Fear of falling among seniors needs assessment and intervention strategies
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Fear of Falling Among Seniors: Needs 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). Objectives.

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Fear of falling among seniors needs assessment and intervention strategies

Fear of Falling Among Seniors:Needs 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)


Objectives
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


Falls and fear of falling
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


Fear of falling
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


Prevalence of fear of falling
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


Who develops fear of falling and why
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


Who develops fear of falling and why1
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


Possible consequences of fear of falling
Possible Consequences of Fear of Falling

  • Increased caution during activity performance

  • Excessive restriction of activities

  • Diminished quality of life


The impact of fear of falling on activity performance
The Impact of Fear of Falling on Activity Performance

Fear of falling

Restricts activity

Physical capabilities reduced

Restricts more activities

More impaired physical capabilities


The impact of fear of falling on quality of life
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


Results of longitudinal studies
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)



Fear of falling1
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 senior’s:

    • Personal abilities

    • Activity performance

      • Assess in conjunction with screening instruments


Activity performance
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


When is fear of falling a problem
When Is Fear of Falling a Problem?

Personal Abilities

Activity Performance

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


When is fear of falling a problem1
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


Screening instruments

Direct Assessments

Indirect Assessments

Screening Instruments


Fear of falling instruments

Purpose

Items included

(#, Type)

Population tested

(If applicable)

Validity

Reliability

Pros

Cons

Fear of Falling Instruments


Validity and reliability
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


Howland peterson index

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


Choosing an instrument

Client’s status

Functional level

Health issues

Response to instrument’s wording

Negative vs. Positive

Characteristic the instrument measures

Fear

Restriction

Confidence

Purpose of using a screening instrument

Comparison

Pre and post test

Choosing an Instrument