Fear of Falling and Postural Performance in the Elderly

Maki, Brian E.; Holliday, Pamela J.; Topper, Anne

doi:10.1093/geronj/46.4.m123

Cited by 510 publications

(352 citation statements)

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“…The need for a device that provides greater stability may be evidenced by greater cane use among those who fell. A fear of falling and subsequent limitation in community activity has long been recognized as a risk factor for falls in older adults (34). Recent research indicates that a fear of falling continues to be associated with falls (35)(36)(37).…”

Section: Discussionmentioning

confidence: 99%

A Pilot Study of Factors Associated With Falls in Individuals With Incomplete Spinal Cord Injury

Brotherton¹,

Krause²,

Nietert³

2007

The Journal of Spinal Cord Medicine

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Background/Objective: To determine factors associated with falls among a sample of ambulatory individuals with incomplete spinal cord injury (SCI).Study Design: Cross-sectional mail survey.Methods: A survey instrument of participant characteristics and fall-related variables was developed using relevant items from existing measures and was mailed to 221 individuals with incomplete SCI, who were identified from records of a large specialty hospital in the southeastern United States. Of the 221 prospective participants, 119 completed the questionnaire (54%). Multivariable logistic regression models were used to determine factors that were independently associated with having had a fall in the past year.Results: After adjusting for covariates, having fallen in the past year was significantly (P , 0.05) associated with greater numbers of medical conditions (odds ratio [OR] ¼ 1.3; 95% confidence interval [CI] ¼ 1.0-1.7), having arthritis (OR ¼ 3.4, 95% CI ¼ 1.2-9.6), experiencing dizziness (OR ¼ 5.6, 95% CI ¼ 1.1-27.7), greater numbers of days with poor physical health (OR ¼ 1.1; 95% CI ¼ 1.0-1.3), and the restriction of community activities because of fear of falling (OR ¼ 1.5, 95% CI ¼ 1.1-2.1). The multivariable models also showed that the odds of having fallen were significantly lower among those with better current perceived physical health (OR ¼ 0.5; 95% CI ¼ 0.3-0.9), those with better perceived health compared to a year ago (OR ¼ 0.4; 95% CI ¼ 0.2-0.8), individuals who exercised more frequently (OR ¼ 0.2; 95% CI ¼ 0.1-0.7), and those who used a walker (OR ¼ 0.3; 95% CI ¼ 0.1-0.9). Conclusions:Results suggest that interventions that address exercise frequency, walker use, and dizziness have promise for reducing falls for individuals with incomplete SCI.

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Section: Discussionmentioning

confidence: 99%

A Pilot Study of Factors Associated With Falls in Individuals With Incomplete Spinal Cord Injury

Brotherton¹,

Krause²,

Nietert³

2007

The Journal of Spinal Cord Medicine

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“…On the other hand, this form of anxiety is not present when vision is not available. State anxiety induced by visual anticipation is expected to affect more adversely the elderly's capacity to reweight the available sensory information since cognitive impairment associated with aging affects risk perception in balance threatening conditions (Brown et al 2002;Hatzitaki et al 2005;Maki et al 1991). In addition, elderly adults experience increased trait anxiety in the form of fear of falling (Yardley and Smith 2002) that also leads to higher visual field dependence (Hainaut et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Age-dependent modulation of sensory reweighting for controlling posture in a dynamic virtual environment

Eikema

Hatzitaki

Tzovaras

et al. 2011

AGE

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Older adults require more time to reweight sensory information for maintaining balance that could potentially lead to increased incidence of falling in rapidly changing or cognitively demanding environments. In this study, we manipulated the visual surround information during a collision avoidance task in order to investigate how young and elderly adults engage in sensory reweighting under conditions of visual anticipation. Sixteen healthy elderly (age: 71.5±4.9 years; height: 159.3±6.6 cm; mass: 73.3±3.3 kg) and 20 young (age: 22.8±3.3 years; height: 174.4±10.7 cm; mass: 70.1±13.9 kg) participants stood for 240 s on a force platform under two experimental conditions: quiet standing and standing while anticipating randomly approaching virtual objects to be avoided. During both tasks, the visual surround changed every 60 s from a stationary virtual scene (room) to either a moving room or darkness and then back to a stationary scene to evoke sensory reweighting processes. In quiet standing, elderly showed greater sway variability and were more severely affected by the removal or degradation of visual surround information when compared to young participants. During visual anticipation, sway variability was not different between the age groups. In addition, both young and elderly participants were similarly affected by the degradation or removal of the visual surround. These findings suggest that sensory reweighting in a dynamic virtual environment that evokes visual anticipation interacts with postural state anxiety regardless of age. Elderly show less efficient sensory reweighting in quiet standing due to greater visual field dependence possibly associated with fear of falling.

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“…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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confidence: 99%

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

Iaboni

Flint

2013

The American Journal of Geriatric Psychiatry

225

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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Fear of Falling and Postural Performance in the Elderly

Cited by 510 publications

References 0 publications

A Pilot Study of Factors Associated With Falls in Individuals With Incomplete Spinal Cord Injury

A Pilot Study of Factors Associated With Falls in Individuals With Incomplete Spinal Cord Injury

Age-dependent modulation of sensory reweighting for controlling posture in a dynamic virtual environment

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

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