Characteristics associated with activity restriction induced by fear of falling in community-dwelling elderly.

OBJECTIVES: The aim of this study was to determine the social-demographic, clinical, functional and psychological factors associated to activity restriction due to fear of falling in community-dwelling elderly and identify which variables best discriminate groups of elderly with different levels of activity restriction and fear of falling. METHODS: One hundred and thirteen community-dwelling elderly (74.5±7 years old) participated in the study. Activity restriction induced by fear of falling, previous falls, fall related self-efficacy, frailty phenotype, functional capacity, depressive symptoms, health self-perception, socio-demographic and clinical factors were assessed. Descriptive statistics, chi-square, ANOVA and Kruskal Wallis tests were used to analyze the associations between activity restriction due to fear of falling and all other variables. Path analysis (CHAID) method was used to verify which variables better discriminated groups in relation to activity restriction (α=0.05). RESULTS: The participants who reported fear of falling and activity restriction demonstrated higher depression (p=0.038), lower fall related self-efficacy (p<0.001), lower gait velocity (p=0.043) and independence level for instrumental daily living activities (p=0.017), higher number of diseases (p=0.048), worse health self-perception (p=0.040) and more depressive symptom (p=0.023). The best variables to discriminate groups were depression (p=0.004), exhaustion (frailty phenotype) (p=0.010) and social participation activities (p=0.016). CONCLUSION: Activity restriction due to fear of falling may have negative effects on functional capacity and psychological aspects in community-dwelling elderly. Psychosocial factors seem to better discriminate the elderly who avoid activities due to fear of falling.

Characteristics associated with activity restriction induced by fear of falling in community-dwelling elderly / Características associadas à restrição de atividades por medo de cair em idosos comunitários

OBJECTIVES: The aim of this study was to determine the social-demographic, clinical, functional and psychological factors associated to activity restriction due to fear of falling in community-dwelling elderly and identify which variables best discriminate groups of elderly with different levels of activity restriction and fear of falling. METHODS: One hundred and thirteen community-dwelling elderly (74.5±7 years old) participated in the study. Activity restriction induced by fear of falling, previous falls, fall related self-efficacy, frailty phenotype, functional capacity, depressive symptoms, health self-perception, socio-demographic and clinical factors were assessed. Descriptive statistics, chi-square, ANOVA and Kruskal Wallis tests were used to analyze the associations between activity restriction due to fear of falling and all other variables. Path analysis (CHAID) method was used to verify which variables better discriminated groups in relation to activity restriction (α=0.05). RESULTS: The participants who reported fear of falling and activity restriction demonstrated higher depression (p=0.038), lower fall related self-efficacy (p<0.001), lower gait velocity (p=0.043) and independence level for instrumental daily living activities (p=0.017), higher number of diseases (p=0.048), worse health self-perception (p=0.040) and more depressive symptom (p=0.023). The best variables to discriminate groups were depression (p=0.004), exhaustion (frailty phenotype) (p=0.010) and social participation activities (p=0.016). CONCLUSION: Activity restriction due to fear of falling may have negative effects on functional capacity and psychological aspects in community-dwelling elderly. Psychosocial factors seem to better discriminate the elderly who avoid activities due to fear of falling.

OBJETIVOS: Determinar os fatores sociodemograficos, clinicos, funcionais e psicologicos associados a restricao de atividades por medo de cair em idosos comunitarios e identificar quais variaveis melhor discriminam os grupos em relacao a restricao de atividades por medo de cair. MÉTODOS: Cento e treze idosos comunitarios (74,5±7 anos) participaram do estudo. Foram avaliados: restricao de atividades por medo de cair, historia de quedas, autoeficacia relacionada as quedas, fenotipo de fragilidade, aspectos sociodemograficos e clinicos, capacidade funcional, depressao e autopercepcao de saude. Estatisticas descritivas, teste qui-quadrado, ANOVA e o teste Kruskal-Wallis foram utilizados para analisar as relacoes entre a restricao de atividades por medo de cair e as outras variaveis. O metodo Chi-Square Automatic Interaction Detection (CHAID) foi utilizado para verificar quais variaveis melhor discriminavam os grupos em relacao a restricao de atividades (α=0,05). RESULTADOS: Idosos que relataram restricao de atividades por medo de cair apresentaram maior autorrelato de depressao (p=0,038), menor autoeficacia em relacao as quedas (p<0,001), menor velocidade de marcha (p=0,043) e nivel de independencia para realizacao de atividades instrumentais de vida diaria (p=0,017), maior numero de doencas (p=0,048), pior autopercepcao de saude (p=0,040) e maior presenca de sintomatologia depressiva (p=0,023). As variaveis que melhor discriminaram os grupos foram depressao (p=0,004), exaustao (fenotipo de fragilidade) (p=0,010) e participacao em atividades sociais (p=0,016). CONCLUSÃO: A restricao de atividades por medo de cair pode ter efeitos negativos na capacidade funcional e nos aspectos psicologicos de idosos comunitarios. Fatores psicossociais parecem discriminar melhor os idosos que apresentam restricao de atividades por medo de cair.

Cross-cultural adaptation and evaluation of the psychometric properties of the Falls Efficacy Scale-International Among Elderly Brazilians (FES-I-BRAZIL).

OBJECTIVES: To culturally adapt the Falls Efficacy Scale-International (FES-I) and assess its psychometric properties in a sample of community-dwelling elderly Brazilians. METHODS: The instrument was translated into Brazilian Portuguese and culturally adapted to the Brazilian population (FES-I-Brazil) as recommended by the Prevention of Falls Network Europe. FES-I-Brazil was applied to 163 elderly people (73.44+/-5.51 years), and the demographic data and history of falls were also collected. From this group, 58 participants were randomly distributed to evaluate reliability. The reliability was analyzed using the intraclass correlation coefficient (ICC) and the internal consistency, using Cronbach's alpha coefficient (alpha). The internal structure of FES-I-Brazil was evaluated by means of exploratory factor analysis. The logistic regression model was used to determine which tasks on the scale were more relevant for discriminating falls. To analyze the sensitivity and specificity of FES-I-Brazil, the receiver operating characteristic (ROC) curve was used. RESULTS: The internal consistency of FES-I-Brazil was alpha=0.93, and the intra- and inter-examiner reliability were ICC=0.84 and 0.91, respectively. Factor analysis suggested two factors: concern about falling during social activities and activities of daily living (basic and instrumental), and postural control tasks. FES-I-Brazil scores > or = 23 suggested an association with a previous history of sporadic falls, whereas scores > or = 31 suggested an association with recurrent falls. CONCLUSIONS: FES-I-Brazil was shown to be semantically, linguistically and psychometrically appropriate to evaluate the fear of falling in the community-dwelling Brazilian elderly population.

Adaptação transcultural e avaliação das propriedades psicométricas da Falls Efficacy Scale - International em idosos Brasileiros (FES-I-BRASIL) / Cross-cultural adaptation and evaluation of the psychometric properties of the Falls Efficacy Scale - International Among Elderly Brazilians (FES-I-BRAZIL)

OBJETIVOS: Adaptar culturalmente a Falls Efficacy Scale-International (FES-I) e avaliar suas propriedades psicométricas em uma amostra de idosos brasileiros da comunidade. MÉTODOS: Conforme recomendações da Rede Européia de prevenção às quedas, o instrumento foi traduzido para o português do Brasil e adaptado culturalmente para a população brasileira (FES-I-Brasil). A FES-I-Brasil foi aplicada em 163 idosos (73,44±5,51 anos), e foram coletados dados demográficos e relacionados à história de quedas. Dentre esses idosos, 58 foram distribuídos aleatoriamente para avaliação da confiabilidade. A confiabilidade foi analisada pelo Índice de Correlação Intraclasse (ICC) e a consistência interna pelo α de Cronbach. A estrutura interna da FES-I-Brasil foi avaliada pela análise fatorial exploratória. O modelo de regressão logística foi utilizado para identificar quais tarefas da escala eram mais relevantes para discriminar quedas. Para análise de sensibilidade e especificidade da FES-I-Brasil, empregou-se a curva Receiving Operator Characteristic (ROC). RESULTADOS: A consistência interna da FES-I-Brasil foi α=0,93, e a confiabilidade foi ICC=0,84 e 0,91 (intra e interexaminadores, respectivamente). A análise fatorial sugeriu dois fatores que verificavam preocupação em cair durante atividades de socialização e de vida diária (básicas e instrumentais) e tarefas relacionadas ao controle postural. Uma pontuação >23 pontos na FES-I-Brasil sugeriu associação com histórico de queda esporádica, ao passo que uma pontuação >31 pontos ensejou uma associação com queda recorrente. CONCLUSÕES: A FES-I-Brasil apresentou-se semântica, linguística e psicometricamente adequada para avaliar o medo de cair na população de idosos brasileiros da comunidade.

OBJECTIVES: To culturally adapt the Falls Efficacy Scale - International (FES-I) and assess its psychometric properties in a sample of community-dwelling elderly Brazilians. METHODS: The instrument was translated into Brazilian Portuguese and culturally adapted to the Brazilian population (FES-I-Brazil) as recommended by the Prevention of Falls Network Europe. FES-I-Brazil was applied to 163 elderly people (73.44±5.51 years), and the demographic data and history of falls were also collected. From this group, 58 participants were randomly distributed to evaluate reliability. The reliability was analyzed using the intraclass correlation coefficient (ICC) and the internal consistency, using Cronbach's alpha coefficient (α). The internal structure of FES-I-Brazil was evaluated by means of exploratory factor analysis. The logistic regression model was used to determine which tasks on the scale were more relevant for discriminating falls. To analyze the sensitivity and specificity of FES-I-Brazil, the receiver operating characteristic (ROC) curve was used. RESULTS: The internal consistency of FES-I-Brazil was α=0.93, and the intra- and inter-examiner reliability were ICC=0.84 and 0.91, respectively. Factor analysis suggested two factors: concern about falling during social activities and activities of daily living (basic and instrumental), and postural control tasks. FES-I-Brazil scores >23 suggested an association with a previous history of sporadic falls, whereas scores >31 suggested an association with recurrent falls. CONCLUSIONS: FES-I-Brazil was shown to be semantically, linguistically and psychometrically appropriate to evaluate the fear of falling in the community-dwelling Brazilian elderly population.