Fear of Falling Among Seniors: Needs Assessment and Intervention Strategies

1
Fear of Falling Among SeniorsNeeds Assessment
and Intervention Strategies

• Susan L. Murphy ScD, OTR
• World Federation of Occupational Therapy
  Conference
• June 2002, Stockholm Sweden
• (part 2 of talk with co-presenter Elizabeth
  Walker-Peterson MPH OTR/L)

2
Objectives

• Describe fear of falling in terms of its
  prevalence, contributing factors, and
  consequences
• Discuss research-based strategies to screen
  clients
• Describe and compare several fear of falling
  assessments

3
Falls and Fear of Falling

• 1 in 3 persons 65 and older experience at least
  one fall each year
• Falls are responsible for 40 of nursing home
  admissions
• Falls can result in soft tissue injuries,
  fractures, and conditions resulting from long
  lies on the floor or ground

4
Fear of Falling

• Definition A lasting concern about falling that
  can lead to an individual avoiding activities
  that he/she remains capable of performing
• (Tinetti and Powell, 1993).
• Described as a problem seen in the clinic and in
  the community

5
Prevalence of Fear of Falling

• 30 - 55 of community-living seniors
• 46 of nursing home residents
• 50 of seniors with rheumatoid arthritis
• 47 of seniors with chronic dizziness
• More women report fear of falling than men
• may be an underreporting by men
• with advanced age, women are at greater risk for
  falls and fall injuries

6
Who Develops Fear of Falling and Why?

• Longitudinal study of community-living older
  women (Murphy, Dubin, Gill)
• Factors which predisposed women to reporting
  fear of falling at follow-up
• age over 80
• visual impairment
• sedentary lifestyle
• lack of available emotional support

7
Who Develops Fear of Fallingand Why?

• Joint contribution of predisposing factors and
  fall events after baseline
• Predisposing factors were more strongly related
  to developing fear of falling than fall events
• Appears necessary to prevent and treat fear of
  falling in older women regardless of whether they
  have a history of falls

8
Possible Consequences of Fear of Falling

• Increased caution during activity performance
• Excessive restriction of activities
• Diminished quality of life

9
The Impact of Fear of Falling on Activity
Performance
Fear of falling
Restricts activity
Physical capabilities reduced
Restricts more activities
More impaired physical capabilities
10
The Impact of Fear of Falling on Quality of Life

• Reduced social interaction
• Preoccupied thoughts
• Extreme anxiety

Diminished Quality of Life
Fear of Falling
Activity Restriction
11
Results of Longitudinal Studies

• Fear of Falling at baseline associated with
  several negative outcomes at follow-up
• Increased risk for falls
• declines in ability to perform ADLs
• declines in gait
• lower health-related quality of life
• increased risk of nursing home admission
• (Cumming et al., 2001, Vellas et al., 1997)

12
Screening Seniors for Fear of Falling
13
Fear of Falling

• A lasting concern about falling that can lead to
  an individual avoiding activities that he/she
  remains capable of performing
• For screening purposes, it is necessary for the
  therapist to assess a seniors
• Personal abilities
• Activity performance
• Assess in conjunction with screening instruments

14
Activity Performance

• Current activities performed
• environmental constraints
• Fearfulness while performing activities
• Which activities are being restricted
• activities necessary for independent living
• activities that are meaningful for individual

15
When Is Fear of Falling a Problem?
Personal Abilities
Activity Performance

• Person is performing activities that are
  appropriate for level of abilities

16
When Is Fear of Falling a Problem?
Personal Abilities
Activity Performance

• Person has excessive fear or is restricting
  activities that he/she should otherwise be able
  to perform

17
Screening Instruments

• Direct Assessments
• Indirect Assessments

18
Fear of Falling Instruments

• Purpose
• Items included
• (, Type)
• Population tested
• (If applicable)

• Validity
• Reliability
• Pros
• Cons

19
Validity and Reliability
Validity
Reliability
(Does the instrument test
(Does the instrument measure
what it is supposed to test?)
consistently over time?)
Criterion
Internal Consistency
Construct
Test-Retest
Content
20
Howland-Peterson Index

• How concerned are you that you will fall and hurt
  yourself in the next year?
• 1 Very concerned
• 4 Not at all concerned
• useful to measure prevalence
• -- difficult to detect change

21
Choosing an Instrument

• Characteristic the instrument measures
• Fear
• Restriction
• Confidence
• Purpose of using a screening instrument
• Comparison
• Pre and post test

• Clients status
• Functional level
• Health issues
• Response to instruments wording
• Negative vs. Positive