year. Factors such as the female gender, negative health perceptions, and functional dependence were associated with depressive symptoms. Adjusted analyses indicated that both a fear of falling (FOF) (B = 0.043; p = 0.012) and a history of falls (B = 0.725; p = 0.015) were associated with depressive symptoms. CONCLUSIONS: Falls, FOF, and depressive symptoms are interlinked among older adults, underscoring the need for targeted interventions to improve their mental and physical health.

Impact of activity limitations due to fear of falling on changes in frailty in Korean older adults: a longitudinal study.

This study investigated the frailty change patterns among Korean older adults during 2006-2020 and the effect of activity limitations induced by the fear of falling (FOF) on these patterns. We employed a descriptive longitudinal design utilizing data from Waves 1 to 8 of the Korean Longitudinal Study of Aging. The exclusion criteria were a baseline age < 65 years, frailty index (FI) captured only at baseline, and death or unknown survival status. Multilevel modeling, combining regression equations at two levels, was used to examine the effect of activity limitations due to FOF on frailty, adjusting for other confounding factors. An increase in FI (1.97; p < .001) was demonstrated in participants who had experienced falls versus those who had not in the past 2 years. Notably, those facing activity limitations due to FOF exhibited a more significant increase in FI (4.62; p < .001) compared with those without; frailty progression intensified over time in the former (0.54, p < .001). Activity limitations due to FOF had a more pronounced impact on frailty than falls; moreover, these activity limitations accelerated the progression of frailty. Healthcare providers must prioritize addressing FOF by employing both physical and psychological interventions to mitigate activity limitations and ultimately decelerate frailty.

Prevalence and Factors Associated with Fear of Falling in the Elderly Attending a Tertiary Hospital in South-South Nigeria.

BACKGROUND: Fear of falling is a loss of confidence in balance which affects the quality of life of the elderly. Falls in older people can result in disability, death, financial stress on the family, and higher medical expenses. A significant proportion of those who fall are said to be afraid of falling. This study determined the prevalence and the factors associated with the fear of falling in the elderly attending the Rivers State University Teaching Hospital, Port Harcourt. METHODS: This was a cross-sectional study of patients, 60 years and older, attending the Family Medicine clinic in the hospital. A questionnaire was used to collect data on the socio-demographic characteristics, history of chronic illness and lifestyle of the respondents. It also included the Modified Fall Efficacy scale to assess the fear of falling in the respondents and the functional assessment of the respondents was also carried out using the Timed Up and Go Test (TUG). Descriptive analysis and logistic regression were done to determine the factors associated with the fear of falling in the elderly. RESULTS: A total of 292 patients consented to participate, Fear of falling was prevalent in 58 (19.9%) of the participants. The female gender was found to have 50% lower odds of having a fear of falling than their male counterparts (O.R.=0.541, 95% C. I=0.327-0.896) An association was found between reduced frequency of physical activity and fear of falling. (χ2=10.25 P-value=0.006) An association was found between fear of falling and TUG as those with a fear of falling took a longer time to complete the TUG test. CONCLUSION: The study suggests that healthcare professionals should routinely investigate the fear of falling in geriatric care to devise preventive and intervention strategies to combat the fear of falling among the elderly.

CONTEXTE: La peur de tomber est une perte de confiance en l'équilibre qui affecte la qualité de vie des personnes âgées. Les chutes chez les personnes âgées peuvent entraîner une invalidité, la mort, une pression financière sur la famille et des dépenses médicales plus élevées. Une proportion significative de ceux qui tombent est dite avoir peur de tomber. Cette étude a déterminé la prévalence et les facteurs associés à la peur de tomber chez les personnes âgées fréquentant l'Hôpital Universitaire de Rivers State, à Port Harcourt. MÉTHODES: Il s'agissait d'une étude transversale des patients âgés de 60 ans et plus, fréquentant la clinique de médecine familiale de l'hôpital. Un questionnaire a été utilisé pour recueillir des données sur les caractéristiques sociodémographiques, les antécédents de maladies chroniques et le mode de vie des répondants. Il comprenait également l'échelle modifiée d'efficacité des chutes pour évaluer la peur de tomber des répondants et l'évaluation fonctionnelle des répondants a également été réalisée à l'aide du test Timed Up and Go (TUG). Des analyses descriptives et une régression logistique ont été effectuées pour déterminer les facteurs associés à la peur de tomber chez les personnes âgées. RÉSULTATS: Un total de 292 patients ont consenti à participer, la peur de tomber était prévalente chez 58 (19,9 %) des participants. Le sexe féminin avait 50 % moins de chances d'avoir peur de tomber que leurs homologues masculins (O.R.=0,541, 95% C.I=0,327-0,896). Une association a été trouvée entre la réduction de la fréquence de l'activité physique et la peur de tomber (χ2=10,25, P-value=0,006). Une association a été trouvée entre la peur de tomber et le TUG, car ceux qui avaient peur de tomber mettaient plus de temps à terminer le test TUG. CONCLUSION: L'étude suggère que les professionnels de la santé devraient systématiquement enquêter sur la peur de tomber dans les soins gériatriques afin de concevoir des stratégies préventives et interventionnelles pour combattre la peur de tomber chez les personnes âgées. MOTS-CLÉS: Peur de tomber, Personnes âgées, Prévalence des chutes, Test Timed Up and Go, Échelle modifiée d'efficacité des chutes.