Academic journal article Health and Social Work

Fear of Falling and Activity Avoidance in a National Sample of Older Adults in the United States

Academic journal article Health and Social Work

Fear of Falling and Activity Avoidance in a National Sample of Older Adults in the United States

Article excerpt

Falls represent a major source of death and disability in older people (Gallagher et al., 2001; McKee, Orbell, & Radley, 1999), posing a serious threat to their physical health and psychological well-being (Oakley et al., 1996; Ory et al., 1993; Parker, 2000). Even falls that do not result in physical injury often have serious social and psychological consequences for the elderly population, including loss of confidence (Gallagher et al., 2001; Kressig et al., 2001), fear of falling (Lach, 2005; Martin, Hart, Spector, Doyle, & Harari, 2005; Nourhashemi et al., 2001), depression (Vghooley et al., 1999), and mobility restrictions (Jensen, Nyberg, Rosendahl, Gustafson, & Lundin-Olsson, 2004; Lundin-Olsson, Nyberg, & Gustafson, 2000).

Much work has focused on investigating factors associated with the etiology of falls (Dos & Joseph, 2005; Rigler, 1999). However, less attention has been paid to social and behavioral correlates of falls (Lach, 2005; Li, Fisher, Harmer, & McAuley, 2005; Parker, 2000), including the predisposing factors and consequences of falls.

In a prospective study in 20 independent-living facilities in Atlanta, activity-related fear of falling was higher in African American older adults than it was in Caucasian older adults (Kressig et al., 2001); depression, slow gait, and the use of a walking aid were independently related to fear of falling. Among a representative sample of community-dwelling older adults age 72 years or older, women were about twice as likely as men to experience a fall with serious injury (Tinetti, Doucette, & Claus, 1995). Another study showed that older age and black race were negatively associated with the ability to walk at least eight blocks per week (Simonsick, Guralnik, & Fried, 1999).

Fear of falling has been linked with physical health status and psychological factors. Fear of falling has been associated with lower activities of daily living (ADL) scores; for example, fear of falling was mainly predicted by lower ADL scores and the presence of depression in a study of older adults with chronic dizziness (Burker et al., 1995). In a more recent study of 7,364 women over 75 years of age, fear of falling, but not falls, was significantly associated with having a disability around at least one ADL (Nourhashemi et al., 2001). Consistent with this research, fear of falling has also been independently associated with poor health status in a longitudinal study of 890 community-dwelling older adults (Lach, 2005). Among community-dwelling older women, reductions in mobility accounted for fear of falling more than did psychological factors (Martin et al., 2005). In summary, there is a growing body of evidence that suggests that fear of falling may constitute an important risk factor for unnecessary restriction of activity that can lead to greater disability and ultimately reduced ability to live independently.

Fear of falling has been associated with activity limitation in a few recent studies. In a study of 713 community-dwelling young-old women, for example, fear of falling was related to early reduction of mobility function, suggesting that it may help to identify individuals at risk of subsequent functional decline (Martin et al., 2005). A study of older adults with a fear of falling had marked deficits in strength (lower limb weakness) and slower walking speed, despite living independently in the community and being in good general health, compared with those without fear, which underscores the seriousness of fear of falling as a potential health risk factor in the well elderly population (Brouwer, Musselman, & Culham, 2004).


Theoretical Framework

The beliefs and behaviors of those who fear falling may be understood and examined in the context of threat avoidance logic. The Health Belief Model incorporates this approach by accounting for the perceived susceptibility and seriousness of a threat, perceived benefits of various actions to reduce a threat, and self-efficacy related to one's ability to take actions that will reduce a perceived threat (Rosenstock, 1990). …

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