Does Fear of Falling Influence Spatial and Temporal Gait Parameters in Elderly Persons Beyond Changes Associated With Normal Aging?

Chamberlin, Melissa E.; Fulwider, Brandy D.; Sanders, Sheryl L.; Medeiros, John M.

doi:10.1093/gerona/60.9.1163

Cited by 217 publications

(171 citation statements)

References 18 publications

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“…In this study, FOF was assessed using a quick, simple and clinically useful dichotomous question similar to what has been used in other studies [10,16,29]. While self-efficacy scales are sometimes used [9,10], they reflect confidence in the ability to carry out a range of activities, therefore they are not exactly the same construct and are not directly comparable [30]. Finally, gait variability for each participant was calculated from a minimum of six strides.…”

Section: Discussionmentioning

confidence: 99%

“…Existing studies have found reduced gait speed [8][9][10], reduced step or stride length [9,11], increased step width and increased double support phase (DSP) [9] in those with FOF but similar changes are observed with increasing age [12,13], depression [14] and with a history of falls [15], all of which are also associated with FOF. Rochat et al [16] found similar gait changes between groups with no FOF, FOF alone and FOF with activity restriction but while the differences between the no FOF and FOF alone groups were fully explained by confounding variables, those with FOF and activity restriction had decreased gait performance and increased gait variability independent of health and functional status.…”

Section: Introductionmentioning

confidence: 87%

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Effects of fear of falling and activity restriction on normal and dual task walking in community dwelling older adults

Donoghue¹,

Cronin²,

Savva³

et al. 2013

Gait & Posture

114

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Fear of falling (FOF) is associated with poor physical and psychosocial health and can have debilitating consequences especially when it leads to activity restriction. This study examined whether normal and dual task gait disruptions were independently associated with FOF and activity restriction or if they were fully explained by impaired health status. Data was obtained from The Irish Longitudinal Study on Ageing (TILDA). Community dwelling adults =65 years, with a Mini-Mental State Examination score =18 and who completed a gait assessment (n=1307) were divided into three groups: no FOF, FOF but no activity restriction (FOF-NAR), FOF with activity restriction (FOF-AR). Physical, psychosocial and cognitive measures were obtained and gait characteristics were assessed using a GAITRite(®) mat during normal and dual task (cognitive) walking. After adjusting for sociodemographics, physical, mental and cognitive health, FOF was associated with reduced gait speed and stride length and increased double support phase and step width in normal and dual task conditions; these changes were most pronounced in those who restrict activities as a result of FOF. These gait changes may be associated with an increased fall risk, however some changes especially increased step width may also reflect positive, compensatory adaptations to FOF. The results also highlight the importance of treating underlying health impairments and preventing the transition from FOF to activity restriction

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 87%

Effects of fear of falling and activity restriction on normal and dual task walking in community dwelling older adults

Donoghue¹,

Cronin²,

Savva³

et al. 2013

Gait & Posture

114

View full text Add to dashboard Cite

show abstract

“…The absence of vision during backward walking places higher demands on already age impaired sensorimotor function [34]. This can result in the older adult taking shorter strides and using a slower velocity as they try to minimize the feeling of falling [4,35,36]. Other explanations for decreased backward walking velocity include lower extremity muscle weakness, hip flexion contractures and generalized deconditioning all of which are common in the older population.…”

Section: Backward Walking Variables Mean (Sd) N=58mentioning

confidence: 99%

Relationship of backward walking to clinical outcome measures used to predict falls in the older population: A factor analysis

Maritz¹,

Silbernagel²,

Pohlig³

2017

Phys Ther Rehabil

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Background: Backward walking has been found to be a more sensitive measure to detect fallers than forward walking. It involves greater reliance on neuromuscular control to make up for the lack of vision. In fact, backward walking speed has been determined to more accurately identify fallers in the older population than forward walking. This study examined if backward walking measures more than one underlying factor while also examining the relationship between it and other clinical measures used to identify falls risk. Methods: A convenience sample of 57 older adults (10 males and 47 females) with a mean age of 78.8 years (SD 8.9 years) participated in this cross-sectional study. Subjects walked backward on the GAITRite ® computerized walkway system recording gait velocity, stride and step length, stance and swing time, single and double support. Additionally, subjects were tested on clinical measures commonly used to assess falls risk which included the Timed up and go test, Four square step test, Activity-specific balance confidence scale, single heel rise test and the 30-second chair stand test. An exploratory factor analysis with Maximum Likelihood extraction and Varimax rotation was performed on various aspects of backward walking. The relationship between the backwards walking factor scores and selected clinical measures was tested using Spearman correlations and regression. Results: Results revealed that there are two factors associated with backward walking: cadence and velocity. Cadence was only mildly correlated to 30-second chair stand test, r=0.29; whereas velocity was highly correlated with each of the known predictors of falls used, all r>0.44. Conclusion: Given theses findings, a clinician could quickly measure backward walking velocity and count the number of steps an individual takes in order to screen those at-risk for falls.

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“…Anxious elders walk more slowly, take shorter strides, have a wider base, and have a longer double limb support time and higher gait variability. 40,41 Those who are most concerned about falling tend to make disproportionate adjustments to gait speed in response to postural threat. 30 There is some evidence that a slowed gait is maladaptive and reduces, rather than improves, stability.…”

Section: Fear Of Fallingmentioning

confidence: 99%

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

Iaboni

Flint

2013

The American Journal of Geriatric Psychiatry

227

178

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Depression and falls have a significant bidirectional relationship. Excessive fear of falling, which is frequently associated with depression, also increases the risk of falls. Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways. The management of depression in fall-prone individuals is challenging, since antidepressant medications can increase the risk of falls, selective serotonin reuptake inhibitors may increase the risk of fragility fractures, and data are lacking about the effect of fall rehabilitation programs on clinically significant depression. Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive-behavioral therapy should be considered for the first-line treatment of mild depression in older fallers. Antidepressant medications are indicated to treat moderate to severe depression in fall-prone individuals, but with appropriate precautions including low starting dose and slow dose titration, use of psychotropic monotherapy whenever possible, and monitoring for orthostatic hypotension and hyponatremia. To date, there have been no recommendations for osteoporosis monitoring and treatment in individuals prescribed antidepressant medications, beyond the usual clinical guidelines. However, treatment of the older depressed person who is at risk of falls provides the opportunity to inquire about his or her adherence with osteoporosis and fracture-prevention guidelines. KeywordsAntidepressants; depression; falls; fear of falling; fractures One-third of community-dwelling seniors fall each year, with half of these individuals falling more than once. Ten percent of all falls result in a major injury, which can lead to institutionalization and death. 1 Falls often result in a fear of further falls, leading to fearrelated restriction of activities: this activity restriction has been associated with subsequent impairment in balance, mobility, and disability. 2,3 Send correspondence and reprint requests to Alastair

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Does Fear of Falling Influence Spatial and Temporal Gait Parameters in Elderly Persons Beyond Changes Associated With Normal Aging?

Cited by 217 publications

References 18 publications

Effects of fear of falling and activity restriction on normal and dual task walking in community dwelling older adults

Effects of fear of falling and activity restriction on normal and dual task walking in community dwelling older adults

Relationship of backward walking to clinical outcome measures used to predict falls in the older population: A factor analysis

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

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