The impact of fear of falling on functional independence

Falls are the fifth leading cause of death for persons over the age of 55 (CDC, 2010). However, not all falls result in death. In 2006, 10.5% or 2.1 million visits to the emergency room were the result of older adults falling. Non-fatal falls have long-term effects that impact a person\u27s well-being physically, financially, and emotionally. It is estimated that health care costs of non-fatal falls is expected to reach $54.9 billion by 2020 (Englander, Hodson & Terregrossa, 1996). Intrinsic and extrinsic fall risk factors have been identified for persons over the age of 65. Intrinsic fall risk factors include age, gender, ethnicity, medical conditions, number and type of medications, impaired mobility/gait, impaired vision, impaired cognition, psychological status, poor nutritional status, sedentary behavior, living alone, and a history of falls. Extrinsic fall risk factors include poor lighting, slippery floors, uneven surfaces, inappropriate walking aids, and lack of assistive devices (Feder, 2000; Lord, Sherrington, & Menz, 2000). A less understood fall risk factor is the fear of falling. Therefore, an emotional rather than physical component fear of falling is known to increase the risk of falls (Friedman, et al., 2002). This is highly relevant given that approximately half of community-dwelling older adults experience a fear of falling (Howland et al., 1993). Recent falls is a known cause for developing a fear of falling . However, fear of falling is also reported to be prevalent among non-fallers (Vellas, et al., 1997). Up to 70% of recent fallers and up to 40% of those not reporting recent falls acknowledge experiencing a fear of falling (Arfken, 1994; Tinetti, 1994; Tinetti, Speechley, & Ginter, 1988). Of greater relevance is that up to 50% of people who report fear of falling restrict or eliminate social and physical activities because of that fear (Tinetti et al., 1988). Researchers hypothesize that fear of falling begins a cycle of decreased activity that leads to loss of independence followed by further debility that increases the risk of further falls (Arfken, Lach, Birge et al., 1994). The purpose of this correlational study is to evaluate the impact of fear of falling on functional independence for older adults living in a border community under the care of home health services. The Health Belief Model is used to understand how fear of falling impacts functional independence (one\u27s perceived susceptibility to fear of falling, one\u27s perceived level of severity to fear of falling and self-efficacy, which is the person\u27s perception of his/her capabilities within specific situations and activities). Ninety nine participants greater than or equal to 65 years of age were recruited from a convenience sample of home health patients receiving services from two local home health agencies. Fear of falling was measured using the Falls Efficacy Scale (FES) (Tinetti, Richman & Powell, 1990) and activities of daily living (ADL) were measured using the KATZ ADL-staircase (Sonn & Hulter-Åsberg, 1991). The research questions used to guide this study were: Fear of falling will improve prediction of functional independence when considered with other known fall risk factors (KATZ ADL-staircase) (gender, number of medications, age, FES, subjective question fear of falling, socio-economic status and number of diagnoses). For participants in this study, there was a significant correlation between fear of falling and independence with ADL. Furthermore, results of a regression analysis indicated that reported fear of falling and FES scores both contributed to strengthen a model to predict participant\u27s level of functional independence. However, fear of falling did not contribute to predicting these participants\u27 history of falls. Reported number of falls was best predicted with a model that included number of diagnoses, number of medications, and age. Future research should incorporate and evaluate the efficacy of using an interdisciplinary team approach for an intervention to prevent falls and reduce the impact of fear of falling on functional independence of older adults living in the community