1: Am J Phys Med Rehabil 2001 Sep;80(9):662-73 Developing meaningful Fear of Falling Measures for community dwelling elderly. Velozo CA, Peterson EW. Department of Occupational Therapy, University of Illinois at Chicago, 60612, USA.

OBJECTIVE: The objective of this study is to demonstrate how a Rasch analytic approach can be used to create fear of falling measures that remain connected to the meaningful descriptions provided by the instrument items. DESIGN: The University of Illinois at Chicago Fear of Falling Measure was developed using focus groups and consists of 19 common activities designed to represent an increasing level of concern about falling among older adults. RESULTS: Rasch analysis of responses from 106 community dwelling elderly revealed that the two middle rating scale categories (a little worried and moderately worried) were not being used in the expected fashion. After modification of the rating scale, Rasch analysis showed that the three items causing the least worry (get dressed, get on/off toilet, and get in/out of bed) were statistically erratic. CONCLUSION: Final analysis demonstrated that the remaining 16 items represented a unidimensional construct that, in general, supported the original expected item difficulty hierarchy. Because person and item measures were calibrated on the same linear scale person measures are translatable to item descriptions. This connection provides meaning to the numeric values obtained from the instrument and provides a basis for setting clinically relevant criteria for interventions. Publication Types: Validation Studies PMID: 11523969 [PubMed - indexed for MEDLINE]

2: Arch Phys Med Rehabil 2001 Sep;82(9):1238-44. The influence of falling, fear of falling, and balance confidence on prosthetic mobility and social activity among individuals with a lower extremity amputation.  Miller WC, Deathe AB, Speechley M, Koval J. Faculty of Medicine, School of Rehabilita-tion Sciences, University of British Colum-bia, Vancouver, BC, Canada. bcmil-ler@telus.net

OBJECTIVE: To assess in amputee patients the relationship between having fallen in the past 12 months, fear of falling, and balance confidence on mobility capability, mobility performance, and social activity. DESIGN: Population-based survey and chart review. SETTING: Two university-affiliated outpatient amputee programs in southwestern Ontario. PARTICIPANTS: Community-living individuals (n = 435) with a unilateral lower limb amputation. INTERVENTIONS: Patient chart review and a survey questionnaire. MAIN OUTCOME MEASURES: Self-report assessment of prosthetic capability and performance and social activity participation was assessed with the Prosthetic Evaluation Questionnaire mobility subscale, the Houghton Scale, and the Frenchay Activities Index. RESULTS: Falling experiences in the past 12 months were not significantly associated with any outcomes. Fear of falling was important in univariate relationships in all 3 outcomes, but not when balance confidence was included in multivariable modeling. Balance confidence was statistically significant with each of the outcomes and remained significant with inclusion of the covariates. There was statistical interaction (balance confidence x automatism; balance confidence x medication count) in modeling mobility capability and in modeling mobility performance (balance confidence x pain + balance confidence x amputation level). The final models accounted for 70%, 60%, and 55% of the variation in mobility capability, mobility performance, and social activity, respectively. CONCLUSION: Balance confidence was the only factor associated with mobility capability and performance and social activity in the final adjusted models. Clinicians and researchers should consider this variable in the rehabilitation of amputee patients.  PMID: 11552197 [PubMed - indexed for MEDLINE]

3: Arch Phys Med Rehabil  2001 Aug;82(8):1031-7.  The prevalence and risk factors of falling and fear of falling among lower extremity amputees.  Miller WC, Speechley M, Deathe B.  Faculty of Medicine, School of Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada. bcmiller@telus.net

OBJECTIVE: To estimate the falling experience and fear of falling status and to describe characteristics associated with falling and fear of falling. DESIGN: Population-based consecutive sample survey and chart review. SETTING: Two Canadian, regional, university-affiliated outpatient amputee clinics. PARTICIPANTS: The sample (n = 435; mean age, 62 +/- 15.7 yr) of community-living participants was mostly male (71%), had unilateral (below knee 73%; above knee 27%) amputations primarily for vascular (53% vs 47% nonvascular) reasons. INTERVENTION: Review patient charts and survey questionnaires to determine sociodemographic information (eg, social support), information about the amputation (eg, cause, level, problems), physical health and function (eg, pain, limitations, comorbidity), and psychologic state (depression, adaptation). MAIN OUTCOME MEASURES: Occurrence of a fall in the past 12 months and presence of a fear of falling. RESULTS: Exactly 52.4% subjects reported falling in the past year, whereas 49.2% reported a fear of falling. Logistic regression analyses revealed falling was related to having an above knee amputation (odds ratio [OR] = 2.78; 95% confidence interval [CI] = 1.71-4.51), back (OR = 1.96; 95% CI = 1.08-3.54) and joint (OR = 1.67; 95% CI = 1.01-2.74) pain, and multiple stump and prosthesis problems (OR = 3.09; 95% CI = 1.58-6.04). Having had the amputation > or = 4 years in the past was protective (OR =.53; 95% CI =.29-.89). Factors related to an increase risk of fear of falling included having to concentrate on each step while walking (OR = 4.06; 95% CI = 2.46-6.71) and having a fall in the past 12 months (OR = 1.62; 95% CI = 1.04-2.54), whereas being male (OR = 0.35; 95% CI =.21-.57) and having good to excellent perceived health (OR =.35; 95% CI =.21-.58) were protective. CONCLUSIONS: Falling and fear of falling are pervasive among amputees. Comprehensive and ongoing intervention and education should be considered. Research is required to assess the consequences of falling and fear of falling.  PMID: 11494181 [PubMed - indexed for MEDLINE]

4: Exp Brain Res  2001 May;138(2):210-8.  The influence of postural threat on the control of upright stance.  Carpenter MG, Frank JS, Silcher CP, Peysar GW.  Neural Control Laboratory, University of Waterloo, Waterloo, Ontario, Canada.

In order to utilize static posturography as a tool with which to diagnose pathological balance disorders, it is necessary to understand the contribution of psychological factors such as fear of falling. In this study we examined kinetic and kinematic parameters during quiet stance of eight young healthy adults standing under three conditions which posed increasing levels of postural threat. Participants were required to stand quietly, both with and without visual information and with normal or reduced vestibular information for 2-min periods at each of three surface conditions: ground level (low threat), 81 cm above the ground completely surrounded by a support surface (medium threat) and 81 cm above ground at the edge of the surface (high threat). In addition to calculating displacement and frequency measures for movements of centre of pressure (COP) and centre of mass (COM), a measure of stiffness was derived from the difference between COP-COM signal. Mean EMG activity was recorded bilaterally from anterior and posterior muscles of the lower and upper leg. A stiffening strategy was adopted when individuals stood under high threat conditions involving significant changes in kinematic, kinetic and EMG variables. The A-P stiffness constant increased significantly (27.5%) for the high threat compared to low threat condition, independent of vision or vestibular information. Changes in stiffness were accompanied by: (1) backward shift of the mean A-P position of COP and COM, (2) increased mean power frequency and decreased amplitude displacement of the COP and (3) decreased amplitude displacements of the COM. Of the significant changes observed in mean EMG activity with increased postural threat, only tibialis anterior was significantly correlated with increased stiffness, while activity in soleus, medial gastrocnemius and rectus femoris was highly correlated with mean position of COP.  PMID: 11417462 [PubMed - indexed for MEDLINE]

5: Arch Phys Med Rehabil  2000 Nov;81(11):1485-8.  Hypocapnia and its relation to fear of falling.  Clague JE, Petrie PJ, Horan MA.  Geriatric Medicine, Clinical Division 1, University of Manchester, UK.

OBJECTIVE: To determine if hypocapnia occurs in patients with fear of falling and to explore potential causes of hypocapnia. DESIGN: Observational study in patients who fall with and without fear of falling. SETTING: Rehabilitation wards of an elderly care unit. PATIENTS: Consecutive fallers with (n = 20) and without (n = 10) fear of falling. MAIN OUTCOME MEASURES: End-tidal CO2 (PETCO2) and respiratory rate (RR) responses were measured during sustained isometric muscle contraction (SIMC) (40% of maximum voluntary contraction of quadriceps for 2 min) and during a 5-meter walk. Falls efficacy scale (FES) and Hospital anxiety and depression scale (HAD). RESULTS: Patients with fear of falling had significantly higher FES and HAD scores (p < .01). During SIMC, baseline and nadir PETCO2 levels were significantly lower in patients with a fear of falling (p < .01). During the 5-meter walk, PETCO2 was lower at baseline, at nadir, and at the end of the walk in the fear of falling group than in controls (p < .01). RR was higher at nadir and end of the walk in the fear of falling group than in controls (p < .02). CONCLUSIONS: Hypocapnia may occur in patients with a fear of falling during SIMC and walking. Anxiety seems to be the main cause, but muscle weakness may contribute. Breathing or relaxation techniques and reconditioning may have a role in treating fear of falling in the rehabilitation setting.  Publication Types: Clinical Trial.  PMID: 11083352 [PubMed - indexed for MEDLINE]

OBJECTIVE: To investigate the relation between fall-related efficacy in daily-life activities and functional as well as instrumental tests of balance in patients with hip fracture. DESIGN: Analysis of different aspects of balance using the Falls Efficacy Scale, Swedish version FES(S), questions on fear of falling, Functional Reach (FR) and tests on a balance platform (Chattanooga). SUBJECTS: Fifty-five elderly inpatients (mean age 82.3) with newly operated hip fracture who were assessed during the last week in hospital before discharge. RESULTS: The results showed a significant relationship between the subjective ability measured with the FES(S) and the objectively measured balance in the Functional Reach test and also between fall-related efficacy measured with FES(S) and fear of falling. Very few significant correlations were found between the results from balance tests on the force platform and those obtained with FES(S) and FR. CONCLUSIONS: Both the Falls Efficacy Scale, Swedish version, and the Functional Reach have been shown to be useful in analysing balance function in elderly patients newly operated on for hip fracture. The Falls Efficacy Scale also indicates which of the daily activities the patient perceives as troublesome and thus require further training.  PMID: 11043875 [PubMed - indexed for MEDLINE]

BACKGROUND: The aim of this study was to assess the impact of fear of falling on the health of older people. METHODS: A total of 528 subjects (mean age 77 years) were recruited from two hospitals in Sydney, Australia, and followed for approximately 12 months. Eighty-five subjects died during follow-up, and 31 were admitted to an aged care institution. Tinetti's Falls Efficacy Scale (FES) was successfully administered to 418 subjects as part of the baseline assessment. Among those with baseline FES scores, ability to perform 10 activities of daily living (ADLs) was assessed at baseline and follow-up in 307 subjects, and SF-36 scores were assessed at baseline and follow-up in 90 subjects recruited during the latter part of the study. Falls during follow-up were identified using a monthly falls calendar. RESULTS: Compared with those with a high fall-related self-efficacy (FES score = 100), those with a low fall-related self-efficacy (FES score < or = 75) had an increased risk of falling (adjusted relative risk 2.09, 95% confidence interval [CI] 1.31-3.33). Those with poorer fall-related self-efficacy had greater declines in ability to perform ADLs (p < .001): the total ADL score decreased by 0.69 activities among persons with low FES scores (< or =75) but decreased by only 0.04 activities among persons with FES scores of 100. Decline in ADLs was not explained by the higher frequency of falls among persons with low FES scores. SF-36 scores (particularly scores on the Physical Function and Bodily Pain subscales) tended to decline more among persons with poor fall-related self-efficacy. Nonfallers who said they were afraid of falling had an increased risk of admission to an aged care institution. CONCLUSIONS: Fear of falling has serious consequences for older people. Interventions that successfully reduce fear of falling and improve fall-related self-efficacy are likely to have major health benefits.  PMID: 10819321 [PubMed - indexed for MEDLINE]

OBJECTIVE: The purpose of this study was to determine the relationship between physical function and fall-related self-efficacy in older patients with a hip fracture who are undergoing an intensive rehabilitation program. DESIGN: We used a prospective cohort study over 12 mo to determine the effect of a specialized hip fracture rehabilitation program in a geriatric hospital on physical function and fear of falling. Fifty-six patients were admitted consecutively from acute care. Physical function was assessed using the Functional Independence Measure, and fall-related self-efficacy was measured using two scales: the Falls-Efficacy scale and the Activities-Specific Balance Confidence scale. We also used the Vitality scale to measure quality of life. All measures, represented by change scores, were determined at the beginning and end of the patients' rehabilitation programs. RESULTS: Significant improvement in physical function and fall self-efficacy was observed. The Vitality scale was also improved after rehabilitation. The Falls-Efficacy scale appeared to be more sensitive to change than the Activities-Specific Balance Confidence scale, whereas no correlation was found between changes in the fall-related self-efficacy measures and the Functional Independence Measure. CONCLUSIONS: These findings may represent a discrepancy between attention of the rehabilitation program on functional outcomes and less emphasis on confidence building behaviors. Restrictions in function from a fear of falling may negate any gains made through rehabilitation, and this could limit the long-term success of these programs and patient outcomes after hip fracture.  PMID: 10744190 [PubMed - indexed for MEDLINE]

11: Hosp Case Manag  2000 Mar;8(3):44.  Help patients recover from the fear of falling.  PMID: 11066596 [PubMed - indexed for MEDLINE]

12: BMJ  2000 Feb 5;320(7231):341-6.  Comment in:  BMJ. 2000 Apr 29;320(7243):1206.  Quality of life related to fear of falling and hip fracture in older women: a time trade off study.  Salkeld G, Cameron ID, Cumming RG, Easter S, Seymour J, Kurrle SE, Quine S.  Social and Public Health Economics Research Group (SPHERe), Department of Public Health, University of Sydney, New South Wales 2006, Australia.

13: Clin Rehabil  1999 Dec;13(6):509-17.  Fear of falling in patients with stroke: a reliability study.  Hellstrom K, Lindmark B.  Department of Neuroscience/Rehabilitation Medicine, Uppsala University, Sweden.  Karin.Hellstrom@SjukGym.uu.se

14: Clin Excell Nurse Pract  1999 Sep;3(5):254-61.  Defying gravity and fear: the prevention of falls in community-dwelling older adults.  Baumann SL.  Hunter College, City University of New York, NY 10010, USA. sbaumann@shiva.hunter.cuny.edu

15: J Gerontol B Psychol Sci Soc Sci  1998 Nov;53(6):P384-92.  A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults.  Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A.  New England Research Institutes, Watertown, Massachusetts, USA. sharont@neri.org

A randomized, single-blind controlled trial was conducted to test the efficacy of a community-based group intervention to reduce fear of falling and associated restrictions in activity levels among older adults. A sample of 434 persons age 60+ years, who reported fear of falling and associated activity restriction, was recruited from 40 senior housing sites in the Boston metropolitan area. Data were collected at baseline, and at 6-week, 6-month, and 12-month follow-ups. Compared with contact control subjects, intervention subjects reported increased levels of intended activity (p < .05) and greater mobility control (p < .05) immediately after the intervention. Effects at 12 months included improved social function (p < .05) and mobility range (p < .05). The intervention had immediate but modest beneficial effects that diminished over time in the setting with no booster intervention.  Publication Types: Clinical Trial Randomized Controlled Trial.  PMID: 9826971 [PubMed - indexed for MEDLINE]

16: Gerontologist  1998 Oct;38(5):549-55.  Covariates of fear of falling and associated activity curtailment.  Howland J, Lachman ME, Peterson EW, Cote J, Kasten L, Jette A.  Boston University School of Public Health, MA 02118, USA. jhowl@bu.edu

With a sample survey (N = 266) of elderly adults residing in six housing developments in Massachusetts, we used logistic regression to: (a) identify covariates of fear of falling among all subjects and (b) identify covariates of activity curtailment among the subset of subjects who were afraid of falling. Fifty-five percent of respondents were afraid of falling; of those who were afraid, 56% had curtailed activity due to this fear. Factors associated with fear of falling were: being female, having had previous falls, and having fewer social contacts. Factors associated with activity curtailment among those who were afraid were: not communicating about falls; having less social support; and knowing someone who had fallen. Falls history appears an important contributor to fear of falling, whereas the impact of this fear on activities appears more a function of social support. These findings suggest different strategies for the primary and secondary prevention of fear of falling.  PMID: 9803643 [PubMed - indexed for MEDLINE]

17: J Aging Health  1998 Aug;10(3):267-86.  Intensity and correlates of fear of falling and hurting oneself in the next year: baseline findings from a Roybal Center fear of falling intervention.  Lawrence RH, Tennstedt SL, Kasten LE, Shih J, Howland J, Jette AM.  New England Research Institutes, USA.

18: J Gerontol B Psychol Sci Soc Sci  1998 Jan;53(1):P43-50.  Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE).  Lachman ME, Howland J, Tennstedt S, Jette A, Assmann S, Peterson EW.Department of Psychology, Brandeis University, Watertown, Massachusetts, USA. lachman@brandeis.edu

A new instrument was developed to assess the role of fear of falling in activity restriction. The instrument assesses fear of falling during performance of 11 activities, and gathers information about participation in these activities as well as the extent to which fear is a source of activity restriction. The instrument demonstrated good internal consistency reliability and showed convergent validity with other fear of falling measures. Concurrent (empirical) validity was demonstrated in that the scale was effective in differentiating among those who were expected to be afraid vs. not afraid of falling. Criterion validity was examined in relation to quality of life variables. Fear of falling was shown to be related to lower quality of life, even when controlling for related background factors. One advantage of this measure over existing measures is the possibility for differentiating fear of falling that leads to activity restriction from fear of falling that accompanies activity. This may provide useful information for those interested in treating fear of falling of promoting activity among the elderly.  PMID: 9469171 [PubMed - indexed for MEDLINE]

19: Phys Ther  1997 Sep;77(9):904-17.  Use of the "fast evaluation of mobility, balance, and fear" in elderly community dwellers: validity and reliability.  Di Fabio RP, Seay R. Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis 55455, USA. difab001@maroon.tc.umn.edu

BACKGROUND AND PURPOSE: Identifying elderly community dwellers who are at risk for falling was assessed using a comprehensive screening tool referred to as the "Fast Evaluation of Mobility, Balance, and Fear" (FEMBAF). The purpose of this study was to evaluate the concurrent validity and reliability of scores on the FEMBAF. SUBJECTS: Thirty-five elderly persons living in the community (4 men, 31 women), with a mean age 79.9 years (SD = 8.5, range = 60-92), participated. METHODS: Subjects were tested using the FEMBAF and three other instruments-the balance subscale of the Tinetti Performance-Oriented Mobility Assessment (B-POMA), the Clinical Test of Sensory Interaction on Balance (CTSIB), and the Timed Up and Go Test. Scores on the FEMBAF were compared with scores on each the other instruments using Spearman rank-order correlation coefficients and analysis of covariance (with age as the covariate) for living status and diagnostic category. A comparison of the number of subjects classified as being at risk for falling was done descriptively for the FEMBAF, B-POMA, and CTSIB. RESULTS: Associations (r > .35) were found between the FEMBAF and each of the other instruments in the areas of FEMBAF risk-factor count, task completion, mobility, and strength. The FEMBAF classified a greater number of subjects as being at risk for falling (89%) compared with the B-POMA (43%) and the CTSIB (63%). The mean chance-corrected percentage of agreement between raters on the FEMBAF was kappa = .95 (SD = .15) for assessment of risk factors and kappa = .96 (SD = .12) for task completion. CONCLUSION AND DISCUSSION: The FEMBAF provides valid and reliable measurements of risk factors, functional performance, and factors that hinder mobility.  PMID: 9291948 [PubMed - indexed for MEDLINE]

20: Arthritis Care Res  1997 Aug;10(4):222-8.  Correlates of fear of falling and activity limitation among persons with rheumatoid arthritis.  Fessel KD, Nevitt MC.  Department of Quality and Utilization, Permanente Medical Group, Oakland, California 94612-3429, USA.

OBJECTIVES: To examine factors associated with fear of falling, activity limitation due to fear of falling, and how persons modified their activities in response to fear of falling, among older persons with rheumatoid arthritis (RA). METHODS: Participants in a panel study of RA who were over age 50 (n = 570) were questioned about whether they experienced fear of falling and whether and how they limited activities due to fear of falling. RESULTS: Fifty percent reported fear of falling, and 38% modified activities due to fear of falling. Correlates of fear of falling included female gender, depressive symptoms, poor physical functioning, minor fall-related injuries, and a greater number of painful joints. Correlates of limiting activities due to fear of falling included worse self-rated health, poor physical functioning, and high painful joint count. Activities commonly affected included stair climbing, walking, and outings. CONCLUSIONS: Fear of falling and limiting activities are common problems for persons with RA. Persons at risk should be targeted for appropriate interventions.  PMID: 9295451 [PubMed - indexed for MEDLINE]

21: Adv Nurse Pract  1997 Jul;5(7):41-4.  Falling among the aged. Exploring psychological issues.  Gray-Miceli D.  Center for Aging, University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, USA.  Publication Types: Review Review, Tutorial.  PMID: 9459943 [PubMed - indexed for MEDLINE]

22: Age Ageing  1997 May;26(3):189-93.  Fear of falling and restriction of mobility in elderly fallers.  Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ.  Clinical Nutrition Program, University of New Mexico School of Medicine, Albuquerque 87131, USA.

23: J Am Geriatr Soc  1997 Mar;45(3):313-20.  Comment in:  J Am Geriatr Soc. 1997 Nov;45(11):1406.  Gait changes in older adults: predictors of falls or indicators of fear.  Maki BE.  Centre for Studies in Aging, Sunnybrook Health Science Centre/University of Toronto, Canada.

24: J Outcome Meas  1997;1(1):34-55.  Development of a scale to assess concern about falling and applications to treatment programs.  Lusardi MM, Smith EV Jr.  University of Oklahoma, Department of Educational Psychology, Norman 73019, USA.

This study used Rasch methodology to pursue three goals. First, we sought to demonstrate the psychometric limitations of the Falls Efficacy Scale (Tinetti, Richman, & Powell, 1990). Second, we addressed these limitations using a simultaneous calibration of the Falls Efficacy Scale and Mobility Efficacy Scale items. Third, we review previous explorations of the self-efficacy construct in relationship to health behaviors and discuss a possible treatment program based on the simultaneous calibrated items and Social Cognitive Theory. Results indicate that responses from the Falls Efficacy Scale fail to assess the higher ends of the self-efficacy continuum. Simultaneous calibration of items improved this lack of scale definition. This initial work in assessing self-efficacy perceptions provides a theoretical framework for planning treatment programs that may be more cost effective than collecting performance measures.  PMID: 9661714 [PubMed - indexed for MEDLINE]

25: Arch Phys Med Rehabil  1996 Oct;77(10):1025-9.  Fear of falling revisited.  Hill KD, Schwarz JA, Kalogeropoulos AJ, Gibson SJ  National Ageing Research Institute, Parkville, Victoria, Australia.

OBJECTIVE: To evaluate the measurement properties of an expanded version of the Falls Efficacy Scale (FES)-a measure of fear of falling. The original FES measures fear on almost exclusively indoor activities, which may limit the usefulness of the scale in identifying early stages of fear of falling in active community-dwelling older people. DESIGN: Two-group convenience sample. SETTING: An outpatient referral clinic, and community-dwelling older people recruited from various sources. SUBJECTS: A volunteer sample of 111 healthy community-dwelling elderly (mean age 74.0 years) and a sample of 68 older people referred to a Falls and Balance Clinic (FBC) (mean age 79.2). Twenty-one subjects (9 healthy elderly and 12 FBC patients) were tested twice 1 week apart to investigate retest reliability. MAIN OUTCOME MEASURES: A 14-activity questionnaire (the Modified Falls Efficacy Scale [MFES]) was used that incorporated the original 10-activity FES and four additional activities. Falls efficacy was rated on a 10-point visual analogue scale for each activity. RESULTS AND CONCLUSIONS: The MFES demonstrated high internal consistency (Cronbach's alpha.95) and less skew than the original FES (-2.4 and -3.3, respectively). Factor analysis of the MFES revealed two factors accounting for 75% of the sample variance, grouping into an "indoor type activity" factor and an "outdoor type activity" factor. Retest reliability for the MFES was high (intraclass correlation coefficients = .93). Significant differences were evident between the FBC group and the healthy older group on all items of the MFES and on the total MFES score (p < .05). On the basis of these preliminary findings, the MFES appears to be a reliable and valid measure of falls self-efficacy, and could be a useful addition in the comprehensive assessment of older people with balance disturbance or falls.  PMID: 8857881 [PubMed - indexed for MEDLINE]

26: J Am Geriatr Soc  1995 Jun;43(6):638-44.  Posturography and balance problems in older people.  Baloh RW, Spain S, Socotch TM, Jacobson KM, Bell T.  Department of Neurology, UCLA School of Medicine 90024-1769, USA.

OBJECTIVE: To determine which measurements and test conditions on posturography are most useful for identifying balance problems in older people. SUBJECTS: Two samples of 70 community-dwelling older subjects (> 75 years). One group (controls) considered their balance normal for their age, and the other (patients) complained of imbalance. MEASUREMENTS: Velocity of sway on static (with and without foam) and dynamic posturography, Tinetti gait and balance score, self-reported fear of falling, and number and circumstances of falls. RESULTS: Mean sway velocity was significantly increased in patients compared with controls. The greatest difference between patients and controls occurred with measures of anterior-posterior sway velocity during angular tilt of the platform. Sway velocity was not significantly increased in patients or controls who reported falls compared with those who did not report falls. Even when comparing those who fell as a result of loss of balance with those who fell because of trips or slips, there was no significant difference in sway velocity. By contrast, those who reported fear of falling (patients and controls) had significantly increased sway velocity compared with those who did not report fear of falling. CONCLUSION: On average, velocity of sway (particularly in the anterior-posterior direction) is higher in older subjects who complain of imbalance compared with age-matched controls, and the difference is greater with dynamic posturography than with static posturography. However, the posturography data provided little information about the cause of the imbalance and did not correlate with the frequency of reported falls.  PMID: 7775722 [PubMed - indexed for MEDLINE]

27: Psychol Aging  1995 Mar;10(1):104-10.  Predictors of fear of falling in dizzy and nondizzy elderly.  Burker EJ, Wong H, Sloane PD, Mattingly D, Preisser J, Mitchell CM.  Department of Medical Allied Health Professions, School of Medicine, University of North Carolina, Chapel Hill 27599-7205, USA.

Fear of falling may constitute an independent risk factor for disability, leading older people to unnecessarily restrict their activity. Sixty older adults with chronic dizziness and 66 healthy controls were studied to help clarify the interrelationships among demographic factors, psychological status, physical health, and fear of falling. Chronic dizziness was strongly associated with fear of falling; among dizzy patients, nearly half (47%) expressed fear of falling, in comparison with 3% of controls. In participants with dizziness, 3 factors predicted fear of falling: an activity of daily living score, the revised Symptom Checklist 90 Depression (Derogatis, 1983) score, and stability when standing with feet together. These results support the concept that fear of falling is multiply determined and that psychological factors play a major role in influencing the symptoms and responses in many older patients with dizziness.  PMID: 7779308 [PubMed - indexed for MEDLINE]

28: Behav Res Ther  1995 Feb;33(2):215-21.  Danger expectancies and insight in acrophobia.  Menzies RG, Clarke JC. Faculty of Health Sciences, University of Sydney, N.S.W., Australia.

29: Optom Vis Sci  1994 Dec;71(12):761-9.  Visual stabilization of posture in the elderly: fallers vs. nonfallers.  Turano K, Rubin GS, Herdman SJ, Chee E, Fried LP.  Wilmer Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.

BACKGROUND. Postural instability is one of the important contributors to falling in observers aged 65 years and older. In this study we examine the role of vision in the relation between postural stability and falling, as well as in the relation between postural stability and the fear of falling. METHODS. Community-dwelling adults 65 years and older were administered a questionnaire about their history of falls and fear of falling (N = 185). Postural sway was measured in the same subjects with eyes open and eyes closed. Visual function was assessed by measures of visual acuity and contrast sensitivity. RESULTS. The 29 subjects who reported falling in the last year showed less of a visual contribution to posture stabilization than those who reported no falls. Controlling for age and gender, there is a 2.13-fold increase in the likelihood of reporting falling for a 0.1 decrement in the visual stabilization index when it is measured within the context of reliable somatosensory feedback. Those who reported a fear of falling and those who reported no fear showed similar visual stabilization. Contrast sensitivity was significantly associated with visual stabilization when it was measured within the context of reliable somatosensory feedback. CONCLUSIONS. The visual contribution to postural stabilization is significantly greater in nonfallers compared to fallers, and it is significantly associated with contrast sensitivity.  PMID: 7898883 [PubMed - indexed for MEDLINE]

30: J Gerontol  1994 May;49(3):M140-7.  Fear of falling and fall-related efficacy in relationship to functioning among community-living elders.  Tinetti ME, Mendes de Leon CF, Doucette JT, Baker DI.  Department of Internal Medicine, Yale University School of Medicine.

31: Am J Public Health  1994 Apr;84(4):565-70.  The prevalence and correlates of fear of falling in elderly persons living in the community.  Arfken CL, Lach HW, Birge SJ, Miller JP.  Division of Biostatistics, Washington University School of Medicine, St. Louis, MO 63110.

OBJECTIVES. Fear of falling has been recognized as a potentially debilitating consequence of falling in elderly persons. However, the prevalence and the correlates of this fear are unknown. METHODS. Prevalence of fear of falling was calculated from the 1-year follow-up of an age- and gender-stratified random sample of community-dwelling elderly persons. Cross-sectional associations of fear of falling with quality of life, frailty, and falling were assessed. RESULTS. The prevalence of fear increased with age and was greater in women. After adjustment for age and gender, being moderately fearful of falling was associated with decreased satisfaction with life, increased frailty and depressed mood, and recent experience with falls. Being very fearful of falling was associated with all of the above plus decreased mobility and social activities. CONCLUSIONS. Fear of falling is common in elderly persons and is associated with decreased quality of life, increased frailty, and recent experience with falls.  PMID: 8154557 [PubMed - indexed for MEDLINE]

32: J Am Geriatr Soc  1994 Apr;42(4):405-12.  Comparison of static and dynamic posturography in young and older normal people.  Baloh RW, Fife TD, Zwerling L, Socotch T, Jacobson K, Bell T, Beykirch K.  Department of Neurology, UCLA School of Medicine 90024-1769.

OBJECTIVE: To measure sway velocity during static and dynamic posturography in "normal" older people and to determine which tests best distinguish young from older subjects. SUBJECTS: A sample of 30 young (18-39 years) and 82 community-dwelling older (> 75 years) subjects who reported normal balance underwent a battery of balance tests. MEASUREMENTS: Velocity and frequency of sway, Tinetti gait and balance score, self-reported fear of falling and number of falls. RESULTS: Mean sway velocity and the ratio of high to low frequency sway velocity were significantly increased in older subjects compared with younger subjects for static and dynamic tests with eyes open and with eyes closed. Measures of anterior-posterior sway velocity during angular tilt of the platform with eyes closed best distinguished young from older subjects (almost three-fourths of older subjects had values greater than 2 standard deviations from the young normal mean). Older subjects who reported falls in the past year did not have a significantly higher sway velocity on static or dynamic tests compared with those who did not report falls. However, subjects who reported a fear of falling had significantly higher sway velocity on dynamic tests with eyes closed compared to those who did not report a fear of falling. CONCLUSIONS: On average, velocity of sway is higher in older subjects compared with younger subjects, and the difference between young and old is greater with dynamic posturography than with static posturography.  PMID: 8144826 [PubMed - indexed for MEDLINE]

33: Eksp Klin Farmakol  1994 Jan-Feb;57(1):5-8.  [The characteristics of the pharmacological action of buspirone.]  [Article in Russian]  Dzhagatspanian IA, Asrian AB.

Some aspects of the anxiolytic action of buspirone were investigated by differentiating fear from anxiety. Buspirone showing anxiolytic and antineurotic action in the models of anxiety and conflicting situation was demonstrated to be inactive in the model of fear of falling down from the elevated cross-shaped labyrinth. The antiamnestic effect of buspirone was revealed in the electroshock amnesia model. It is assumed that serotonin receptors are possibly responsible both for the anxiety and for memory processes.  PMID: 8142866 [PubMed - indexed for MEDLINE]

34: Gerontology  1994;40(1):38-44.  Fear of falling in nursing home patients.  Franzoni S, Rozzini R, Boffelli S, Frisoni GB, Trabucchi M.  Geriatric Rehabilitation Ward, P. Richiedei Hospital, Gussago, Italy.

The study analyzes the characteristics of 54 nursing home patients (12 male, 42 female; mean age 81.9 +/- 7.9 years) with and without the complaint of the fear of falling, and the association of this fear with falling and functional status. Patients who had a fear of falling at baseline (n = 25) had a lower functional status (Barthel Index) score (69.8 +/- 22.3 vs. 79.3 +/- 15.4), lower scores for balance (8.4 +/- 4.4 vs. 10.6 +/- 3.7) and gait (Tinetti; 6.7 +/- 3.3 vs. 8.3 +/- 2.6) and were taking a higher number of psychotropic drugs (0.8 +/- 1.1 vs. 0.2 +/- 0.5) than those with no fear (n = 29). At 24 months' follow-up, 25 subjects were still available for evaluation. Fear of falling at baseline was predictive of a decline in activities of daily living, as measured by the Barthel Index, in a multiple regression model, after controlling for baseline cognitive function and change in cognitive function, age, gender, balance and gait, frequency of psychotropic drug usage, and number of chronic symptoms. The findings of this study suggests that, in mobile patients, the fear of falling can be a clinically important predictor of functional decline.  PMID: 8034202 [PubMed - indexed for MEDLINE]

35: J Gerontol  1993 Sep;48 Spec No:35-8.  Fear of falling and low self-efficacy: a case of dependence in elderly persons.  Tinetti ME, Powell L.  Department of Medicine, Yale University School of Medicine.  PMID: 8409238 [PubMed - indexed for MEDLINE]

36: J Aging Health  1993 May;5(2):229-43.  Fear of falling among the community-dwelling elderly. Howland J, Peterson EW, Levin WC, Fried L, Pordon D, Bak S.  Boston University School of Public Health, MA 02118.

To assess the incidence of falls and the prevalence, intensity, and covariates of fear of falling among community-dwelling elderly, the authors surveyed a random sample of 196 residents (> or = 58 years of age) of housing developments for the elderly in Brookline and Plymouth, Massachusetts. Forty-three percent reported having fallen in recent years, 28% in the last year. Of those who had fallen within the year prior to the interview, 65% reported injury, 44% sought medical attention, and 15% required hospitalization as a consequence of their fall(s). Fear of falling ranked first when compared to other common fears (i.e., fear of robbery, financial fears). Self-rated health status and experience of previous falls were significantly associated with fear of falling. Further analysis suggests that fear of falling may affect social interaction, independent of risks for falling.  PMID: 10125446 [PubMed - indexed for MEDLINE]

A cross-sectional study was performed to investigate the association between fear of falling and postural performance in the elderly. One hundred ambulatory and independent volunteers (aged 62-96) were subjected to five types of balance tests: (a) spontaneous postural sway, (b) induced anterior-posterior sway, (c) induced medial-lateral sway, (d) one-leg stance, and (e) a clinical balance assessment scale. Pseudorandom platform motions were used in the induced-sway tests. The subjects were classified into both "faller"/"nonfaller" and "fear"/"no-fear" categories, to allow the influence of fear of falling and falling history to be separated in the analyses. Subjects who expressed a fear of falling were found to exhibit significantly poorer performance in blindfolded spontaneous-sway tests and in eyes-open, one-leg stance tests. The clinical scale was the only balance measure that showed a significant association with retrospective, self-reported falling history. We could not ascertain whether the fear of falling affected balance-test performance in an artifactual manner, or whether the fear and poorer performance were related to a true deterioration in postural control. Until this issue can be resolved, balance-test performance should be interpreted with caution when testing apprehensive individuals. Furthermore, studies of postural control and falling should allow for the potentially confounding influence of fear of falling.  PMID: 2071833 [PubMed - indexed for MEDLINE]

38: Am J Occup Ther  1991 Feb;45(2):119-22.  Falls and fear of falling among elderly persons living in the community: occupational therapy interventions.  Walker JE, Howland J. Beth Israel Hospital, Boston, Massachusetts 02215.