|Year : 2018 | Volume
| Issue : 2 | Page : 50-55
Fear of falling and related factors in older adults in the city of Kashan in 2017
Mohsen Taghadosi1, Elhamsadat Motaharian2, Hamidreza Gilasi3
1 Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
2 Student Research Committee, Kashan University of Medical Sciences, Kashan University of Medical Sciences, Kashan, IR Iran
3 Department of Epidemiology and Biostatistics, Kashan University of Medical Sciences, Kashan, IR Iran
|Date of Web Publication||18-Nov-2018|
Dr. Mohsen Taghadosi
Trauma Nursing Research Center, Kashan University of Medical Sciences
Source of Support: None, Conflict of Interest: None
Background: Fear of falling has been reported in various societies for different reasons and affects the quality of life of older adults. The present study was conducted to determine the level of fear of falling and related factors in older adults in the city of Kashan in 2017. Materials and Methods: In this cross-sectional study, 414 older adults living in the city of Kashan, in 2017, were selected by cluster sampling. Data were collected using a demographic questionnaire (including age, gender, number of children, having a caregiver, education, marital status, occupation, smoking, alcohol use, use of anxiolytic medication, history of diseases, ability to carry out daily tasks, history of fall, injury due to fall, osteoporosis, access to medical care, access to social supports, walking aids, living alone, income, housing, insurance, and insomnia), and Falls Efficacy Scale-International (FES-I), and then were analyzed using Chi-square and logistic regression. Results: Fear of falling was low in 63.3% of the older adults, moderate in 22.7%, and intense in 4.3%. Fear of falling showed a significant relationship with age, having a caregiver, education, history of taking anxiolytic and hypnotic medications, history of psychosomatic diseases, ability to perform daily tasks, history of falling, injury caused by falling, use of walking aids, access to social support in case of emergency, and income. Multivariate analysis showed that fear of falling in older adults had a direct relationship with age of over 70 years (odds ratio [OR] = 3.24), history of use of anxiolytic and hypnotic medications (OR = 0.26), and illiteracy (OR = 0.37). Conclusion: The results showed that a high percentage of participants suffered fear of falling, of whom one-third had moderate-to-severe fear. Age, use of anxiolytic medications, and illiteracy were effective in increasing the risk of fear of falling in older adults. Further studies and appropriate measures are required in this regard.
Keywords: Fear of falling, falls efficacy scale-international, older adults, osteoporosis
|How to cite this article:|
Taghadosi M, Motaharian E, Gilasi H. Fear of falling and related factors in older adults in the city of Kashan in 2017. Arch Trauma Res 2018;7:50-5
|How to cite this URL:|
Taghadosi M, Motaharian E, Gilasi H. Fear of falling and related factors in older adults in the city of Kashan in 2017. Arch Trauma Res [serial online] 2018 [cited 2019 Apr 24];7:50-5. Available from: http://www.archtrauma.com/text.asp?2018/7/2/50/245578
| Introduction|| |
Fear of falling has been defined as a psychologically and physically restricting condition that has been introduced to describe excessive concern about falls that lead to inhibited motility. This syndrome happens in 50% of older adults with and 50% of those without the experience of falls. The results from recent studies show that 26%–55% of older adults have experienced fear of falling.,
Fear of falling may be useful when it increases older adults' care and attention in walking. In such cases, fear leads to a logical reaction to the potential risk of falling. However, fear of falling in some older adults can turn into a debilitating sickness. Researchers have warned that although fear of falling has been reported less frequently in men, this can be due to the perceived stigma associated with showing fear and asking for help by men., Other factors associated with fear of falling include difficulty in getting out of the chair, low income, and use of walking aids, balancing problems, and low education level. The results obtained by Zijlstra et al. showed that variables associated with fear of falling in more than 4000 older adults included age over 80 years, female gender, perceived poor health, obesity, and history of frequent falls. Murphy showed that factors predicting fear of falling in women included impaired vision, sedentary lifestyle, and lack of social support.
Despite the relationship between age and fear of falling, relevant studies have reported conflicting results; some studies argue that fear of falling usually increases with aging,, while no significant relationship was observed between age and fear of falling in a study conducted by Kressig et al. and Andresen et al. Moreover, the majority of studies have reported a greater fear of falling in women compared to men.,, Many researchers have reported a significant relationship between fear of falling and chronic conditions, the majority of whom were receiving long-term cares and suffered from backache and lower limb arthritis, osteoarthritis, and orthopedic injuries and neurological diseases. Most studies have found that fear of falling is related to the quality of life, and psychological conditions including depression and anxiety.,,
The number of older adults with a history of falls is increasing in Iran, and treatment costs of psychological disorders resulting from fear of falling and its effect on living activities are huge. Fear of falling occurs for different reasons that may be different in different contexts. To the best of our knowledge, no study was conducted on fear of falling in older adults in Iran, especially in the city of Kashan until 2016. Furthermore, the results reported about related factors are conflicting. Therefore, the present study was conducted in 2017 to determine the level of fear of falling and its related factors in older adults in the city of Kashan.
| Materials and Methods|| |
The study population included people over 60 years of age covered by health centers in the city of Kashan in 2017, selected by cluster sampling. Based on the previous studies and the location of health centers, Kashan has five health districts. One health center was randomly chosen from each district, making the number of health centers selected five in total. Next, the number of older adults covered by each center was determined. Based on the population covered, the study samples were randomly and proportionally selected. The cluster size was different depending on the population covered. Sampling continued until the required sample size was reached. According to the previous studies and estimation of the prevalence of fall in elderly people at 95% confidence level (d = 0.05 and P = 0.332 for fear of fall in Taiwanese elderly and z = 1.69), the following formula was determined: 300 persons, which was considered as cluster sampling, taking into account the coefficient 1.5, the number of samples was 420 people.
The study samples were selected following arrangements made with the health deputy of Kashan University of Medical Sciences in 2017 and obtaining permission to collect data. The inclusion criteria were (1) minimum age of 60 years, (2) consent to take part, (3) Iranian nationality, (4) ability to speak Persian, (5) no known psychological disorders at the time of the study, (6) full consciousness and no prominent hearing or speech problems, (7) ability to communicate and answer questions, (8) living in Kashan, and (9) not living in nurseries or other such centers. The exclusion criterion was inability to continue answering questions and hospitalization in health sectors. The objectives of the study were explained and the questionnaires were given to selected older adults to complete at home or in the center. The questionnaires were completed for each person individually and by observing their privacy. For older adults who were unable to read and write, questionnaires were read and items were completed according to their answers. The questionnaires were given to those with reading and writing ability to complete by them. Participants who had not fully completed their questionnaires were asked to do so.
Data collection tools included a demographic questionnaire containing questions about age, gender, education, marital status, occupation, history of illness, medications used, osteoporosis, history and type of injury caused by falling, ability to perform daily tasks, use of walking aids, smoking and alcohol use, access to medical services, social support in emergency (by relatives and public sources), and income level. Demographic and Falls Efficacy Scale-International (FES-I) questions were completed by self-administration. FES-I contains 16 items, with scoring based on a 4-point Likert scale from not worried at all (1 point), to somewhat worried (2 points), fairly worried (3 points), and totally worried (4 points). Total score ranges from 16 to 64 points; 1–16 meant no fear, 17–32 little fear, 33–48 moderate fear, and 49–64 intense fear. Validity and reliability of FES-I were assessed by Yardley et al. in 704 older adults confirmed with Cronbach's alpha of 0.96. This questionnaire was translated into Persian by Khajavi et al., and intraclass correlation coefficient was found 0.98 and internal consistency using Cronbach's alpha was also 0.98.
The necessary permission for research implementation was obtained from the research deputy of Kashan University of Medical Sciences. An informed consent was obtained, and all questionnaires were registered without name and profile. Participants were free to opt out of cooperation at each stage of the research. The researcher was committed to compensate for any costs incurred by participating in this study. Participating in this study did not present any physical or psychological risk to the elderly. Participating in this study did not cause any impairment in the treatment and daily life of individuals. In the event of any disease in the subjects participating in this study, the necessary assistance was provided to improve the disease.
Normal distribution of data was assessed using the Kolmogorov–Smirnov test. The results Data was analyzed with SPSS for Windows version 17.0 (SPSS Inc., Chicago, IL) using descriptive statistics such as mean and standard deviation (SD) and inferential tests such as Chi-square and logistic regression analysis. These fear groups had significant relationships with age, having a caregiver, education, use of medication, history of diseases, ability to carry out daily tasks, history of falls, injuries from previous falls, having walking aids, and income level (P < 0.05).
| Results|| |
Of the 420 questionnaires completed, six were identified as outliers, and they were eliminated from analysis to increase the empirical advantage such as evaluation rigor and reducing deductive errors, and ultimately, 414 questionnaires were analyzed. The mean age of the older adults was 68.76 years (SD = 6.24). According to the data obtained, the majority of the older adults were women with primary to high school education, married, housewives, with no history of smoking or alcohol and coffee use, no history of anxiolytic and hypnotic medications, and no history of physical or mental diseases, able to perform daily tasks, with no history of falls and resulting injuries, no osteoporosis, with access to medical services and social supports in emergency, able to walk without walking aids, with moderate income, and homeowners, covered by health insurance, and had insomnia or sleep disturbance [Table 1].
Fear of falling in older adults of Kashan was categorized in the following four groups: no fear = 9.7%, low fear = 63.3%, moderate fear = 22.7%, and intense fear = 4.3% [Table 2].
Comparing three age groups in terms of frequencies of no fear and fear groups showed that these fear groups had a significant relationship with age, having a caregiver, education, use of medication, history of diseases, ability to carry out daily tasks, history of falls, injuries from previous falls, having walking aids, and income level (P < 0.05), but no significant relationship with gender, number of children, marital status, employment status, smoking and alcohol use, osteoporosis, access to medical care, access to social supports, living alone, housing status, insurance, and insomnia [Table 1].
Furthermore, no significant relationship was observed with gender (2.052), number of children (0.1), marital status (0.61), employment status (7.12), smoking (0.0001), osteoporosis (2.6), access to medical services in emergency (0.11), history of alcohol or coffee use (2.92), housing status (1.17), living alone (2.79), health insurance (0.15), and insomnia and sleep disturbance (3.18) (P > 0.05). Therefore, in terms of the above variables, these two fear groups were not significantly different [Table 1].
The above factors were entered into a backward logistic regression model to examine their relationship with fear of falling. The results showed that age over 70 years, a history of anxiolytic and hypnotic medications, and illiteracy had a direct relationship with fear of falling in the older adults (P < 0.05) [Table 3].
|Table 3: Final multivariate analysis model of factors related to fear of falling in older adults in Kashan (n=414)|
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| Discussion|| |
According to the results, older adults in Kashan showed a high percentage of fear of falling, such that nine out of ten people had a fear of falling. The level of fear of falling was low in more than half of the older adults, and moderate and intense in one-third. Previous studies have shown that more than 50% of the Asian older adults had some fear of falling, and this was reported higher in western older adults.,,, It appears that the prevalence of fear of falling is affected by the cultural environment. The results of the present study show that fear of falling in the older adults has a significant relationship with age, having a caregiver, education, use of anxiolytic and sleeping medications, history of physical or psychological diseases, ability to carry out daily tasks, history of falls and injuries caused, use of walking aids, access to social support in emergency, and income level. According to the multivariate analysis, fear of falling had relationships with age over 70 years, history of anxiolytic and hypnotic medications, and illiteracy.
The results showed a significant relationship between fear of falling in older adults and age. People who are older than 70 years suffer fear of falling 3.24 times more than younger elderly. Loss of physical and psychological function is accelerated with aging, and this set of changes leads to greater fear in older adults. A study conducted on 9033 people older than 65 years showed that people older than 75 years show greater fear of falling compared to younger older adults. The relationship between older age and fear of falling has also been seen in an international study.
The use of anxiolytic and hypnotic medications was another factor that had a relationship with fear of falling, such that older adults with a history of using these medications suffered fear of falling 0.26 times more than those with no such a history. Given the high level of sleep problems in older adults, the need for using hypnotic medications is high in these people, and this impairs their alertness and balance and paves the way for greater fear of falling. This is in line with previous studies that show a significant relationship between risk of falling in older adults and use of hypnotic medications.,,
The results showed that fear of falling had a relationship with education. It is critical to center around an education related to a prevention of fear of falling. Illiteracy is one of the demographic variables that influence fear of falling. This finding is consistent with another study.
In this study, no significant relationship was observed between fear of falling and gender, but in other studies have shown that older women are more likely to fall compared to older men, and fear of falling in these women has a relationship with lower physical activity, obesity, severe depression symptoms,, and greater risk for future falls. Fear of falling in older women is affected by gender-related factors such as postmenopausal low bone density, greater and faster loss of muscle mass due to reduced hormones, a higher prevalence of chronic noncommunicable diseases, and musculoskeletal frailty. Family-related matters can also affect this fear. Older women have greater problems with muscle building activities. Having a known diagnosis of osteoporosis and information about osteoporosis was correlated with fear of falling. However, no relationship was found between the osteoporosis and fear of falling in the current study. This might be because of low statistical power and a small sample of people with a history of falling or osteoporosis. Previous researches regarding the relationship between osteoporosis, insomnia, and fear of falling do not confirm the findings of the current study.,, These conflicting results can be explained by other factors, such as individuals' physical condition and mental reaction.
The high number of falls and injuries they cause are related to fear of falling, such that older adults who have fallen express greater fear compared to those who have never fall down. The studies conducted by other researchers show that older people with a history of falling (with or without injury) are at a greater risk of fear of falling., In addition, repeating the experience of falling makes older adults fear the risk of falling., In most cases, fear is related to the possibility of fracture, hospitalization, and loss of independence in older adults., Such a fear may cause behavioral changes in older adults, for instance, limiting daily activities, and lowering physical readiness, which leads to cardiovascular diseases and musculoskeletal disorders, and on the other hand, leads to increased risk of falling and affects older adults' quality of life.
There are limitations that may have affected the findings of the current study. First, although the participants of this study were selected by cluster sampling from the general population of community-living older people, they were selected from one of the provinces in Iran and that probably have their own specific results. Second, the participants' mental status (including unwillingness and frustration) during the completion of the questionnaires could affect the responses that the control was beyond the ability of the researcher. Considering the limitations proposed, it is suggested that the present study is conducted on other elderly people, including residents of the nursing home and with physical and psychological disorders.
| Conclusion|| |
Based on the results obtained, fear of falling is in excess of 90% in Kashan's older adults, and older people using anxiolytic and hypnotic medications, those older than 70 years of age, and those with no education have a greater fear of falling.
The results show an increasing need for assessing fear of falling among older adults. This assessment was not very costly or complex. Given factors related to falls identified in the present study, preventive measures and further studies should be considered to reduce the fear of falling and possible consequences that affect physical and mental health, social activities, and the quality of life.
This article was extracted from MSc thesis by Elham Sadat Motaharian in geriatric nursing from Kashan University of Medical Sciences with project 9672 and code of ethics number IR.KAUMS.NUHEPM.REC.1396. The author wishes to thank the research and technology deputy of Kashan University of Medical Sciences and all participating older adults.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Chang HT, Chen HC, Chou P. Factors associated with fear of falling among community-dwelling older adults in the Shih-Pai study in Taiwan. PLoS One 2016;11:e0150612.
Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, et al
. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009;(2):CD007146.
Tanjani P, Ainy E, Akbarpuor S, Soori H. Study of characteristics of falls among Iranian elders. Saf Promot Inj Prev 2015;2:313-20.
Lach HW. Incidence and risk factors for developing fear of falling in older adults. Public Health Nurs 2005;22:45-52.
Tomita Y, Arima K, Kanagae M, Okabe T, Mizukami S, Nishimura T, et al
. Association of physical performance and pain with fear of falling among community-dwelling japanese women aged 65 years and older. Medicine (Baltimore) 2015;94:e1449.
Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: Measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 2008;37:19-24.
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701-7.
Murphy SL, Dubin JA, Gill TM. The development of fear of falling among community-living older women: Predisposing factors and subsequent fall events. J Gerontol A Biol Sci Med Sci 2003;58:M943-7.
Jung D. Fear of falling in older adults: Comprehensive review. Asian Nurs Res (Korean Soc Nurs Sci) 2008;2:214-22.
Kressig RW, Wolf SL, Sattin RW, O'Grady M, Greenspan A, Curns A, et al
. Associations of demographic, functional, and behavioral characteristics with activity-related fear of falling among older adults transitioning to frailty. J Am Geriatr Soc 2001;49:1456-62.
Andresen EM, Wolinsky FD, Miller JP, Wilson MM, Malmstrom TK, Miller DK. Cross-sectional and longitudinal risk factors for falls, fear of falling, and falls efficacy in a cohort of middle-aged african americans. Gerontologist 2006;46:249-57.
Najafi Ghezlcheh T, Ariapour S, Jafari Oori M. Epidemiology and relationship of fall and fear of falling in the elderly residing at Kamrani Nursing home, Tehran, Iran. Salmand Iran J Aging 2015;10:152-61.
Zijlstra GA, van Haastregt JC, van Eijk JT, van Rossum E, Stalenhoef PA, Kempen GI, et al
. Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing 2007;36:304-9.
Gillespie SM, Friedman SM. Fear of falling in new long-term care enrollees. J Am Med Dir Assoc 2007;8:307-13.
Sharaf AY, Ibrahim HS. Physical and psychosocial correlates of fear of falling: Among older adults in assisted living facilities. J Gerontol Nurs 2008;34:27-35.
Yeung F, Chou KL, Wong E. Characteristics associated with fear of falling in Hong Kong Chinese elderly residing in care and attention homes. Clin Gerontol 2006;29:83-98.
Kato C, Ida K, Kawamura M, Nagaya M, Tokuda H, Tamakoshi A, et al
. Relation of falls efficacy scale (FES) to quality of life among nursing home female residents with comparatively intact cognitive function in japan. Nagoya J Med Sci 2008;70:19-27.
Ozcan A, Donat H, Gelecek N, Ozdirenc M, Karadibak D. The relationship between risk factors for falling and the quality of life in older adults. BMC Public Health 2005;5:90.
Chou KL, Yeung FK, Wong EC. Fear of falling and depressive symptoms in chinese elderly living in nursing homes: Fall efficacy and activity level as mediator or moderator? Aging Ment Health 2005;9:255-61.
Chang NT, Chi LY, Yang NP, Chou P. The impact of falls and fear of falling on health-related quality of life in taiwanese elderly. J Community Health Nurs 2010;27:84-95.
Blanchard RA, Myers AM, Pearce NJ. Reliability, construct validity, and clinical feasibility of the activities-specific fall caution scale for residential living seniors. Arch Phys Med Rehabil 2007;88:732-9.
Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C, et al
. Development and initial validation of the falls efficacy scale-international (FES-I). Age Ageing 2005;34:614-9.
Khajavi D, Farokhi A, Jaberimoghadam A, Kazemnejad A. Effect of a training intervention program on fallrelated psychological factors of community-doweling men older adults. Salmand Iran J Aging 2014;9:22-31.
Kim S, So WY. Prevalence and correlates of fear of falling in korean community-dwelling elderly subjects. Exp Gerontol 2013;48:1323-8.
Liu JY. Fear of falling in robust community-dwelling older people: Results of a cross-sectional study. J Clin Nurs 2015;24:393-405.
Choi K, Ko Y. Characteristics associated with fear of falling and activity restriction in south korean older adults. J Aging Health 2015;27:1066-83.
Oliver D, Daly F, Martin FC, McMurdo ME. Risk factors and risk assessment tools for falls in hospital in-patients: A systematic review. Age Ageing 2004;33:122-30.
Chen YC, Chien SF, Chen LK. Risk factors associated with falls among chinese hospital inpatients in taiwan. Arch Gerontol Geriatr 2009;48:132-6.
Vitorino LM, Teixeira CA, Boas EL, Pereira RL, Santos NO, Rozendo CA, et al
. Fear of falling in older adults living at home: Associated factors. Rev Esc Enferm USP 2017;51:e03215.
Pohl P, Sandlund M, Ahlgren C, Bergvall-Kåreborn B, Lundin-Olsson L, Melander Wikman A, et al
. Fall risk awareness and safety precautions taken by older community-dwelling women and men – A qualitative study using focus group discussions. PLoS One 2015;10:e0119630.
Chen YM, Hwang SJ, Chen LK, Chen DY, Lan CF. Risk factors for falls among elderly men in a veterans home. J Chin Med Assoc 2008;71:180-5.
Thiamwong L, Suwanno J. Fear of falling and related factors in a community-based study of people 60 years and older in Thailand. Int J Gerontol 2017;11:80-4.
White UE, Black AA, Wood JM, Delbaere K. Fear of falling in vision impairment. Optom Vis Sci 2015;92:730-5.
Ambrose AF, Cruz L, Paul G. Falls and fractures: A systematic approach to screening and prevention. Maturitas 2015;82:85-93.
Hita-Contreras F, Martínez-Amat A, Lomas-Vega R, Álvarez P, Aránega A, Martínez-López E, et al
. Predictive value of stabilometry and fear of falling on falls in postmenopausal women. Climacteric 2013;16:584-9.
Ayoubi F, Launay CP, Annweiler C, Beauchet O. Fear of falling and gait variability in older adults: A systematic review and meta-analysis. J Am Med Dir Assoc 2015;16:14-9.
Visschedijk JH, Caljouw MA, Bakkers E, van Balen R, Achterberg WP. Longitudinal follow-up study on fear of falling during and after rehabilitation in skilled nursing facilities. BMC Geriatr 2015;15:161.
Knauth DR, Couto MT, Figueiredo Wdos S. The standpoint of professionals on the presence and demands of men on the healthcare services: Perspectives for the analysis of the implementation of the comprehensive healthcare policy for men. Cien Saude Colet 2012;17:2617-26.
Cho H, Seol SJ, Yoon DH, Kim MJ, Choi BY, Kim T. Disparity in the fear of falling between urban and rural residents in relation with socio-economic variables, health issues, and functional independency. Ann Rehabil Med 2013;37:848-61.
Resnick B, Nahm ES, Zhu S, Brown C, An M, Park B, et al
. The impact of osteoporosis, falls, fear of falling, and efficacy expectations on exercise among community-dwelling older adults. Orthop Nurs 2014;33:277-86.
Delbaere K, Close JC, Heim J, Sachdev PS, Brodaty H, Slavin MJ, et al
. A multifactorial approach to understanding fall risk in older people. J Am Geriatr Soc 2010;58:1679-85.
Lopes KT, Costa DF, Santos LF, Castro DP, Bastone AC. Prevalence of fear of falling among a population of older adults and its correlation with mobility, dynamic balance, risk and history of falls. Rev Bras Fisioter May/June 2009;13:223-9.
Bryant MS, Rintala DH, Hou JG, Protas EJ. Influence of fear of falling on gait and balance in parkinson's disease. Disabil Rehabil 2014;36:744-8.
Mane AB, Sanjana T, Patil PR, Sriniwas T. Prevalence and correlates of fear of falling among elderly population in urban area of Karnataka, India. J Midlife Health 2014;5:150-5.
Mazumder R, Lambert WE, Nguyen T, Bourdette DN, Cameron MH. Fear of falling is associated with recurrent falls in people with multiple sclerosis: A Longitudinal Cohort Study. Int J MS Care 2015;17:164-70.
Akosile CO, Anukam GO, Johnson OE, Fabunmi AA, Okoye EC, Iheukwumere N, et al
. Fear of falling and quality of life of apparently-healthy elderly individuals from a nigerian population. J Cross Cult Gerontol 2014;29:201-9.
[Table 1], [Table 2], [Table 3]