Original Study
Self-Reported Unsteadiness Predicts Fear of Falling, Activity Restriction, Falls, and Disability

https://doi.org/10.1016/j.jamda.2017.01.022Get rights and content

Abstract

Objective

To determine if self-reported unsteadiness during walking is associated with fear of falling (FOF), fear-related activity restriction, falls, and disability over 2 years in community-dwelling adults.

Design

Data were obtained from the first 2 waves of The Irish Longitudinal Study on Ageing, a population-based study.

Setting

Participants completed a home-based interview and a center-based health assessment at baseline and a home-based interview at 2 years follow-up.

Participants

Community-dwelling adults aged ≥65 years, with Mini-Mental State Examination score ≥18 at baseline, and fully observed variables were included in the analyses (N = 1621).

Measurements

Outcome variables were FOF, fear-related activity restriction, recurrent falls, and disability.

Results

Unsteadiness was independently associated with an increased risk of all outcomes at follow-up after adjusting for sociodemographic variables, and physical, mental, and cognitive health (Incidence Rate Ratio [IRR] range 1.49–2.29; P < .05). All associations were attenuated after adjusting for usual gait speed but remained consistent in direction. The association was strongest for fear-related activity restriction [IRR = 1.82 (1.21–2.73); P < .01]. There was also evidence of an association between unsteadiness and an increased risk of activity restriction in adults who did not report FOF at baseline [IRR = 1.99 (1.10–3.61); P < .05].

Conclusions

Self-reported unsteadiness is independently associated with an increased risk of FOF, fear-related activity restriction, recurrent falls, and disability at follow-up. Self-reported balance/steadiness should be included in routine assessment of older adults especially those at risk of falls. As unsteadiness is modifiable, older adults should be targeted for balance-related training or medication review to minimize future risk of these outcomes.

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.

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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.

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