Original StudySelf-Reported Unsteadiness Predicts Fear of Falling, Activity Restriction, Falls, and Disability
Section snippets
Study Design
The Irish Longitudinal Study on Ageing (TILDA) is a prospective cohort study examining the social, economic, and health circumstances of community-dwelling adults in Ireland. Study design and data collection have been described previously.12, 13 Briefly, the sampling frame is the Irish Geodirectory, a listing of all residential addresses in the Republic of Ireland. A clustered sample of addresses was randomly selected and all household residents aged ≥50 years and their spouses/partners (of any
Results
Participants were excluded from this analysis if they were ineligible at baseline (ie, aged <65 years; MMSE<18) or had incomplete participation at baseline (ie, did not answer the steadiness question or complete the gait assessment). This resulted in 1760 participants at baseline, of whom 139 were lost to attrition during follow-up. Analysis was based on data from 1621 participants (Figure 1).
In this population-based sample (mean age 71.2 years; range 65–93 years), 382 participants (24.2%)
Discussion
In this study, we showed that a simple, self-reported measure of unsteadiness while walking is independently associated with an increased risk of FOF, fear-related activity restriction, recurrent falls, and disability over 2 years in community-dwelling older adults. This supports previous research that found that poor self-reported balance was associated with an increased risk of falls, decline in ADLs/IADLs, and FOF,2, 4, 5 but it is the first study to show evidence for an association between
Conclusions
In conclusion, we found evidence that self-reported unsteadiness has a moderate independent association with an increased risk of FOF, fear-related activity restriction, recurrent falls, and disability over 2 years. When controlling for usual gait speed, there is evidence of an association between unsteadiness and fear-related activity restriction, even in those who did not report FOF at baseline. This, or a similar simple self-reported measure of steadiness/balance should be included in
Acknowledgments
The authors would like to acknowledge the contribution of the TILDA team and study participants.
References (35)
- et al.
Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force
J Nutr Health Aging
(2009) - et al.
“Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician
J Psychiatr Res
(1975) - et al.
Effects of fear of falling and activity restriction on normal and dual task walking in community dwelling older adults
Gait Posture
(2013) - et al.
Development and validation of the Penn State Worry Questionnaire
Behav Res Ther
(1990) - et al.
Balance concerns in the elderly: Real or imaginary?
J Clin Gerontol Geriatr
(2011) - et al.
Quantifying the magnitude of risk for balance impairment on falls in community-dwelling older adults: A systematic review and meta-analysis
J Clin Epidemiol
(2010) - et al.
Successful balance training is associated with improved multisensory function in fall-prone older adults
Comput Hum Behav
(2015) Postural orientation and equilibrium: What do we need to know about neural control of balance to prevent falls?
Age Ageing
(2006)- et al.
Reliability and validity of a steadiness score
J Am Geriatr Soc
(2005) - et al.
Accumulation of sensory difficulties predicts fear of falling in older women
J Aging Health
(2013)
Balance impairment as a risk factor for falls in community-dwelling older adults who are high functioning: A prospective study
Phys Ther
Incidence and risk factors for developing fear of falling in older adults
Public Health Nurs
Fear of falling and coexisting sensory difficulties as predictors of mobility decline in older women
J Gerontol Ser A Biol Sci Med Sci
Balance confidence and fear of falling avoidance behavior are most predictive of falling in older adults: Prospective analysis
Phys Ther
Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention
J Am Geriatr Soc
Falls in older people: Epidemiology, risk factors and strategies for prevention
Age Ageing
Falls in the nursing home
Ann Intern Med
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2020, Clinical Psychology ReviewCitation Excerpt :The inconsistency between perceived and actual fall risk and the impact on presence of FoF may be explained by the intermediary step of appraisal of one's abilities. First evidence for this comes from a study of 1621 older adults (65+ years) in which self-reported unsteadiness (a measure of appraisal of own balance ability) predicted FoF and FoF-related activity restriction 2 years later, even after adjustment for health and functioning parameters and falls history (Donoghue, Setti, O'Leary, & Kenny, 2017). The association remained statistically significant for new onset FoF-related activity restriction after exclusion of participants with FoF-related activity restriction at baseline (Donoghue et al., 2017).
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This work was supported by the Irish Government; the Atlantic Philanthropies; and Irish Life plc.
The authors declare no conflicts of interest.