Fear of falling and restriction of mobility in elderly fallers

Abstract

Objectives: to identify the characteristics of elderly persons who develop a fear of falling after experiencing a fall and to investigate the association of this fear with changes in health status over time. Design: a prospective study of falls over a 2-year period (1991-92). Falls were ascertained using bimonthly postcards plus telephone interview with a standardized (World Health Organisation) questionnaire for circumstances, fear of falling and consequences of each reported fall. Each participant underwent a physical exam and subjective health assessment each year from 1990 to 1993. Setting: New-Mexico Aging Process Study, USA Subjects: 487 elderly subjects (> 60 years) living independently in the community. Main outcome measures: fear of falling after experiencing a fall. Results: 70 (32%) of 219 subjects who experienced a fall during the 2 year study period reported a fear of falling. Women were more likely than men to report fear of falling (74% vs 26%). Fallers who were afraid of falling again had significantly more balance (31.9% vs 12.8%) and gait disorders (31.9% vs 7.4%) at entry in the study in 1990, Among sex, age, mental status, balance and gait abnormalities, economic resource and physical health, logistic regression analysis show gait abnormalities and poor self-perception of physical health, cognitive status and economic resources to be significantly associated with fear of falling. Subjects who reported a fear of falling experienced a greater increase in balance (P = 0.08), gait (P < 0.01) and cognitive disorders (P = 0.09) over time, resulting in a decrease in mobility level. Conclusion: the study indicated that about one-third of elderly people develop a fear of falling after an incident fall and this issue should be specifically addressed in any rehabilitation programme.