The effectiveness of the A Matter of Balance (MOB) program, a multifactorial falls prevention intervention, is uncertain. Although targeting multiple risk factors of falling at the same time seems reasonable and desirable, in that falls are often caused by several risk factors, results from previous studies investigating the effects of multifactorial falls prevention interventions are inconsistent. In addition, research shows that single factor interventions (e.g., exercise) can produce the same effects. The cost-effectiveness of multifactorial falls prevention interventions has varied across studies (e.g., Jenkyn, Hoch, & Speechley, 2012; Tinetti, Baker, et al., 1994). Despite the fact that the American Geriatrics Society and British Geriatrics Society (2001) have incorporated multifactorial falls prevention interventions into geriatric practice guidelines, more studies are needed to better understand the effects of the MOB program on falls and risk factors for falling among older adults. The MOB program aims to reduce fear of falling by increasing self-efficacy and perceived control (Tennstedt et al., 1998). This program provides exercises to enhance older adults' physical capacities, lessons to teach seniors fall-related risk factors, and methods to enhance self-efficacy. Previous studies mainly focused on the effects of the MOB program on fear of falling and falls efficacy. However, falls, fear of falling, and physical frailty (e.g., poor balance) are all correlated. Little is known about the effects of the MOB program on falls and related physical risk factors. Meanwhile, fear of falling and falls efficacy are two constructs often used to delineate psychological consequences of falling, but there has been confusion about these two constructs. As a result, researchers have been using measures developed for falls efficacy to assess fear of falling in error. Previous study also shows that both fear of falling and falls efficacy need to be examined after intervention with separate appropriate measures(e.g., Valentine, Simpson, Worsfold, & Fisher, 2011). Nevertheless, in the research of the MOB program, studies often examined either fear of falling or falls efficacy, but not both (e.g., Tennstedt et al., 1998; Zijlstra et al., 2009). Therefore, whether the MOB program could improve both fear of falling and falls efficacy is uncertain. This dissertation includes three studies to examine the effects of the MOB program. The first study explores whether the program could effectively prevent falls and improve physical risk factors (i.e., mobility, walking speed, and postural control) among older adults. The second study examines the psychometric properties of a modified fear of falling measure and the effects of the program on fear of falling and falls-efficacy. The third study investigates whether the effects of the MOB program on falls, mobility, walking speed, and postural control can be maintained across five months. Three studies using a comparison group design were conducted to examine each objective. Data were collected at baseline (Time 1), the conclusion of the program (Time 2), and at a 3-month follow-up (Time 3). Overall, the studies in this dissertation show that older adults can improve their mobility, walking speed, postural control, fear of falling, and falls efficacy by participating in the MOB program but the program did not affect the total number of falls. The results also showed that older adults who received the MOB program reached their highest performance on mobility and walking speed immediately at the end of the program. However, their performance on postural control continued to improve and was the best at the 3-month follow-up.

This study examined the potential moderating effects that the fear of falling may have on potential white-collar crime perpetrators using rational choice and differential association theory perspectives. A self-report, factorial survey measurement tool utilizing three hypothetical vignettes placing respondents in a business situation with the potential to commit insider trading was given to 612 students at a Midwestern university. Results indicate that the fear of falling had no moderating effects, differential association theory was partially supported in Vignette 1, and rational choice theory was partially supported across all three vignettes.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introdução: Com o expressivo aumento da população idosa, as quedas são eventos comuns e levam a desfechos adversos à saúde. As consequências do medo de quedas podem ser tão incapacitantes como as quedas. Objetivo: O presente estudo teve como objetivo estimar a prevalência do medo de quedas em idosos e sua associação com fatores clínicos, funcionais e psicossociais. Métodos: Utilizaram-se os dados do Estudo FIBRA-RJ, que avaliou clientes de uma operadora de saúde, residentes na Zona Norte do município do Rio de Janeiro. A seleção desta amostra foi realizada através de amostragem aleatória inversa, de acordo com estratos de faixa etária e sexo do cadastro oferecido pela operadora. As entrevistas foram realizadas face a face no domicilio. O medo de quedas, variável dependente, foi avaliado através da FES-I-BR. As seguintes variáveis clínicas, funcionais e psicossociais foram avaliadas como variáveis independentes: histórico de quedas, fratura pós-queda, número de comorbidades, número de medicamentos, internação no último ano, uso de dispositivo de auxílio à marcha, dependência funcional nas atividades básicas e instrumentais de vida diária, dificuldade visual e auditiva, força de preensão palmar, velocidade de marcha, autopercepção de saúde, sintomas depressivos, alteração cognitiva, morar só, apoio social instrumental e nível de atividade. As associações foram avaliadas através de regressão logística. Resultados: Dentre os 742 idosos avaliados, 51,9% apresentaram medo de quedas, sendo esta prevalência maior no sexo feminino e nos mais idosos. Na análise logística multivariada, houve associação com histórico de 1 ou 2 quedas (OR=2,18; IC95%1,42-3,36), 3 ou mais quedas (OR=2,72; IC95% 1,10-6,70), usar 7 ou mais medicamentos (OR=1,70; IC95%1,04-2,80), dificuldade auditiva (OR=1,66; IC95% 1,10-2,49), ter dependência funcional nas atividades de vida diária (AVDs) (OR=1,73; IC95%1,07-2,79), velocidade de marcha diminuída (OR=1,64; IC95%1,04-2,58), autopercepção de saúde regular (OR=1,89; IC95%1,30-2,74) e ruim/muito ruim (OR=4,92; IC95%1,49-16,27) e sintomas depressivos (OR=1,68; IC95%1,07-2,63). Conclusão: Os resultados obtidos mostram a prevalência elevada de medo de quedas. Destaca-se a necessidade de avaliação desta condição nos idosos. Identificar os fatores associados é útil para desenvolver estratégias efetivas de intervenção dos possíveis fatores modificáveis. / Introduction: With the significant increase in the elderly population, falls are common events and lead to adverse health outcomes. The consequences of fear of falling can be as disabling as the falls. Objective: This study aimed to determine the prevalence of fear of falling in elderly and its association with clinical, functional, and psychosocial factors. Methods: We used data from FIBRA-RJ study, who evaluated customers of a private health provider, aged 65 or older, residing in the northern of Rio de Janeiro city. Fear of falling was measured by the Falls Efficacy Scale-I-BR (FES-I-BR).The following independents variables were assessed: history of falls, fracture post fall, number of comorbidities, number of medications, hospitalization in the previous year, use of walking aid, functional dependency in activities of daily living and instrumental activities of daily living, visual and auditive impaiment, grip strength, walking speed, self-rated health, depressive symptoms, cognitive impairment, living alone, social support and activity level. To evaluate these associations, multiple logistic regression were used. Results: Among the 742 assessed elderly, 51.9% had fear of falling, which were more prevalente in women and with increase age. Was associated with fear of falling: a history of 1 or 2 falls (OR=2.18; IC 95%1.42-3.36), 3 or more falls (OR=2.72; IC95% 1.10-6.70), use of 7 or more drugs (OR=1.70; IC95%1.04-2.80), hearing impairment (OR=1.66; IC95%1.10- 2.49), functional dependence in activities of daily living (ADL) (OR=1.73; IC95%1,07-2,79), gait speed decreased (OR=1.64; IC 95%1.04-2.58), self-rated health regular (OR=1.89; IC 95%1.30-2.74) and poor / very poor (OR=4.92; IC95%1.49-16.27) and depressive symptoms (OR=1.68; IC95%1.07-2.63). Conclusion: The obtained results show a high prevalence of fear of falling in this sample. We highlight the need for the assessment of this condition in the elderly in order to identify these individuals earlier to develop effective intervention strategies of modifiable factors.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introdução: Com o expressivo aumento da população idosa, as quedas são eventos comuns e levam a desfechos adversos à saúde. As consequências do medo de quedas podem ser tão incapacitantes como as quedas. Objetivo: O presente estudo teve como objetivo estimar a prevalência do medo de quedas em idosos e sua associação com fatores clínicos, funcionais e psicossociais. Métodos: Utilizaram-se os dados do Estudo FIBRA-RJ, que avaliou clientes de uma operadora de saúde, residentes na Zona Norte do município do Rio de Janeiro. A seleção desta amostra foi realizada através de amostragem aleatória inversa, de acordo com estratos de faixa etária e sexo do cadastro oferecido pela operadora. As entrevistas foram realizadas face a face no domicilio. O medo de quedas, variável dependente, foi avaliado através da FES-I-BR. As seguintes variáveis clínicas, funcionais e psicossociais foram avaliadas como variáveis independentes: histórico de quedas, fratura pós-queda, número de comorbidades, número de medicamentos, internação no último ano, uso de dispositivo de auxílio à marcha, dependência funcional nas atividades básicas e instrumentais de vida diária, dificuldade visual e auditiva, força de preensão palmar, velocidade de marcha, autopercepção de saúde, sintomas depressivos, alteração cognitiva, morar só, apoio social instrumental e nível de atividade. As associações foram avaliadas através de regressão logística. Resultados: Dentre os 742 idosos avaliados, 51,9% apresentaram medo de quedas, sendo esta prevalência maior no sexo feminino e nos mais idosos. Na análise logística multivariada, houve associação com histórico de 1 ou 2 quedas (OR=2,18; IC95%1,42-3,36), 3 ou mais quedas (OR=2,72; IC95% 1,10-6,70), usar 7 ou mais medicamentos (OR=1,70; IC95%1,04-2,80), dificuldade auditiva (OR=1,66; IC95% 1,10-2,49), ter dependência funcional nas atividades de vida diária (AVDs) (OR=1,73; IC95%1,07-2,79), velocidade de marcha diminuída (OR=1,64; IC95%1,04-2,58), autopercepção de saúde regular (OR=1,89; IC95%1,30-2,74) e ruim/muito ruim (OR=4,92; IC95%1,49-16,27) e sintomas depressivos (OR=1,68; IC95%1,07-2,63). Conclusão: Os resultados obtidos mostram a prevalência elevada de medo de quedas. Destaca-se a necessidade de avaliação desta condição nos idosos. Identificar os fatores associados é útil para desenvolver estratégias efetivas de intervenção dos possíveis fatores modificáveis. / Introduction: With the significant increase in the elderly population, falls are common events and lead to adverse health outcomes. The consequences of fear of falling can be as disabling as the falls. Objective: This study aimed to determine the prevalence of fear of falling in elderly and its association with clinical, functional, and psychosocial factors. Methods: We used data from FIBRA-RJ study, who evaluated customers of a private health provider, aged 65 or older, residing in the northern of Rio de Janeiro city. Fear of falling was measured by the Falls Efficacy Scale-I-BR (FES-I-BR).The following independents variables were assessed: history of falls, fracture post fall, number of comorbidities, number of medications, hospitalization in the previous year, use of walking aid, functional dependency in activities of daily living and instrumental activities of daily living, visual and auditive impaiment, grip strength, walking speed, self-rated health, depressive symptoms, cognitive impairment, living alone, social support and activity level. To evaluate these associations, multiple logistic regression were used. Results: Among the 742 assessed elderly, 51.9% had fear of falling, which were more prevalente in women and with increase age. Was associated with fear of falling: a history of 1 or 2 falls (OR=2.18; IC 95%1.42-3.36), 3 or more falls (OR=2.72; IC95% 1.10-6.70), use of 7 or more drugs (OR=1.70; IC95%1.04-2.80), hearing impairment (OR=1.66; IC95%1.10- 2.49), functional dependence in activities of daily living (ADL) (OR=1.73; IC95%1,07-2,79), gait speed decreased (OR=1.64; IC 95%1.04-2.58), self-rated health regular (OR=1.89; IC 95%1.30-2.74) and poor / very poor (OR=4.92; IC95%1.49-16.27) and depressive symptoms (OR=1.68; IC95%1.07-2.63). Conclusion: The obtained results show a high prevalence of fear of falling in this sample. We highlight the need for the assessment of this condition in the elderly in order to identify these individuals earlier to develop effective intervention strategies of modifiable factors.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-04T15:52:52Z No. of bitstreams: 1 Jessica Janete Novais Santos.pdf: 1230062 bytes, checksum: 7010840151e0bca98cee207f12500ce1 (MD5) / Made available in DSpace on 2015-12-04T15:52:52Z (GMT). No. of bitstreams: 1 Jessica Janete Novais Santos.pdf: 1230062 bytes, checksum: 7010840151e0bca98cee207f12500ce1 (MD5) Previous issue date: 2012 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / O envelhecimento da população brasileira, recebeu influências do fenômeno da transição demográfica e a partir dos dados censitários disponíveis já encontramos números semelhantes ao de países desenvolvidos. Com isto aumentaram as preocupações com as comorbidades. As quedas dos idosos são consideradas como um dos grandes problemas dos que envelhecem e investigar as quedas dos idosos foi a proposta deste estudo que investigou os idosos que frequentavam as oficinas propostas no projeto Vida Saudável que ocorreram na Unidade Básica de Saúde João da Silva Vizella. A literatura indica como preditor de queda o medo que as mesmas causam, que tanto pode ocorrer pós uma queda, como também sem a pessoa reconhecer a existência de uma queda importante na sua vida. O objetivo geral do estudo foi o de estudar a relação medo e quedas. Utilizou-se como metodologia a aplicação de uma escala denominada FES-I Brasil que investiga a autoeficácia em executar determinadas tarefas, e de uma análise de conteúdo das entrevistas realizadas com as 15 participantes que se dispuseram a participar do estudo. No capítulo 1 discutimos a fundamentação que deu suporte a investigação, na sequência, no capítulo 2, apresentamos as opções metodológicas, descrevemos a forma como se estruturou a pesquisa e a coleta dos dados. No capítulo 3 apresentamos a análise dos dados coletados: encontramos uma medida central através da mediana, sem no entanto, sermos capazes de dizer se quem cai mais é quem tem mais medo; dito de outra forma, quem têm menor autoeficácia. No grupo investigado todos apresentaram quedas importantes e o medo das quedas em maior ou menor grau esteve presente no discurso das entrevistadas. A partir da análise do conteúdo das entrevistas pode-se conhecer melhor sobre as quedas do grupo. Categorias serviram para dialogar com as entrevistas e uma delas não prevista, veio a ser a da “fé como justificativa”, procurou minimizar o problema, desta forma, controlando a emoção expressa pelo sentir medo que acompanhou o grupo investigado. Apresentamos nas nossas considerações finais a relação das quedas que acontecem com os idosos e o sentimento de medo que as mesmas provocam entre as participantes da UBS-Vizella. / The aging population, has been influenced by the phenomenon of demographic transition and from the census data available since we found similar numbers to that of developed countries. With this raised concerns with comorbidities. Falls in elderly are regarded as one of the major problems of aging and to investigate the falls of the elderly was the purpose of this study investigating the elderly who attended the workshops proposed in the Vida Saudável Project which occurred in the Basic Health João da Silva Vizella. The literature indicates the decline as a predictor of fear that they cause, which may occur either after a fall, but no one recognized the existence of a significant drop in his life. The overall objective of the study was to study the relationship fear and falls. Was used as a methodology to apply a scale called FES-I Brazil that investigates the self-efficacy in performing certain tasks, and a content analysis of interviews with 15 participants who were willing to participate. In chapter 1 we discussed the rationale that has supported the research, following, in Chapter 2, we present the methodological options, we describe the way they structured the research and data collection. In chapter 3 we present the analysis of data collected: find a measure through the center median, without however being able to say whether those who fall is over who has more fear, in other words, who have lower self-efficacy. In the group investigated all showed significant falls and fear of falls in greater or lesser degree was present in the discourse of the interviewees. From the analysis of the interviews one can know better about the falls of the group. Categories used to dialogue with the interviews and one not envisaged, became the "faith as a justification," sought to minimize the problem, thereby controlling the emotion expressed by the fear that accompanied the group investigated. We present our final considerations in the relationship of falls that occur with the elderly and the feeling of fear that they cause among the participants of the UBS-Vizella.

Fallolyckor är vanligt förekommande bland äldre personer i Sverige. Trots detta saknas studier på de drabbades upplevelse efter ett fall. Syfte: Examensarbetets syfte var därför att beskriva hur äldre upplever sina dagliga aktiviteter efter fall. Metod: Metoden för examensarbetet var kvalitativ med semistrukturerade intervjuer. Nio personer i södra Sverige mellan 71–94 år har deltagit. Materialet har analyserats genom en kvalitativ innehållsanalys. Resultat: Resultatet mynnade ut i tre kategorier, känslor som påverkar utförandet av aktiviteter, fysiska upplevelser som leder till begränsningar samt strategier för att hantera vardagen. Efter fall upplevde många trötthet, rädsla och oro. Även smärta och försämrad rörelseförmåga förekom bland deltagarna. Konsekvenserna efter fall upplevdes påverka och begränsa vardagliga aktiviteter. Slutsats: I resultatet framkom att de personliga erfarenheterna, känslorna och upplevelsen av fall hade minst lika stor påverkan på vardagen som den tillhörande fysiska skadan. / Fall accidents are common among older people in Sweden. Despite that there is lack of studies about the affected person's experience after a fall. Purpose: The purpose of the study is therefore to describe how older people’s experience their daily activities after falling. Method: The study was a qualitative interview study with semi-structured interviews. Nine people 71-94 years old from south Sweden have been participating in the interview study. The collected data was analyzed with a qualitative content analysis. Result: The result was divided into three categories:  Feelings that affect the performance of activities, physical experiences that lead to limitations and strategies for managing everyday life. Many experienced tiredness, fear and anxiety after a fall. Even pain and impaired mobility occurred among the participants. The consequences after a fall were found to affect and limit the everyday life. Conclusion: Based on the results of this study the personal experiences, feelings and the experience of the fall had at least as much influence on the daily life as the physical injury.

Les modifications de la marche liées à la peur de chuter sont généralement classées comme des troubles du contrôle de la marche supraspinaux, dits « de haut niveau » car rapportées à une déficience dans le contrôle cortical de la marche. Il est maintenant bien établi que l’étude de la variation des caractéristiques du pas, et notamment celles du temps du pas, est un moyen d’appréhender la désorganisation du caractère automatique de la marche. En effet, la variabilité du temps du cycle de marche qui semble être un marqueur du contrôle cortical de la marche est inversement reliée à la stabilité de la marche.Très peu d’études se sont intéressées à l’association entre la variabilité du temps du cycle de marche et la peur de chuter chez la personne âgée. Ces études ont montré des résultats divergents principalement en raison de la non-prise en compte de potentiels facteurs de confusion. Le travail de thèse que nous présentons a pour objectif principal d’étudier l’association entre la variabilité de la marche et la peur de chuter chez des personnes âgées en tenant compte des potentiels facteurs pouvant influencer la relation entre ces deux variables, afin d’appréhender la relation de causalité qui peut les unir. Nos résultats montrent que la peur de chuter est associée significativement à une augmentation de la variabilité de la marche. En effet, la combinaison peur de chuter et antécédent de chutes augmente la variabilité du temps du cycle de marche. Cependant, l’effet de cette combinaison dépend du niveau de la vitesse de la marche. / Changes in gait performance related to fear of falling (FOF) are usually classified as supraspinal gait control disorders called “higher-level gait disorders” due to impairment in cortical gait control. It is now well established that the study of the variability in stride characteristics and in particular the variability of stride time, provide information on the impairment of the automatic character of gait. In fact, gait variability, which is a biomarker of higher-level gait disorders, is inversely related to gait stability. A limited number of studies have examined the association between FOF and higher stride time variability (STV), and have showed mixed results mainly due to the non-consideration of potential factors that may influence the relationship between STV and FOF. Thus, the main objective of this thesis was to examine the association between STV and FOF in elder people taking into account the potential factors influencing the relationship between these two variables.Our results show that FOF is significantly associated with an increase in STV. Indeed, the combination of FOF and history of previous falls increases STV. The adverse gait effect of this combination depends on the level of the walking speed.

This thesis includes three manuscripts with an overarching objective to improve understanding of behavioural risk factors for falling in community-dwelling older adults. The first manuscript presented in Chapter two, presents a protocol for a scoping review. The objective of this scoping review was to highlight the current methods used to identify fall-related risk-taking behaviours in community-dwelling older adults, and to identify factors that might contribute to these behaviours. The second manuscript (Chapter three) presents the results of the scoping review written in the format for publication. The review identified older adults are generally aware of their own falls risk and engage in protective behaviours to reduce their risk of falling. Older adults engaged in risk-taking behaviours based on the potential benefits outweighing perceived risk of the behaviours. An individual’s abilities, self-perception, personal values, and the environment likely influence the perception of risk which contributes to risk-taking behaviours. The third manuscript (Chapter four) includes the analysis of clinical data from a community-based multi-component fall prevention program – the Building Balance Program. Individuals who participated in this six-week fall prevention program improved in balance ability, lower extremity muscle strength, mobility, and reduced fear of falling from baseline. Fear of falling (FoF) was the highest amongst the youngest participants despite having better physical function at the outset of the Program. This suggests that in addition to physical function, other factors, like psychological and social factors may be involved with FoF. / Thesis / Master of Health Sciences (MSc) / Falling is very common for older adults. Falling can lead to injuries and long-term side effects like fear of falling. Community-based exercise programs are a cost-effective way to help large groups of older adults reduce their risk of falling. Exercise programs can reduce older adults’ risk of falling by improving their balance and muscle strength. But exercise might not be enough to prevent falling in older adults. Falls can happen for various reasons, such as the activities or behaviours in which the individual participates. This thesis includes two studies presented in three papers aimed to better understand behavioural components which may be associated with falls. The results of this research suggest there is a psychological and social component involved with falling. The findings from this thesis highlight the importance of a holistic approach to and may help to inform the development of comprehensive interventions for fall prevention.

No description available.

Background: Fear of falling has significant adverse physical and psychological effects for the community-dwelling older adult. Objective: The purpose of this study was to assess fear of falling in community-dwelling older adults and explore participant perceptions of fear of falling assessments and interventions. Methods: A mixed methods case study was utilized to gain an in-depth understanding of older adults' perceptions. It consisted of quantitative data collection by objective measures and qualitative data collection by four individual in-depth interviews. A sample of four community-dwelling adults aged 65 years and older and living in Orlando, Florida, completed the study in their home environment. To combine quantitative and qualitative data for each participant, a case-specific analysis was used, resulting in narratives with a storytelling approach aiming to explore each participant independently. This was followed by a cross-case analysis to gain a more comprehensive understanding of the participants in relation to one another. Results: Four themes emerged: 1) Feedback from an objective measure is valuable; 2) Family experiences with fear of falling drive personal interventions; 3) Fundamental assessments for fear of falling are missing, and 4) Fluctuating definitions of "fear" contribute to difficulty in assessments and interventions. Conclusion: Clear perceptual themes developed to provide a comprehensive understanding of community-dwelling older adults' perceptions of fear of falling assessments and interventions. Future research is needed to determine how to best combine feedback-oriented assessments with established interventions, such as exercise. Standardization of a subjective measure for fear of falling to use in combination with objective measures is also needed. Keywords: assessment, intervention, fear of falling, older adults, community-dwelling, mixed methods