Fear of Falling Among Seniors: Needs Assessment and Intervention Strategies Susan L. Murphy ScD, OTR World Federation of Occupational Therapy Conference June 2002, Stockholm Sweden (part 2 of talk with co-presenter Elizabeth Walker- Peterson MPH OTR/L)

Objectives Describe fear of falling in terms of its prevalence, contributing factors, and consequences Discuss research-based strategies to screen clients Describe and compare several fear of falling assessments

Falls and Fear of Falling 1 in 3 persons 65 and older experience at least one fall each year Falls are responsible for 40% of nursing home admissions Falls can result in soft tissue injuries, fractures, and conditions resulting from long lies on the floor or ground

Fear of Falling Definition: A lasting concern about falling that can lead to an individual avoiding activities that he/she remains capable of performing (Tinetti and Powell, 1993). Described as a problem seen in the clinic and in the community

Prevalence of Fear of Falling % of community-living seniors 46% of nursing home residents 50% of seniors with rheumatoid arthritis 47% of seniors with chronic dizziness More women report fear of falling than men –may be an underreporting by men –with advanced age, women are at greater risk for falls and fall injuries

Who Develops Fear of Falling and Why? Longitudinal study of community-living older women (Murphy, Dubin, & Gill) – Factors which predisposed women to reporting fear of falling at follow-up age over 80 visual impairment sedentary lifestyle lack of available emotional support

Who Develops Fear of Falling and Why? Joint contribution of predisposing factors and fall events after baseline: –Predisposing factors were more strongly related to developing fear of falling than fall events –Appears necessary to prevent and treat fear of falling in older women regardless of whether they have a history of falls

Possible Consequences of Fear of Falling Increased caution during activity performance Excessive restriction of activities Diminished quality of life

The Impact of Fear of Falling on Activity Performance Restricts activity Physical capabilities reduced Restricts more activities More impaired physical capabilities Fear of falling

The Impact of Fear of Falling on Quality of Life Fear of Falling Activity Restriction Diminished Quality of Life Reduced social interaction Preoccupied thoughts Extreme anxiety

Results of Longitudinal Studies Fear of Falling at baseline associated with several negative outcomes at follow-up: Increased risk for falls declines in ability to perform ADLs declines in gait lower health-related quality of life increased risk of nursing home admission (Cumming et al., 2001, Vellas et al., 1997)

Screening Seniors for Fear of Falling

Fear of Falling A lasting concern about falling that can lead to an individual avoiding activities that he/she remains capable of performing For screening purposes, it is necessary for the therapist to assess a senior’s: –Personal abilities –Activity performance Assess in conjunction with screening instruments

Activity Performance Current activities performed –environmental constraints Fearfulness while performing activities Which activities are being restricted –activities necessary for independent living –activities that are meaningful for individual

When Is Fear of Falling a Problem? Personal AbilitiesActivity Performance Person is performing activities that are appropriate for level of abilities

When Is Fear of Falling a Problem? Personal Abilities Activity Performance Person has excessive fear or is restricting activities that he/she should otherwise be able to perform

Screening Instruments Direct Assessments Indirect Assessments

Fear of Falling Instruments Purpose Items included (#, Type) Population tested (If applicable) Validity Reliability Pros Cons

Validity and Reliability Criterion Construct Content Validity (Does the instrument test what it is supposed to test?) Internal Consistency Test-Retest Reliability (Does the instrument measure consistently over time?)

Howland-Peterson Index How concerned are you that you will fall and hurt yourself in the next year? 1 = Very concerned 4 = Not at all concerned + useful to measure prevalence -- difficult to detect change

Choosing an Instrument Client’s status –Functional level –Health issues Response to instrument’s wording –Negative vs. Positive Characteristic the instrument measures –Fear –Restriction –Confidence Purpose of using a screening instrument –Comparison –Pre and post test