Anxiety, Depression, and Fall-Related Psychological Concerns in Community-Dwelling Older People.
ABSTRACT OBJECTIVES:: Establish the association between affect and fall-related psychological concerns (fear of falling, fall-related self-efficacy, balance confidence, and outcome expectancy). METHODS:: A total of 205 community-dwelling older people (mean age 81, SD 7.5 years) completed the Geriatric Depression Scale-15, Geriatric Anxiety Inventory, Modified Survey of Activities and Fear of Falling, Falls-Efficacy Scale-International, Activity-Specific Balance Confidence Scale, and the Consequences of Falling Scale. RESULTS:: Hierarchical regression models showed that anxiety was independently associated with all fall-related psychological concerns; depression was only associated with falls efficacy. Associations between fall-related psychological concerns and age, gender, accommodation, medications, self-rated physical health, falls history, mobility, and sensory aids are also discussed. CONCLUSION:: This is the first study that investigates the association between affect and the four fall-related psychological concerns. Anxiety was a significant factor associated with all four, whereas depression was only associated with activity avoidance. Implications for healthcare providers are discussed.
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ABSTRACT: Fear of falling (FOF) is an important threat to autonomy. Current interventions to reduce FOF have yielded conflicting results. A possible reason for this discrepancy could be its multi-causality. Some risk factors could have not been identified and addressed in recent studies. The last systematic review included studies until 2006. To identify additional risk factors for FOF and to test those that have been mentioned previously we conducted a systematic literature review. Studies examining FOF in community dwelling older adults between 2006 and October 2013 were screened. Results are summarized with respect to different constructs such as FOF, fall-related self-efficacy/ balance confidence and fear of falling-related activity restriction. Odds ratios and p-values are reported. There is no clear pattern with regard to the different FOF-related constructs studied. The only parameters that were robustly associated across all constructs were female gender, performance-based and questionnaire-based physical function, the use of a walking aid and – less robust – a history of falls and poor self-rated health. Conflicting results have been identified for depression and anxiety, multiple drugs and psychotropic drugs. Other potentially modifiable risk factors were only mentioned in one or two studies and warrant further investigation. Parameters with mainly negative results are also presented. To conclude, only few of the risk factors identified were robustly associated across all FOF-related constructs and should be included in future studies on FOF. Some newer factors have to be tested again in different cohorts. The comprehensive overview might assist in the conceptualization of future studies.The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 01/2014; · 3.35 Impact Factor
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ABSTRACT: Abstract Purpose: To systematically review and synthesise the research evidence linking pain to psychological concerns about falling in community dwelling older adults. Methods: A systematic review was conducted in accordance with the preferred reporting items of systematic reviews and meta-analysis statement (PRISMA). Major electronic databases were searched from inception until June 2013. Two authors independently conducted the searches, extracted data and completed methodological quality assessments. Articles were included if they measured one of the psychological concerns related to falling in a sample of community dwelling older adults with pain, or explored the association between the two. Results: Of a potential 892 articles, 12 met the eligibility criteria (n = 3398). The methodological quality of the included studies was variable and none of the included studies primary aim was to investigate the relationship between pain and psychological concerns related to falls. Two studies found significant differences in psychological concerns related to falls in older adults with pain and a control group. Nine out of 10 studies reported a significant correlation between pain and psychological concerns related to falls in their sample. Conclusion: This review provides provisional evidence that pain is associated with fear of falling (FOF), avoidance of activities due to FOF and falls efficacy in community dwelling older adults. Implications for Rehabilitation Pain is a common and pervasive problem in community dwelling older adults and can affect an individual's mobility, levels of physical activity and increase their falls risk. Psychological concerns related to falls, such as fear of falling (FOF), falls efficacy and balance confidence are also common and troublesome issues in older adults, yet the association with pain has not been investigated with a systematic review. This review provides provisional evidence that pain may increase older adult's risk of developing FOF, avoiding activities due to a FOF and impact their falls efficacy. In recognition of the findings of this review, clinicians working with older adults with pain should consider assessing psychological concerns related to falls and if necessary intervene if they identify an individual at risk.Disability and Rehabilitation 01/2014; · 1.84 Impact Factor