Dataset Information

The short- and long-term temporal relation between falls and concern about falling in older adults without a recent history of falling.

ABSTRACT:

Background and aim

The reciprocal relation between falling and concern about falling is complex and not well understood. We aimed to determine whether concern about falling increases after a fall and whether concern about falling increases the odds of future falls in community-dwelling older adults without a recent fall history.

Methods

We selected 118 community-dwelling older adults (mean age: 71.4 (SD: 5.3) years) without a self-reported history of falling, one year prior to baseline assessment, from the one-year VIBE cohort for analyses. On a monthly basis, we recorded concern about falling (using the Falls Efficacy Scale-International, FES-I), as well as the occurrence of falls (through questionnaires and telephone calls). We determined 1) whether falling predicts an increase in concern about falling and 2) whether a high concern about falling is predictive of falling. Standard linear (fixed-effects) regression and mixed effects regression analyses were performed over long-term, i.e. one year, and short-term, i.e. one-month, intervals, respectively and were adjusted for gender, age and physical activity (quantified as the average total walking duration per day). Analyses were performed separately for all reported falls and for injurious falls only.

Results

High concern about falling at baseline did not predict falls over the course of one year, nor over the course of one month. Furthermore, falls in between baseline assessment and one year thereafter did not predict increased concern about falling from baseline to one year later, independent of whether all falls or only injurious falls were considered. However, falls, either all or injurious only, happening somewhere over the course of a one-month interval, significantly predicted small increases in concern about falling (1.49 FES-I points, 95% CI [0.74, 2.25], p<0.001 for all falls; 2.60 FES-I points, 95% CI [1.55, 3.64], p<0.001 for injurious falls) from the start to the end of that one-month interval.

Conclusion

Older adults without a recent history of falling seem to be resilient against developing concern about falling after having fallen, resulting in a short-term temporary effect of falling on concern about falling. Furthermore, we found no evidence that a high concern about falling predicts future falls over a one-month or a one-year follow-up period, suggesting that concern is not a primary cause for falls in older adults without a recent history of falling.

SUBMITTER: Weijer RHA

PROVIDER: S-EPMC8270453 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:IntroductionConcern about falling is a prevalent worry among community-dwelling older adults and may contribute to a decline in physical and mental health. This study aimed to examine the association between mobility performance and concern about falling.MethodsOlder adults aged 65 years and older, with Mini-Mental State Examination score ≥24, and ambulatory (with or without the assistive device) were included. Concern about falling was evaluated with Falls Efficacy Scale-International (FES-I) scores. Participants with high concern about falling were identified using the cutoff of FES-I ≥23. Participants' motor capacity was assessed in standardized walking tests under single- and dual-task conditions. Participants' mobility performance was measured based on a 48-h trunk accelerometry signal from a wearable pendant sensor.ResultsNo significant differences were observed at participant characteristics across groups with different levels of concern about falling (low: N = 64, age = 76.3 ± 7.2 years, female = 46%; high: N = 59, age = 79.3 ± 9.1 years, female = 47%), after propensity matching with BMI, age, depression, and cognition. With adjustment of motor capacity (stride velocity and stride length under single- and dual-task walking conditions), participants with high concern about falling had significantly poorer mobility performance than those with low concern about falling, including lower walking quantity (walking bouts, steps and time per day, and walking bout average, walking bout variability, and longest walking bout, p ≤ 0.013), and poorer daily-life gait (stride velocity and gait variability, p ≤ 0.023), and poorer walking quality (frontal gait symmetry, and trunk acceleration and velocity intensity, p ≤ 0.041). The selected mobility performance metrics (daily steps and frontal gait symmetry) could significantly contribute to identifying older adults with high concern about falling (p ≤ 0.042), having better model performance (p = 0.036) than only walking quantity (daily steps) with adjustment of confounding effects from the motor capacity (stride length under dual-task walking condition).ConclusionThere is an association between mobility performance and concern about falling in older adults. Mobility performance metrics can serve as predictors to identify older adults with high concern about falling, potentially providing digital biomarkers for clinicians to remotely track older adults' change of concern about falling via applications of remote patient monitoring.

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