Introduction: A review of the literature shows that standard clinical balance measures do not adequately predict fall risk in community-dwelling older individuals. There is significant evidence demonstrating the interactions of fear, anxiety, and confidence with the control of standing posture. Little is known however about the nature of this relationship under more challenging balance conditions, particularly in the elderly. The primary purpose of this work was to evaluate the relationship between fear of falling, clinical balance measures and fall-risk. Methods: Three studies were conducted evaluating the effects of postural threat (manipulated by support surface elevation) and/or cognitive loading (working memory secondary task) on clinical balance performance and task-specific psychological measures. Predictive and construct validity as well as test-retest reliability was evaluated for measures used to assess fear of falling and related psychological constructs . Results: Postural threat resulted in reduced balance confidence and perceived stability as well as increased state anxiety and fear of falling. These changes were significantly correlated to decrements in performance of clinical balance tasks. Neither standard clinical scales of balance and mobility nor generalized psychological measures, alone or in combination, could predict falls in community-dwelling elderly. However, combined scores on selected challenging clinical balance tasks could significantly predict falls. Furthermore, improved predictive precision resulted from having these tasks performed under combined postural threat and cognitive loading. Finally, the inclusion of task-specific psychological measures resulted in further improvements to predictive precision. Psychological measures demonstrated fair to excellent test-retest reliability in both healthy young and independent-living older individuals. Conclusions: Clinical balance tasks performed under more challenging conditions likely better reflect everyday experiences in which a fall is likely to occur. Incorporating easy-to-administer task-specific psychological evaluations and self-reported health estimates with clinical balance assessments might improve the likelihood of correctly identifying community-dwelling individuals at risk for falls. Improved estimates of fall-risk may lead to a reduction in the number of falls experienced in this population, thereby reducing the significant burden of fall-related hospitalizations, treatments and rehabilitation on the individual, families and health care system.

Vi åldras på flera sätt, biologiskt, psykologiskt och socialt. Rädsla för att ramla, en pågående oro för att ramla och som leder till undvikande av aktiviteter man fortfarande kan göra, finns hos många äldre och påverkar dem på flera sätt. Rädslan kan leda till inaktivitet som i sin tur leder till ensamhet och nedstämdhet. Syftet med studien är att beskriva äldre personers egen erfarenhet av att uppleva rädsla för fall och dess konsekvenser. En kvalitativ studie har gjorts där fem personer har intervjuats. Intervjuerna och analysen av dem är gjorda utifrån en fenomenologisk metod. Vid analysen framkom tre huvudkategorier: Oro för konsekvenserna av ett fall, Strategier för att undvika fall samt Saknad. Äldre personer som upplever en rädsla för fall undviker vissa aktiviteter. De upplever också en saknad efter aktiviteter de tidigare utfört men nu slutat med. De har strategier för att hantera sina rädslor. Det är viktigt att inte se äldre som en homogen grupp och att vid rehabilitering ta hänsyn till olika faktorer som person, miljön personen vistas i, aktiviteter de utför eller önskar utföra och känslan av delaktighet. / We age in different ways, biologically, psychologically and socially. Fear of falling which means a lasting concern about falling which leads to an avoiding of activities that the person still has a capability to do. This can cause inactivity that eventually leads to loneliness and depression. The aim of this study is to describe older peoples own experiences to live with fear of falling and its consequences. A qualitative study was done where five older people were interviewed. The interviews and analyses were done using a phenomenological method. At the analysis three main categories were found: Concern about the consequences of a fall, Strategies to avoid a fall and A feeling of missing. Older people with fear of falling avoid some activities. There is a feeling that they miss some activities they have previously done but don't do any longer. They have strategies to handle their fears. In rehabilitation it is important not to see the elderly as an homogeneous group. It is also important to consider different factors such as the person, the environment in which the person lives, activity and feeling of involvement.

Introduction: A review of the literature shows that standard clinical balance measures do not adequately predict fall risk in community-dwelling older individuals. There is significant evidence demonstrating the interactions of fear, anxiety, and confidence with the control of standing posture. Little is known however about the nature of this relationship under more challenging balance conditions, particularly in the elderly. The primary purpose of this work was to evaluate the relationship between fear of falling, clinical balance measures and fall-risk. Methods: Three studies were conducted evaluating the effects of postural threat (manipulated by support surface elevation) and/or cognitive loading (working memory secondary task) on clinical balance performance and task-specific psychological measures. Predictive and construct validity as well as test-retest reliability was evaluated for measures used to assess fear of falling and related psychological constructs . Results: Postural threat resulted in reduced balance confidence and perceived stability as well as increased state anxiety and fear of falling. These changes were significantly correlated to decrements in performance of clinical balance tasks. Neither standard clinical scales of balance and mobility nor generalized psychological measures, alone or in combination, could predict falls in community-dwelling elderly. However, combined scores on selected challenging clinical balance tasks could significantly predict falls. Furthermore, improved predictive precision resulted from having these tasks performed under combined postural threat and cognitive loading. Finally, the inclusion of task-specific psychological measures resulted in further improvements to predictive precision. Psychological measures demonstrated fair to excellent test-retest reliability in both healthy young and independent-living older individuals. Conclusions: Clinical balance tasks performed under more challenging conditions likely better reflect everyday experiences in which a fall is likely to occur. Incorporating easy-to-administer task-specific psychological evaluations and self-reported health estimates with clinical balance assessments might improve the likelihood of correctly identifying community-dwelling individuals at risk for falls. Improved estimates of fall-risk may lead to a reduction in the number of falls experienced in this population, thereby reducing the significant burden of fall-related hospitalizations, treatments and rehabilitation on the individual, families and health care system.

This Thesis follows the portfolio format and a brief overview is given here. Chapter one is a systematic review of the literature on the relationship between emotion regulation, anxiety and depression in older adults. Chapter two is a research journal which explores the relationship between fear of falling and emotion regulation in community dwelling older adults. The systematic review is written up for publication in the Journal of Affective Disorders. The research article is written up for publication in Aging and Mental Health. Their respective style guidelines were followed. Purpose The aim of the thesis was to explore the relationship between emotion regulation and psychological distress in older adults. The aim of the systematic review was to explore the relationship between self-reported emotion regulation, anxiety and depression in older adults. The empirical study aimed to look at the relationship between fear of falling, a common type of psychological distress in older adults, and emotion regulation. It also aimed to look at the relationship between fear of falling related avoidance behaviour and emotion regulation. Methods The literature was systematically searched for research which has explored the relationship between emotion regulation, anxiety and depression in older adults. The papers which met the inclusion criteria were rated according to predetermined quality criteria. An overview of the results and implications were discussed. The empirical research used a cross-sectional design to examine the research hypothesis. Older adults completed self-report measures of emotion regulation, fear of falling, fear-related avoidance behaviour, anxiety and depression. Correlational analysis explored the relationship between the study variables. A linear regression model examined the unique contribution of emotion regulation to fear of falling after controlling for age, falls history, anxiety and depression. Results 12 studies met the inclusion criteria for the systematic review. The most prevalent relationship explored was that between rumination and depression with consistent evidence that higher levels of rumination were related to higher levels of depressive symptoms. Common methodological limitations were the lack of valid and reliable emotion regulation measures for older adults, non-random sampling, and failure to control for important confounding factors. Within the empirical research, a significant relationship between emotion regulation and fear of falling was found. There was also a significant relationship between emotion regulation and fear of falling avoidance behaviour. After controlling for age, number of falls, depression and anxiety, emotion regulation was no longer significantly associated with fear of falling. Depression was the only modifiable variable that retained a significant association to fear of falling.

No description available.

Many adults are afraid of falling. While aging can affect one'€™s physical and cognitive abilities related to fear of falling (FOF), research has revealed that FOF increases risk of falls and adversely affects independence levels among older adults. The purpose of this study was to explore older adults'€™ perceptions of FOF and risk of falling. Guided by the health belief model, the research questions focused on older adults'€™ perceptions of FOF, contributing factors of FOF, and how FOF may affect independence levels. How older adults perceive FOF, and how FOF may affect an individual older adult'€™s fall risk and independence levels are not well known. Following face-to-face interviews with adults age 60 and older, Colaizzi'€™s data analysis strategy demonstrated thematic older adult reports of constant anxiety, loss of confidence, and activities of daily living (ADLs) avoidance as perceptions of FOF; traumatic health incidence, loss of health, and decreased quality of life as contributing factors in FOF; and depending on others, loss of muscle strength, and loss of balance as to how FOF affected older adult independence levels. Recommendations for future research include exploring the influence of gender, race, education level, and socioeconomic status on FOF in older adults. This study may enhance social change through greater FOF awareness and added context among caregivers.

No description available.

The objectives of the study were to determine the incidence of falls, the prevalence of fear of falling and fall risk factors and consequences in adults with rheumatoid arthritis (RA). 559 community dwelling adults with RA, aged 18 to 88 years (mean age 62; 69% female) participated in this prospective cohort study. Patients were recruited from four outpatient clinics in the Northwest of England and followed for 1 year after clinical assessment, using monthly falls calendars and telephone calls. Outcome measures included fall occurrence, reason for fall, type and severity of injuries, fractures, fall location, lie-times, use of health services and functional ability. Risk factors for falls included lower limb muscle strength, postural stability, number of swollen and tender joints, functional status, history of falling, fear of falling, pain, fatigue and medication. Data on demographics, vision, co-morbidities, history of surgery, fractures, and joint replacements were also recorded.535 participants followed for one year had a total of 598 falls. 36.4% participants (95% CI 32% to 41%) reported falling with an incidence rate of 1313/1000 person-years at risk or 1.11 falls per person. Over one third of the falls were reportedly caused by hips, knees or ankle joints giving way. Over half of all the falls resulted in moderate injuries, including head injuries (n=27) and fractures (n=26). Univariate logistic regression showed that falls risk was independent of age and gender. A history of falls in the previous one year was a strong medical fall predictor with an odds ratio (OR) for a single fall=3.3 and for multiple falls OR=4.3. Fear of falling was an important self-reported psychological predictor, with the risk increasing by 10% with each point above 7 (up to 28) in the Short FES-I score. The inability to complete the Four Test Balance Scale due to poor balance was a strong postural fall predictor (OR 2.3). The most significant functional predictor of falls was the functional Health Assessment Questionnaire score, and each additional point attained in the score (1-4) nearly doubled the risk of further falls. Multivariate logistic regression revealed that when taken in combination with other factors, a history of multiple falls in the previous one year was the most significant predictive risk factor (OR=5.3) and overall the model accounted for 71% of variation. The most significant modifiable risk factors were swollen and tender lower limb joints (hip, knee and ankle) (OR=1.7), psychotropic medication (OR=1.8) and increasing fatigue (OR=1.13) with this model accounting for 68% of variation. Adults of all ages with RA are at high risk of falls and fall-related injuries, fractures and head injuries. In clinical practice, high risk falls patients with RA can be identified by asking whether patients have fallen in the past year. The management of swollen and tender lower limb joints, fatigue and consideration of psychotropic medicines may be the most effective strategy to reduce falls in this group of patients. Fear of falling, pain, lower limb strength and poor balance are other useful clinical indicators that may be modified to prevent falls.

Maintaining a physically active lifestyle has shown to decrease the risks of falling by slowing down the degenerative changes that occur with aging adults. But despite these physical changes, research has recognized the development of the fear of falling (FOF) as also attributing to the aging adults’ risk of falling. Furthermore, increases the risk of falling and subsequently increases the loss of independency. This study aimed to: 1) examine the relationships between the levels of physical activity, degree of FOF, and fall risk using quantitative approach; and 2) explore the changes of FOF and understand its cause using qualitative approach. Data was collected from participants through various assessments including the Rapid Assessment of Physical Activity (RAPA) for measuring physical activity, shortened version of Falls Efficacy Scale-International (FES-I) for measuring FOF, and semi-structured one-on-one interviews. As data is being analyzed, participants who increased their physical activity levels were identified to having lowered their level of FOF and those who had a decrease of physical activity levels showed an increase with their FOF. It was also translated that the notion of being aware played a key role on the individuals FOF from 46% of the 13 participants interviewed and over 80% also stated not having talked to their doctor about their risks of falling and prevention. The importance of maintaining a physical activity level not only continues to prove the benefits it has on the individual’s risk of falling but how it also plays a role on the individuals fear of falling.

No description available.