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Objectives: The purpose of this study was to provide a comprehensive overview of the prevalence, measurement tools, influencing factors, and interventions for fear of falling (FOF) in stroke survivors., Methods: A PRISMA-guided systematic literature review was conducted. PubMed, EMBASE, Cochrane, and Web of Science were systematically searched. The search time was up to February 2023. All observational and experimental studies investigating FOF in stroke patients were included. The assessment tool of the Joanna Briggs Institute was used to assess the quality of the included studies and the risk of bias assessment. (PROSPERO: CRD42023412522)., Result: A total of 25 observational studies and 10 experimental studies were included. The overall quality of the included studies was "low" to "good." The most common tool used to measure the FOF was the Falls Efficacy Scale-International (FES-I). The prevalence of FOF was 42%- 93.8%. Stroke survivors with physical impairments have the highest prevalence of FOF. The main risk factors for the development of FOF in stroke survivors were female gender, use of assistive devices, balance, limb dysfunction, and functional mobility. The combination of cognitive behavioral and exercise interventions is the most effective strategy., Conclusions: This review suggests that the prevalence of FOF in stroke survivors is high and that understanding the factors associated with FOF in stroke patients can help develop multifactorial prevention strategies to reduce FOF and improve quality of life. In addition, a uniform FOF measurement tool should be used to better assess the effectiveness of interventions for stroke survivors., Ethics Approval: PROSPERO registration (CRD42023412522).

Background: Interdisciplinary evaluation of older adults' health care is a priority in the prevention of chronic health conditions and maintenance of daily functioning. While many studies evaluate different physical performance tests (PPTs) from a retrospective view in predicting mortality or cardiopulmonary health, it remains unclear which of the commonly used PPTs is the most effective at evaluating the current health of older adults. Additionally, the time and participant burden for each PPT must be considered when planning and implementing them for clinical or research purposes., Objective: This cross-sectional study aimed to determine how elements of overall physical capacity, performance, and other nongait factors in older adults affect the results of 3 commonly used tests: the Short Physical Performance Battery (SPPB), 6-minute walk test (6MWT), and Incremental Shuttle Walk Test (ISWT)., Methods: A total of 53 community-dwelling older adults met the inclusion and exclusion criteria (mean age 77.47, SD 7.25 years; n=41, 77% female; and n=21, 40% Hispanic). This study evaluated older adults using 3 different PPTs including the SPPB, 6MWT, and ISWT, as well as constructed multiple linear regression models with measures of physical activity, static balance, and fear of falling (FoF). The nongait measures included 7 days of physical activity monitoring using the ActiGraph GT9X Link instrument, objective measurement of static balance using the BTrackS Balance System, and FoF using the short Fall Efficacy Scale-International., Results: The models revealed that the complete SPPB provided the most comprehensive value, as indicated by a greater R 2 value (0.523), and that performance on the SPPB was predicted by both moderate to vigorous physical activity (P=.01) and FoF (P<.001). The ISWT was predicted by moderate to vigorous physical activity (P=.02), BMI (P=.02), and FoF (P=.006) and had a similar R 2 value (0.517), whereas the gait component of the SPPB (P=.001) and 6MWT (P<.001) was predicted by only FoF and had lower R 2 values (0.375 and 0.228, respectively)., Conclusions: The results indicated the value of a multicomponent, comprehensive test, such as the SPPB, in evaluating the health of older adults. Additionally, a comparison of the 2 field walking tests (ISWT and 6MWT) further distinguished the ISWT as more responsive to overall health in older adults. In comparing these commonly used PPTs, clinicians and researchers in the field can determine and select the most optimal test to evaluate older adults in communities and research settings., (©Chitra Banarjee, Renoa Choudhury, Joon-Hyuk Park, Rui Xie, David Fukuda, Jeffrey Stout, Ladda Thiamwong. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 29.11.2024.)

Background: The congruence or discordance between actual and perceived balance ability has been proposed to be linked to functional outcomes such as falls. However, gaps remain in our ability to quantify discordance, and its relationship to relevant outcomes., Objective: To investigate a novel quantification of concordance/discordance between balance performance and perception and determine the relationship to falls among people with Parkinson's disease (PwPD)., Methods: Data from 244 PwPD were aggregated from 5 previously conducted studies. Variables extracted included age, sex, Activities-Specific Balance Confidence scale (ABC; perceived balance), Timed Up and Go (TUG; balance performance), Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) part III scores, and retrospective falls (6- or 12-month). Data validation between studies was established. Discordance was quantified as the difference between an individual's predicted ABC, based upon their TUG score, to their reported ABC., Results: Two methods for calculating discordance were tested: simple linear regression and segmented regression. As there were no differences between the bootstrap distributions of both approaches ( P  = .520), simple linear regression was utilized for the subsequent logistic regression model. Discordance was the only statistically significant predictor of fall status (OR = 0.98, P  = .003), after controlling for age, MDS-UPDRS part III, sex, and TUG. The inclusion of discordance in the logistic regression model boosted the predictive accuracy by 58%., Conclusions: Discordance between actual and perceived balance was uniquely related to retrospective fall history among PwPD. Clinicians and researchers should consider discordance between actual and perceived balance as a potentially modifiable target to minimize falls., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Fall-related injuries are the leading cause of injury, death and disability among older adults, and their health care costs are high. Therefore, the present study aimed to determine the effect of an educational intervention, based on the health belief model, on the prevention and fear of falling among older people. We conducted this experimental study on 140 older people in Fasa city, Fars Province, Iran, in 2023. We selected the subjects using a simple sampling method. The educational intervention for the experimental group included three 30-min sessions. We analyzed the data using SPSS 22 software, employing chi-square, independent t -tests and paired t -tests. The results showed that before the educational intervention, there was no significant difference between the experimental and control groups in terms of knowledge, perceived sensitivity, perceived intensity, perceived benefits, perceived barriers, self-efficacy, cues to action, and performance; however, three months after the educational intervention, the experimental group showed a significant increase in each of the mentioned variables except the perceived barriers. Additionally, after the educational intervention, the mean score of fear of falling in the experimental group showed a statistically significant decrease. This study demonstrated the effectiveness of an educational intervention based on the health belief model in preventing falls and reducing the fear of falls in older people. Therefore, we suggest using training based on this model to prevent and reduce falls among older people., Competing Interests: Declaration of conflicting interestsThe authors have no conflicts of interest to declare.

This study aimed to investigate the association between global cognitive functioning (GCF) and fear of falling (FOF) in a large population-based sample of adults aged 45 years and older. A total of 2997 and 2012 participants from the original sample were included in the cross-sectional and prospective models, respectively. Participants were re-coded to 'no FOF' and 'FOF' based on their self-reported responses, and those who reported FOF at follow-up were defined as the newly-developed FOF group. GCF was evaluated at baseline and follow-up (2006 and 2020) using the Korean Mini-Mental State Examination (K-MMSE). Multivariable logistic regression models were used to examine the association between GCF at baseline and risk of FOF. In our study, 23.6% (706/2997) of the participants reported FOF at baseline, and 80.3% (1615/2012) reported newly-developed FOF in the follow-up cohort. Importantly, the negative association between GCF and FOF was observed not only in the cross-sectional analyses (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.96-0.99) but also in the prospective analyses (OR 0.93, 95% CI 0.87-0.99). Furthermore, GCF was associated with lower odds of recurrent newly-developed FOF in the stable group than in the original sample (OR 0.87, 95% CI 0.78-0.97 vs OR 0.92, 95% CI 0.86-0.98). Thus, GCF was negatively associated with FOF at baseline and newly-developed FOF in the long-term follow-up cohort, and persistent deficits in GCF may increase the risk of newly-developed FOF. Further research should explore the mechanisms underlying the longitudinal relationship between GCF and newly-developed FOF., Competing Interests: Declaration of Competing interest The authors have no conflicts of interest to declare., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: To examine and synthesize qualitative data about the experiences of fear of falling in older adults., Method: This review used the Joanna Briggs methodology for qualitative systematic reviews. The PubMed, Cochrane Library, Embase, Web of Science, PsycINFO, CINAHL, CBMdisc, CNKI, Wanfang, and VIP databases were searched up to December 2023. In addition, gray literature was manually searched and the references of included studies were traced. Qualitative data was evaluated, synthesized, and analyzed by meta-synthesis., Result: 18 studies were included and 3 themes were summarized, including: multiple fear disturbances; needs not fully met; and self-management strategies., Conclusion: The experiences of older adults suffering from fear of falling needs more attention. Health care providers should identify problems from Older adults' experiences of fear of falling, they should recognize the subjective experiences and unique needs of older adults, understand the underlying behavioral reasons for their fear of falling, and offer effective self-management techniques to enhance their quality of life., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The literature review shows that the fear of falling is present in older persons', but also in their careers and influences the performance of activities of daily living. The objective of this methodological study was to adapt and validate the Falls Efficacy Scale - Formal Caregivers. The development of the examined scale was based on the Falls Efficacy Scale - International, which was adapted for assessing the fear of falling in formal caregivers. The instrument was filled out by 319 formal caregivers of older people living in 11 Portuguese nursing homes for older people. Their average age was 46.8 ± 10.7 years, they had been working in this role for 13.4 ± 8.2 years, and 67.7 % of them attended vocational training in the workplace after being employed at the nursing home. Falls Efficacy Scale - Formal Caregivers, which contains 16 items, showed good internal consistency (α = 0.848). These items were organized into 3 factors after exploratory and confirmatory factor analysis (lesser physical effort activities; intermediate physical effort activities, carried out in safe conditions; and intermediate physical effort activities, carried out in less safe conditions), with adequate convergent validity., Competing Interests: Declaration of competing interest There are no conflicts of interest related to this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The fear of falling (FoF) usually increases in patients with Parkinson's disease (PD); however, it can decrease despite repeated falls for unknown reasons. This phenomenon is similar to the findings that the patients with PD show lower emotional responses in the decision-making during the Iowa gambling task (IGT) than of those without PD. The decision-making during the IGT is reportedly correlated with interoceptive accuracy. This phenomenon could be associated with decreased physiological reaction and interoception deficiency. This study aimed to investigate the factors associated with decreased FoF in patients with PD who fell repeatedly., Methods: We recorded the skin conductance responses (SCR) during the task delivered by a virtual reality system and heartbeat perception task (HPT) as an interoceptive measure. We measured emotional self-awareness using visual analog scale (VAS) scores. We recruited 28 non-demented patients with PD and 24 age-matched Non-clinical population (NC) group. All patients with PD were grouped by FoF scale score and number of falls within the previous year into repeated falls without FoF, repeated falls with FoF, and no falls groups., Results: The SCR during all accident videos experienced by themselves were significantly lower in the repeated falls without FoF group than in the NC group (p < 0.01). The HPT was significantly lower in the repeated falls without FoF group than in the NC group (p = 0.007)., Conclusion: The repeated falls without FoF group did not recognize recurrent falls as being problematic, possibly associated with decreased physiological reactions and interoception deficiency., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Aim: To comprehensively evaluate and synthesize fear of falling assessment tools and their psychometric properties., Methods: The literature in PubMed, Web of Science Core Collection, Cochrane Library, Embase, Google Scholar, CNKI, Wanfang, VIP, and CBM was systematically searched, and the search period was from the establishment of the database to September 1, 2023, and updated on September 1, 2024., Results: A total of 104 documents covering 19 assessment tools were included. Of the 19 instruments, the Falls Efficacy Scale-International was the most widely used and had been tested for reliability and validity in different countries and populations. A total of 18 studies focused on tool development and validation, and the remaining 86 were related to tool validation., Conclusion: Scientific and reliable assessment instruments for FOF are an important part of future targeted intervention research. The future research direction of tools should be based on local demographic characteristics and qualitative interview results, combined with objective quantitative indicators measured by professional instruments., Competing Interests: Declaration of competing interest All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background and Purpose: Fear of falling and low physical activity become prevalent in an aged society, but their association with fall risk warrants further investigation., Methods: Our study involved 600 individuals aged 70.8-96.1 years who completed two rounds of community surveys. During the second survey, we analyzed the correlations between fall incidents and a range of factors, including age, sex, gait maneuverability, vision, comorbidity count, depressive symptoms, cognitive function, history of falls, fear of falling, and physical activity level. The chi-square test and univariate and multivariate logistic regression models were used, with further analyses either adjusted for or stratified by the full-factor combinations of fear of falling (with versus without) and low physical activity (low versus moderate-to-high)., Results: Falls exhibited a prevalence rate of 13.8%. A fall risk gradient by the full-factor combinations was observed. Multivariate logistic regression modeling identified independent risk predictors for falls, including the number of comorbidities, depressive symptoms, a history of falls, and fear of falling. Fear of falling and low physical activity presented a synergistic effect to increase the fall risk by two- and one-third times (adjusted odds ratio: 2.35, 95% confidence interval: 1.12-4.91). Depressive symptoms, cognitive impairment, and a history of falls remained as significant risk predictors for older adults with both factors, those with fear of falling only, and those with neither, respectively, when the models were further stratified., Conclusion: Fear of falling and low physical activity presented likely synergism to increase the fall risk. Those older community-dwellers with both risk factors warrant fall prevention resources as a priority over those with either or neither., (© 2024. The Author(s).)

Objective: There is growing evidence that fear of falling (FOF) is common in people who use wheelchairs full-time and negatively influence their performance of daily activities and quality of life. The purpose of this study was to gain an in-depth understanding of perceptions related to FOF among people who use wheelchairs full-time., Methods: Mixed-method analysis was conducted using semi-structured interviews and surveys to gain insight into FOF. Surveys included demographic information; Spinal Cord Injury-Fall Concerns Scale (SCI-FCS); a questionnaire that directly assesses FOF and associated activity curtailment; and Fall Control Scale (FCS)., Results: Among 39 participants (age = 43.1 ± 15.6 years, disability duration = 21.2 ± 11.1 years), 27 participants (69%) reported FOF. Participants with less perceived ability to control falls indexed by FCS reported higher SCI-FCS scores, indicating greater FOF (r s = -0.384, p  = 0.016). Qualitative findings revealed that participants felt that FOF developed due to sustaining fall-related injuries or limited ability to recover from a fall. Some participants perceived falling as a part of their lives. They believed that it was not the cause of developing FOF., Conclusions: Among people who use wheelchairs full-time, FOF is prevalent and may develop due to fears of sustaining injuries or being unable to get up after falling. Developing an evidenced-based education protocol aimed at managing falls (e.g., establishing a fall recovery strategy and education on techniques to reduce injury during falls) is needed to minimize FOF people who use wheelchairs full-time.

Background: The effects on gait and posture of balneotherapy in fallers are unknown. We assessed the effects on physical functioning and fear of falling of a balneotherapy program alone or combined with a physical activity and educational program in older adult fallers., Methods: A multicenter randomized controlled trial enrolled patients aged 65 or older referred to a 3-week balneotherapy program, and screened for risk of falling (a history of falls in the last year and a timed up and go test or a five chair rising test >12 sec or a 4-meter walk test >4 sec). In addition to balneotherapy, patients had either no intervention (controls) or twelve 60-minute sessions of physical activity including 15 minutes of health education and three 90-minute sessions of an educational program (intervention)., Results: There were 118 control and 105 intervention patients. The balneotherapy program alone had a clinically significant effect on (i) the grip strength, (ii) the five chair rising test, (iii) the 4-meter walk test, and (iv) the short physical performance battery (Cohen's d 0.29-0.46). It had no effect on (i) the maximum time stood on one foot, and (ii) the timed up and go test. Furthermore, it worsened the falls efficacy scale (d = 0.27). Adding a physical activity and educational program significantly improved (i) the time stood on one foot (Cohen's d =-0.34), and (ii) the timed up and go test (d=- 0.44), (iii) and reduced the concern about falling (Falls Efficacy scale, d=-0.25), and (iv) the fear of falling (d=-0.34)., Conclusion: Older patients referred to a balneotherapy program and at high risk of falling when screened at the entrance of the center should be offered an additional physical and educational program to further improve the functional effects of balneotherapy on the timed up and go test, balance, and the fear of falling., Competing Interests: Professor Jean Bousquet reports personal fees from CIPLA, MENARINI, MYLAN, NOVARTIS, PURINA, SANOFI-AVENTIS, TEVA, NOUCOR; shareholder of KYomed-Innov and MASK-air SAS. The authors have no other relevant financial or non-financial interests to disclose for this work., (© 2024 Bernard et al.)

Objective: Altered Postural control could increase the risk of falling in older adults. Factors such as low back pain and fear of falling can be contributing factors to postural control instability. This study aimed to investigate the effect of chronic low back pain (CLBP) and fear of falling (FOF) on postural control of older adults., Method: Forty-one older adults were included (27 LBP and 14 control). Among the participants, 22 people had high FOF, and 19 had low FOF based on Falls efficacy scale cut-off of ≥ 26. For postural control evaluation Center of pressure parameters (COP) of Standard deviation (Sd) of velocity, Sd of amplitude, path length and mean velocity in both Medial-lateral (ML) and Anterior-Posterior (AP) directions were measured. Mixed-model anova with two between group factor (Health status; with and without CLBP, and with high and low FES-I groups) and one within factor postural condition (four conditions with and without vision and Achill tendon vibration) was used., Result: No significant interaction between groups (health status and FES-I) and group with condition (health status and condition or FES-I and condition) was observed for all COP parameters in both AP and ML direction. There was main effect of FES-I for all COP parameters in ML direction, with greater Sd of velocity, Sd of amplitude, path length and mean velocity in older adults with high FES-I compared to low FES-I in the ML direction., Conclusion: High levels of FOF influenced static postural control in the ML direction. Therefore, paying attention to the lateral stability of older adults is of great importance., (© 2024. The Author(s).)

Background: Concern about falling is reportedly related to mobility and balance in older adults. While increased concern about falling may be directly related to balance deficits, establishing a causal relationship remains limited. This study aimed to investigate whether concern about falling affects threat-induced changes in emotions and postural control in older adults., Research Question: How does concern about falling affect threat-induced changes in emotions and postural control among older adults?, Methods: Sixty-two older adults (age; 78.8 ± 5.7 years, height; 152.7 ± 6.3 cm) were exposed to height-related fear while standing, leaning forward, and leaning backward on the floor and a higher surface. The mean position, root mean square, and mean velocity of the center of pressure (COP) displacement were measured during the standing task, as well as the forward and backward limits of stability (LOS) tasks. The degree of self-reported fear of falling (FoF) was also obtained during the standing and LOS tasks. The participants were categorized into lower and higher concerns about falling based on the short form of the Falls Efficacy Scale International (FESI)., Results: Lower and higher concern about falling groups scored 10.2 ± 2.2 and 17.3 ± 3.3 in the short FESI. Both groups experienced increased FoF during the standing and forward LOS tasks on a higher surface. Leaning away from the edge of the surface resulted in increased COP velocity, decreased COP amplitude while standing, and decreased forward LOS. Participants with higher concern about falling had increased FoF during the backward LOS task and decreased backward LOS on a higher surface, while those with lower concern about falling did not., Significance: Concern about falling can directly affect emotions and balance control owing to the occurrence of threat-related changes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Falls are a common and consequential concern for persons with multiple sclerosis (PwMS), with trunk impairment frequently observed even in the early stages of the disease. However, the relationship between falls and trunk impairment using the trunk impairment scale in this population remains unclear. This study aims to explore this association and identify potential factors contributing to falls in PwMS., Method: Sixty-four patients were assessed for falls or near falls in the past 6 months, trunk impairment using the Trunk Impairment Scale (TIS), balance and gait using the Performance-Oriented Mobility Assessment (POMA), depression and anxiety using the Hospital Anxiety and Depression Scale (HADS), fatigue using the Modified Fatigue Impact Scale (MFIS), and fear of falling using the Modified Falls Efficacy Scale (MFES)., Results: Simple binary logistic regression revealed significant associations for TIS (OR = 0.75, p = 0.001, 95 % CI: 0.63 to 0.88), POMA (OR = 0.75, p ≤ 0.001, 95 % CI: 0.65 to 0.87), MFES (OR = 0.96, p ≤ 0.001, 95 % CI: 0.93 to 0.98), MFIS (OR = 1.05, p = 0.002, 95 % CI: 1.02 to 1.08), and HADS (OR = 1.09, p = 0.01, 95 % CI: 1.02 to 1.17). The multiple logistic regression model identified TIS (OR = 0.78, p = 0.007, 95 % CI: 0.66 to 0.94) and MFES (OR = 0.96, p = 0.005, 95 % CI: 0.93 to 0.98) as significant factors of falls., Conclusion: This study confirms the significant impact of trunk impairment, tested by the trunk impairment scale and fear of falling as factors of falls among PwMS. Additionally, it highlights the roles of balance, gait, fatigue, and depression as factors that contribute to fall risk. These findings suggest that a comprehensive assessment incorporating these elements may be crucial for developing effective fall prevention strategies in this population. This research underscores the need for targeted interventions that address both physical and psychological aspects to mitigate the risk of falls in PwMS., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Reem Basuodan reports financial support was provided by Princess Nourah bint Abdulrahman University. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

In-home falls and fear of falling (FOF) are significant concerns among older adults and people with disabilities (PwD), impacting independence in daily lives. The indoor home environment (IHE) plays an important role in influencing FOF, as it is influenced by barriers and facilitators within the home. This systematic review provides an evidence-based list of IHE factors and investigates their association with FOF, especially in older adults, PwD, and wheelchair users. Examining 24 studies, we found associations between IHE factors and FOF, suggesting the importance of home modifications to live in a supportive environment to reduce FOF. Most studies were experimental and intervened for either single or multiple IHE factors, indicating reasonably strong evidence. Our findings highlight the importance of considering psychological factors when evaluating home environments to reduce FOF. The list of barriers and facilitators we provide can help healthcare professionals conduct evidence-based home assessments., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The aim of this study was to clarify the link between experiencing cerebrovascular diseases (strokes as an explicit example) and fear of falling (FOF) among middle-aged and older adults in Europe. Methods: Longitudinal data were used from wave 5 to wave 7 of the representative Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported tools were used to quantify the key variables. Fear of falling was similarly assessed using a dichotomous yes or no question, "For the past six months at least, have you been bothered by any of the health conditions on this card", with fear of falling being one of the options. It was adjusted for various sociodemographic and health-related factors. In particular, to account for unobserved heterogeneity, conditional fixed effect regressions (FE) were used. Accordingly, change in an individual's FOF status over the included waves was analysed and correlated with the reported change of all the included time-varying independent variables within the same individual, including experiencing stroke or other cerebrovascular diseases. The final analytical sample equalled n = 22.071 observations. Results: Conditional logistic FE regressions showed that the onset of a stroke or other forms of cerebrovascular disease was not associated with an increased likelihood of experiencing fear of falling (OR = 1.25, p = 0.095). However, stratified by sex, such an association was present in men (OR = 1.79, p = 0.006), though not in women (OR = 0.94, p = 0.732). Conclusions: The onset of a stroke or other cerebrovascular diseases was associated with an increased likelihood of experiencing FOF in men but not women. Efforts are required to assist older men in avoiding FOF after the onset of stroke or other cerebrovascular pathologies.

Background/Objectives : This study investigated the behavior of postural adjustments throughout the entire action: from the preparatory phase (anticipatory postural adjustment, APA), the focal movement phase (online postural adjustments, OPA), to the compensatory phase (compensatory postural adjustment, CPA) while raising the arms in a standing position, both with eyes opened and closed. The goal was to analyze the effects of reduced sensorial information and different heights on postural muscle activity during these three phases. Methods : Eight young women performed rapid shoulder flexion while standing on the ground and on a 1-m elevated platform. The EMG activity of the trunk and lower limb muscles was recorded during all three phases. Results : Although average muscle activity was similar on the ground and the elevated platform, the pattern of postural muscle activation varied across the motor action. During OPA, all postural muscle activity was the highest, while it was the lowest during APA. On the elevated platform postural muscles have increased their activation during APA. In the most stable condition (standing on the ground with eyes opened), muscle activity showed a negative correlation between APA and OPA, but there was no correlation between OPA and CPA. Conclusions : Our results suggest postural control adapts to sensory, motor, and cognitive conditions. Therefore, the increased demand for postural control due to the height of the support base demands greater flexibility in postural synergies and alters muscle activity., Competing Interests: The authors declare no conflicts of interest.

Background: Concerns about falling (CaF) are common in older people and can lead to avoidance of activities, social isolation and reduced physical function. However, there is limited knowledge about CaF in people with osteoarthritis (OA); yet, symptoms may increase CaF. We aimed to evaluate the prevalence of CaF and associated factors in people with knee or hip OA., Methods: This cross-sectional study used data from the Good Life with osteoArthritis in Denmark registry including patients with OA treated in primary care. CaF was assessed with the Short Falls Efficacy Scale International (Short FES-I, range 7-28, low to high). Associations between CaF and pain, function and psychological factors were evaluated using multivariable linear Tobit regression., Results: In total, 7442 patients were included [mean age 67 years (SD: 9.6), 67% females]. Mean Short FES-I was 9.8 [95% confidence interval (CI): 9.7; 9.8]. Moderate CaF was observed in 48.1% (95% CI: 46.7; 48.9) of participants, whilst 11.3% (95% CI: 10.7; 12.1) had a high level of CaF. CaF was more prevalent in the oldest participants and in females. Pain intensity [β-value (95% CI): 0.52 (0.48; 0.55)], chair stand test [-0.21 (-0.22; -0.19)] and fear of movement [1.38 (1.19; 1.56)] were significantly associated with increased CaF across age groups and sex., Conclusions: CaF is common in people with OA, especially in the oldest participants and in females. Higher pain, lower function and psychological distress are associated with CaF; yet, the causality of the associations remain to be determined. Integrating CaF assessments and interventions into OA management in primary care seems highly relevant., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: Falls and fear of falling (FoF) are relevant contributors to disability and institutionalization among older adults. The aim was to examine the association between multimorbidity and falls/FoF among community-dwelling older adults, exploring the mediating effect of physical function and the use of sleeping pills and pain relievers., Desing: Longitudinal analyses., Setting and Participants: A total of 1824 adults aged ≥65 years from the Seniors-ENRICA II cohort (Spain)., Methods: Multimorbidity was defined as having ≥2 diseases from a predefined list of 13 chronic conditions extracted from clinical records. Falls were self-reported and FoF was estimated using the Short Falls Efficacy Scale International. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the association between multimorbidity/duration of multimorbidity and incident falls/FoF using logistic regression models. The mediating effects of physical function, the use of sleeping pills, and pain relievers were explored using the Karlson Holm Breen method., Results: Multimorbidity was associated with a higher risk of falls (OR, 1.44; 95% CI, 1.14-1.82) and FoF (OR, 1.88; 95% CI, 1.48-2.39). Positive dose-response associations were found between the duration of multimorbidity and the risk of falls (P-trend = .003) and FoF (P-trend = .001). Physical function mediated 5.67% and 5.25% of these associations, respectively, and the use of sleeping pills explained a larger proportion of the associations (9.27% and 11.61%). Last, the mediation effect of pain relievers on the association between multimorbidity and falls was 3.05% and 9.31% in the multimorbidity-FoF association., Conclusions and Implications: Multimorbidity was associated with a higher risk of falls/FoF among Spanish community-dwelling older adults. Use of sleeping pills was a relevant mediator, suggesting that interventions on sleep problems have the potential to reduce the burden of falls/FoF and their consequences among older adults with multimorbidity., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)

Purpose: This study examined prevalence and relationships among falls, injuries, fear of falling, and social participation in people aging with long-term physical disability (PAwLTPD)., Materials and Methods: A convenience sample of 474 PAwLTPD recruited from community agencies and social media as baseline of a longitudinal cohort study. Inclusion criteria: 45-65 years, self-reported physical disability for ≥5 years, and English-speaking. Self-report surveys of physical/mental health, falls in the past year, fear of falling, and Patient-Reported Outcomes Measurement Information System (PROMIS) ability and satisfaction with participation in social roles and activities measures were collected., Results: Mean age 56.8 years; participants were mostly female (66.7%) and White (61.4%). Nearly 65% reported a fall; 56.6% of falls resulted in injury. Falls and fall-related injuries were associated with worse physical/mental health and presence of >5 health conditions. Seventy-five percent of participants reported fear of falling. Lower ability and satisfaction with participation were found in participants who fell and worried about falls., Conclusions: PAwLTPD are at increased risk of falls, fall-related injuries, and fear of falling, which affects their ability to engage in social activities. Future research is needed to understand circumstances associated with falls and to develop effective interventions to address falls in PAwLTPD.

Objective: The aim of this study was to investigate the effects of an 8-week yoga intervention on muscle strength, proprioception, pain, concerns about falling, and quality of life in individuals diagnosed with diabetic neuropathy., Methods: A quasi-experimental design incorporating a pretest-posttest methodology and a control group was implemented in the present study. A total of 30 patients who were diagnosed with type 2 diabetes and neuropathy were recruited and randomly assigned to intervention ( n = 15) or non-exercise control ( n = 15). Yoga sessions were conducted for a duration of 60 min on three occasions per week, with participants requested to practice at home on other days., Results: The results showed significant main effects of time on the muscle strength (both flexor and extensor muscles, p < .001, ηp 2 = 0.652 and p < .001, ηp 2 = 0.539, respectively), proprioception error ( p < .001, ηp 2 = 0.807), pain intensity ( p < .001, ηp 2 = 0.538), concerns about falling ( p < .001, ηp 2 = 0.700), and overall score of quality of life ( p < .001, ηp 2 = 0.475). Moreover, there were significant group-by-time interactions for all variables ( p < .001 for all)., Conclusion: The study reveals that yoga intervention can be an effective alternative therapeutic approach to medication for individuals with diabetic neuropathy. Yet, future studies are needed on a larger sample size to strengthen the present understanding of the advantageous impact of yoga intervention in this population., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Postural instability and gait disturbances (PIGD) represent a significant cause of disability in Parkinson's disease (PD). Cholinergic system dysfunction has been implicated in falls in PD. The occurrence of falls typically results in fear of falling (FoF) that in turn may lead to poorer balance self-efficacy. Balance self-efficacy refers to one's level of confidence in their ability to balance while completing activities of daily living like getting dressed, bathing, and walking. Lower self-efficacy, or greater FoF during these activities is a function of motor, cognitive, and emotional impairments and may impact quality of life in PD. Unlike known cholinergic reduction, especially in the right lateral geniculate and caudate nuclei, little is known about the role of cholinergic transporters in FoF or mobility self-efficacy in PD., Methods: [ 18 F]fluoroethoxybenzovesamicol ([ 18 F]FEOBV) positron emission tomography (PET) studies were conducted to assess vesicular acetylcholine transporter (VAChT) expression in 126 patients with PD (male (m) = 95, female (f) = 31). Participants had a mean age of 67.3 years (standard deviation (SD) = 7.1) and median Hoehn Yahr stage of 2.5. Patients also completed the Short Falls Efficacy Scale (sFES-I) as a survey measure of concerns about falling. [ 18 F]FEOBV data were processed in Statistical Parametric Mapping (SPM) using a voxel-wise regression model with sFES-I scores as the outcome measure., Results: Reduced [ 18 F]FEOBV binding in tectum, metathalamic (lateral more than medial geniculate nuclei), thalamus proper, bilateral mesiotemporal (hippocampal, parahippocampal, fusiform gyri and fimbriae), and right cerebellar lobule VI significantly associated with higher sFES-I scores ( p < 0.05, family-wise error (FWE) correction after Threshold-Free Cluster Enhancement (TFCE))., Conclusions: Unlike the more limited involvement of the brainstem-thalamic complex and caudate nuclei cholinergic topography associated with falls in PD, cholinergic reductions in the extended connectivity between the thalamic complex and the temporal limbic system via the fimbriae associates with FoF. Additional cholinergic changes were seen in the cerebellum. The temporal limbic system plays a role not only in episodic memory but also in spatial navigation, scene and contextual ( e.g. , emotional) processing. Findings may augur novel therapeutic approaches to treat poor mobility self-efficacy in PD., Clinical Trial Registration: No: NCT02458430. Registered 18 March, 2015, https://www., Clinicaltrials: gov/study/NCT02458430; No: NCT05459753. Registered 01 July, 2022, https://www., Clinicaltrials: gov/study/NCT05459753., (© 2024 The Author(s). Published by IMR Press.)

Objective: This study aimed to optimize Fall Risk Appraisal (FRA) graphing for use in intervention programs tailored toward reducing the fall risk of older adults by using computing graphic functions in the R language., Materials and Methods: We utilized RStudio, a free development environment for the R language, as well as the functions within the "ggplot2" and "grid" packages, to develop a code that would recreate the FRA matrix for use in data visualization and analysis, as well as feedback for older adults., Results: The developed code successfully recreates the FRA matrix in R and allows researchers and clinicians to graph participant data onto the matrix itself., Discussion: The use of an R code allows for a streamlined approach to manipulating the FRA matrix for use in data visualization and feedback for older adults, which improves upon the traditional paper-pencil method that has been previously used., Conclusions: The code presented in this study recreates the FRA matrix instrument in the R language and gives researchers the ability to instantaneously add, remove, or change different aspects of the instrument to improve its readability for researchers and older adults., Competing Interests: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The organizations mentioned had no roles in the design of this study., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Introduction: This cross-sectional study analyzed the fear of falling (FOF) and associated influencing factors in patients undergoing maintenance hemodialysis (MHD)., Methods: Patients on MHD (n = 131) were assessed using the short Falls Efficacy Scale International, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Perceived Social Support Scale, and Barthel Index questionnaires., Results: The total FOF score was positively correlated with total anxiety and depression scores but negatively correlated with the total score of activities of daily living. There were significant differences in FOF among different age groups, employment status, the use of walkers, living arrangements (living alone), and having a history of falling in the past year. Age, employment status, history of falls in the past year, and anxiety score were significant risk factors for FOF in MHD patients., Conclusion: FOF in MHD patients is strongly associated with age, employment status, history of falls in the past year, and anxiety level., (© 2024 International Society for Apheresis and Japanese Society for Apheresis.)

Background: The fear of falling is a common issue among older adults that negatively affects physical and psychological aspects of health-related quality of life, regardless of actual fall events. Interventions aimed at reducing fear of falling, independent of falls, may improve older adults' quality of life. This study examined the moderated mediation effect of physical activity in how fear of falling affects health-related quality of life through depression in community-dwelling older adults., Methods: This study used secondary data from the Korea Centers for Disease Control and Prevention's 2019 Community Health Survey. The study included 73,738 adults aged 65 years or older. The researchers used the fear of falling scale, International Physical Activity Questionnaire, Patient Health Questionnaire-9, and EuroQol 5 Dimension as research tools, and performed descriptive statistics, Pearson's correlation coefficient, and SPSS PROCESS macro analysis. The study used the bootstrapping method to assess the adjusted mediating effect by resampling 5,000 times, and determined statistical significance with a 95% confidence interval., Results: In the model in which fear of falling affects health-related quality of life by mediating depression, the moderated mediation effect of physical activity was statistically significant, as the bootstrapping result did not include 0 in the 95% confidence interval (Index of moderated mediation [95% CI] = 0.006 [0.004-0.007], 0.008 [0.006-0.009]). Depression and health-related quality of life impairment decreased as the level of physical activity increased through inactivity, minimal activity, and health promotion activities, as the negative mediating effects decreased., Conclusion: Physical activity reduces depression and improves health-related quality of life by influencing older adults' fear of falling. Community-based programs are needed to encourage and support older adults in maintaining moderate physical activity to manage the depression caused by fear of falling, which is common among older adults, and to improve their health-related quality of life., (© 2024. The Author(s).)

Purpose: To investigate the relationship between baseline visual field (VF) severity and rates of visual field loss with changes in quality of life (QoL) and fear of falling (FoF) in adults with glaucoma., Methods: Prospective cohort study, including participants from the Falls In Glaucoma Study. Quality of life and FoF were assessed annually using the Glaucoma Quality of Life-15 Questionnaire, and the University of Illinois at Chicago FoF Questionnaire, respectively, with higher Rasch-analyzed scores (in logits) indicating better QoL and greater FoF. Mean deviation (MD) values of each eye were collected, with better-eye MD taken as the primary exposure. Change rates in better-eye MD, QoL, and FoF were computed using linear regression. Separate regression models were employed to explore the relationship between baseline better-eye MD and its rate of change with rates of change in QoL and FoF., Results: The mean (standard deviation) rate of change in better-eye MD was -0.08 dB/year (0.5), rate of QoL change was -0.08 logits/year (0.4), and rate of FoF change was 0.16 logits/year (0.7). At baseline, better-eye MD (per dB worse) was significantly associated with worse baseline QoL (β = -0.10 logits [95% confidence interval [CI]: -0.13, -0.08]) and greater FoF (β = 0.06 logits [95% CI: 0.01, 0.10]). Baseline better-eye MD was associated with no significant change in QoL ( -0.004 logits/year, 95% CI: -0.02, 0.01) or FoF (-0.0001 logits/year, 95% CI: -0.02, 0.02) over time. Change rates in better-eye MD showed significant associations with faster increases in FoF over time (β = 0.26 logits/year [95% CI: 0.06, 0.45]; per dB loss/year), but not with changes in QoL (P = 0.79)., Conclusions: Patients with glaucoma generally showed worsening of QoL and FoF over time, though the degree of change was modest and not related to the degree of damage at baseline. Faster rates of better-eye MD change alone were associated with faster increases in FoF. Further studies are needed to evaluate the reasons (visual and nonvisual) for changes in QoL and functionality over time and find ways in which QoL and mobility can be improved for those with VF damage., Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: Low physical activity among older adults is related to adverse health outcomes such as depression and loneliness, poor physical function and increased risk of falls. This study was designed to increase physical activity through a digital, group-based, physical activity and music intervention and to examine its effectiveness on social, mental and physical health outcomes., Methods: Participants were 34 older adults (65 years +) recruited across four care homes in Scotland to a pilot study. Surveys were administered at baseline and post-intervention, comprising measures of fear of falling, depression and anxiety, loneliness, sleep satisfaction and quality of life. A battery of physical function tests and saliva sampling for cortisol and dehydroepiandrosterone hormone analysis were also conducted at each time point. Additionally, process evaluation measures (recruitment, intervention fidelity, attendance, retention rates and safety) were monitored. The intervention comprised 12 weeks of three prescribed digital sessions per week: movement and music (n = 2) and music-only (n = 1), delivered by an activity coordinator in the care home. Post-intervention interviews with staff and participants were conducted to gain qualitative data on the acceptability of the intervention., Results: An average of 88% of prescribed sessions were delivered. Pre- to post-intervention intention-to-treat analysis across all participants revealed significant improvements in anxiety, salivary DHEA, fear of falling and loneliness. There were no significant improvements in health-related quality of life, perceived stress, sleep satisfaction or physical function tests, including handgrip strength. Qualitative analysis highlighted benefits of and barriers to the programme., Conclusions: The digital movement and music intervention was deemed acceptable and delivered with moderate fidelity, justifying progression to a full-scale trial. Although a proper control group would have yielded more confident causal relationships, preliminary psychosocial and biological effects were evident from this trial. To show significant improvements in physical function, it is likely that a bigger sample size providing sufficient power to detect significant changes, greater adherence, longer intervention and/or higher exercise volume may be necessary., Trial Registration: The trial is registered at ClinicalTrials.gov, number NCT05601102 on 01/11/2022., (© 2024. The Author(s).)

Background: Turning difficulties have been reported in stroke persons, but studies have indicated that fall history might not significantly affect turning performance. Fear of falling (FOF) is common after a fall, although it can occur in individuals without a fall history., Research Question: Could FOF have an impact on turning performance among chronic stroke patients?, Methods: This cross-sectional study recruited 97 stroke persons. They were instructed to perform 180° and 360° turns, and their performance was represented by angular velocity. FOF was evaluated using the Falls Efficacy Scale-International (FES-I). Falls that occurred 12 months prior to the study assessment were recorded., Results: A higher FES-I score was significantly correlated with a decline in angular velocity in all turning tasks after adjustment for demographic data. The correlation remained significant after controlling for falls history. Participants with a high level of FOF exhibited significantly slower angular velocities during all turning tasks compared with those with a low level of FOF. Participants with a moderate level of FOF had a significantly slower angular velocity than did those with a low level of FOF during the 360° turn to the paretic side only., Significance: A higher level of FOF, regardless of fall history, was significantly associated with a reduced angular velocity during turning. A high level of FOF affected turning performance in all tasks. Turning performance may not be affected by fall experience. Anxiety about falling may have a greater effect on turning performance than does fall history., Competing Interests: Declaration of Competing Interest No potential conflict of interest was reported by the authors., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Fear of falling (FOF) has emerged as a significant public health issue, contributing to excess disability among middle-aged and older adults. The association between FOF and mortality remains unclear., Methods: Prominent electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycINFO, Scopus, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang Database) were searched from inception until October 21, 2023 (data updated on June 9, 2024), for cohort or longitudinal studies investigating the association between FOF and mortality. The heterogeneity between studies was quantitatively assessed using I 2 . A fixed-effect model calculated the pooled effect size., Results: A total of seven cohort studies, including 27,714 participants, were analyzed in this systematic review and meta-analysis. The meta-analysis results demonstrated a positive association between FOF and mortality, with a significant increase in the risk of mortality for those with FOF (hazard ratio [HR]:1.29, 95 % confidence interval [CI]: 1.19-1.41, p < 0.05). Subgroup analysis indicated that age, male sex, clinical diagnosis of depression, number of chronic diseases, activity restriction due to FOF, and FOF levels were associated with mortality., Conclusions: FOF and mortality have a positive association, which needs to be confirmed by further prospective studies with large samples and long-term follow-up to provide evidence for clinicians to intervene in FOF to reduce mortality in middle-aged and older adults., Competing Interests: Declaration of competing interest None of the authors have any conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Knee OA (KOA) can lead to pain, loss of muscle strength, and changes in gait. Knee stiffness is a classic feature of KOA that can increase the risk of falls but has been understudied., Objective: To evaluate the impact of knee stiffness, the factors influencing the severity of stiffness, and the repercussions on participation for patients with KOA., Methods: This qualitative study used an interpretive description approach. Purposeful sampling was used for patients with KOA over 45 years of age, fluent in English, diagnosed with KOA and reported KOA stiffness within the last 6 months. Participants were recruited through social media and Ontario clinics. Semi-structured interviews were conducted over the phone or using zoom, recorded, and transcribed verbatim. Open, axial, and selective coding were used to identify clinically relevant themes., Results: Twelve participants (5F, 7M) with a mean age of 60 years were included. The five themes identified include elusive and variable perceptions of joint stiffness, inactivity or too much activity exacerbates stiffness, adapting to the ebb and flow of symptoms, risk experiences and safety fears leads to reduced participation, and KOA stiffness impairs quality of life., Conclusion: This study highlights characteristics of knee stiffness, consequences on participation, and quality of life for people with KOA. Monitoring knee stiffness for KOA is recommended for more appropriate treatment intensity, which could improve adherence to a home programme and potentially reduce the risk of falls., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)

Background: Social participation levels of individuals with Multiple Sclerosis (iwMS) are lower than those of healthy individuals., Objective: This study aimed to evaluate to which extent the walking capacity, balance, and fear of falling (FoF) affect the community integration levels of iwMS., Methods: Thirty-nine iwMS were evaluated for their participation levels [The Community Integration Questionnaire (CIQ)], walking capacity [The Six-Minute Walk Test (6MWT)], balance [Kinesthetic Ability Trainer (SportKAT®)], and FoF [The Modified Falls Efficacy Scale (MFES)]. Correlation and regression analyses were performed to detect the effects of SportKAT®, 6MWT, and MFES on CIQ., Results: CIQ scores were significantly correlated with 6MWT ( p  = .043) and MFES ( p  = .005) scores, while CIQ was not related with static (for two feet test p  = .356, for right single-leg stance test p  = .412, for left single-leg stance test p  = .730) and dynamic balance (for clockwise test p  = .097, for counterclockwise test p  = .540) measured with the SportKAT®. It was found that CIQ could be predicted by 6MWT and MFES at the level of 16% and 25%, respectively., Conclusion: FoF and walking capacity are associated with community integration in iwMS. Therefore, physiotherapy and rehabilitation programs of iwMS should be combined with treatment goals to increase community integration, balance, and gait and decrease the disability and FoF from an early stage. Comprehensive studies examining other factors that may impact participation in iwMS with different levels of disability are needed.

Purpose: Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are understudied conditions characterized by hallmark hypermobility and chronic pain. Disease manifestations lead to significant disability. Understanding predictors of disability, over and above the univariate construct of pain severity, is necessary to tailor treatment. Thus, the current study examined the impact of the Fear-Avoidance Model [FAM] on disability in hEDS/HSD. Fear of falling was included as a novel fear-avoidance factor impacting disability., Methods: A total of 168 individuals with hEDS/HSD answered a cross-sectional online survey regarding FAM constructs, fear of falling, disability, and clinical-demographic factors. A hierarchical regression analysis was used to assess whether FAM constructs and fear of falling significantly predicted disability, over and above pain severity and age., Results: Pain catastrophizing, anxiety, and fear of falling contributed significant unique predictive relations, above age and average pain severity. Pain severity and fear of falling were the strongest unique predictors of disability., Conclusions: This is the first study to assess the relations among FAM constructs, pain severity, and disability in hEDS/HSD, and introduces fear of falling as a novel fear-avoidance factor specific to this population. Future research should apply these findings towards individualized interventions to improve disability in hEDS/HSD.

The fear of falling is a pressing public health issue, yet current interventions often fall short in addressing it effectively. As a result, there is a need for innovative interventions that go beyond symptom relief to address the underlying causes. From this standpoint, we propose that limited exposure to floors and a lack of post-fall contingencies may contribute to the uncertainty that amplifies the fear of falling, particularly in fall prone populations. We explore the theoretical underpinnings of this hypothesis and propose a framework based on the Uncertainty and Anticipation model to elucidate potential connections. Building upon this, we introduce the Floor-hugging intervention-a two-part strategy designed to confront these challenges. Firstly, we propose gradual exposure to different floor scenarios through guided imagery to diminish fear by familiarizing individuals with such situations. Secondly, we advocate for the adoption of evidence-based ways to get up from the floor for developing after fall contingencies. We delve into the theoretical framework supporting our approach and its potential to reduce the fear of falling while improving physical, social, and psychological well-being. Additionally, we outline prospective outcome measures to comprehensively assess the impact of the intervention across biopsychosocial domains. This perspective aims to stimulate discussion on the potential role of floor exposure and post-fall strategies in reducing the fear of falling, while also advocating for innovative interventions to empower and protect fall-prone populations., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

This study investigated the frailty change patterns among Korean older adults during 2006-2020 and the effect of activity limitations induced by the fear of falling (FOF) on these patterns. We employed a descriptive longitudinal design utilizing data from Waves 1 to 8 of the Korean Longitudinal Study of Aging. The exclusion criteria were a baseline age < 65 years, frailty index (FI) captured only at baseline, and death or unknown survival status. Multilevel modeling, combining regression equations at two levels, was used to examine the effect of activity limitations due to FOF on frailty, adjusting for other confounding factors. An increase in FI (1.97; p < .001) was demonstrated in participants who had experienced falls versus those who had not in the past 2 years. Notably, those facing activity limitations due to FOF exhibited a more significant increase in FI (4.62; p < .001) compared with those without; frailty progression intensified over time in the former (0.54, p < .001). Activity limitations due to FOF had a more pronounced impact on frailty than falls; moreover, these activity limitations accelerated the progression of frailty. Healthcare providers must prioritize addressing FOF by employing both physical and psychological interventions to mitigate activity limitations and ultimately decelerate frailty., (© 2024. The Author(s).)

Background: Anxiety can exacerbate fear of falling and balance issues, potentially affecting intervention efficacy. This study examines exergaming's impact on fear of falling and balance in anxious and non-anxious older adults., Materials and Methods: Twenty older adults (10 anxious, 10 non-anxious) participated in six weeks of balance-oriented gaming. Fear of falling was assessed using the Falls Efficacy Scale and the Activities-specific Balance Confidence Scale. Balance was measured with the Berg Balance Scale and the Timed Up and Go Test before, after, and six weeks post-intervention., Results: Both groups showed significant improvements in balance and mobility, sustained during follow-up. However, only the non-anxious group exhibited significant reductions in fear of falling and increased balance confidence. Anxiety was linked to reduced enjoyment, lower efficacy perception, and heightened tension during the intervention., Conclusion: Exergaming improves balance and reduces fear of falling in non-anxious older adults. Anxiety may diminish these benefits., Clinical Implications: Assessing anxiety levels is crucial when prescribing exergaming interventions. Tailoring treatments to address anxiety could enhance outcomes.

Background: Longevity increases pose public health challenges, especially in managing falls and their psychological impacts on older adults. Limited evidence exists on the relationship between a fear of falling (FOF), previous falls, and depressive symptoms among community-dwelling older adults., Objective: To evaluate the association between falls, FOF, and depressive symptoms in community-dwelling older adults., Methods: This cross-sectional study, conducted in 2018, included 400 older adults from a Basic Health Unit in São Paulo, Brazil. The Geriatric Depression Scale (GDS-15) and the International Falls Efficacy Scale (FES-I) were used, along with self-report questionnaires on fall history. Linear and logistic regression were used to analyze the relationships between variables., Results: The mean age was 75.2 (SD = 8.53) years, with 63.2% being female. Depressive symptoms were observed in 18.3% of the participants, while 90.5% reported a fear of falling (FOF). More than half (63.0%) experienced falls, with 49.5% occurring in the last year. Factors such as the female gender, negative health perceptions, and functional dependence were associated with depressive symptoms. Adjusted analyses indicated that both a fear of falling (FOF) (B = 0.043; p = 0.012) and a history of falls (B = 0.725; p = 0.015) were associated with depressive symptoms., Conclusions: Falls, FOF, and depressive symptoms are interlinked among older adults, underscoring the need for targeted interventions to improve their mental and physical health., Competing Interests: The authors declare no conflicts of interest.

Purpose: To evaluate the psychometric properties of a Fall Concerns Scale for people who use Wheelchairs and Scooters (FCS-WC/S)., Materials and Methods: Developed by fall prevention experts, FCS-WC/S underwent refinement through interdisciplinary reviews and focus groups with researchers, clinicians, and individuals who use WC/S full-time. The psychometric evaluation involved adults who used WC/S for ≥1 year and had ≥1 fall in the previous 3 years, recruited between April and September 2022., Results: The FCS-WC/S evaluates fall concerns among people with various health conditions who use WC/S full-time across 33 daily activities. One hundred and twenty-four participants responded to the baseline survey. A subgroup of 63 people repeated the FCS-WC/S a week later. The FCS-WC/S demonstrated excellent internal and good test-retest reliability ( α  ≥ 0.90, ICC = 0.86-0.9), as well as concurrent validity (Spearman's rho = 0.72) with the Spinal Cord Injury Falls Concern Scale (SCI-FCS). It effectively differentiated fear of falling levels from an established measure (ORs 4.1, 25.8, 46.7). Factor and parallel analysis revealed three factors, two of which were retained for further analysis., Conclusions: Preliminary findings support FCS-WC/S validity and reliability for assessing fall concerns among individuals with various conditions who use WC/S. Further scale construction analysis is recommended.

Background: Saudi Arabia, like many nations globally, is experiencing a demographic shift towards an aging population. With this demographic shift, falls and the fear of falling (FOF) emerge as serious public health concerns among community-dwelling older adults. Addressing misconceptions and enhancing awareness regarding fall risks among older adults holds significant importance, offering insights for informing targeted interventions and enhancing well-being. This study aimed to examine knowledge and perceptions of fall risk among community-dwelling older women in Saudi Arabia., Methods: A cross-sectional study was conducted with 150 Saudi older women, with a mean age (SD) of 63.98 (4.90) years. Participants completed questionnaires assessing fall history, fall knowledge, fall perception, the Falls Efficacy Scale-International (FES-I), Timed Up and Go (TUG), and the Barthel Index. Fall knowledge and perception were assessed using previously constructed statements translated into Arabic and carried out in interviewer-administered forms., Results: Nearly half of the participants reported experiencing at least one fall in the previous 12 months. Despite good knowledge of falls, some gaps were identified, particularly regarding the awareness of social isolation as a consequence of falls. Participants demonstrated positive perceptions towards fall prevention programs but also highlighted misconceptions regarding aging and falls. FOF was prevalent, with higher levels identified among participants without a history of falls., Conclusion: Multidimensional strategies are needed to address falls and FOF among community-dwelling older women in Saudi Arabia. Leveraging existing knowledge and perceptions towards fall prevention and implementing evidence-based interventions can reduce the burden of falls and enhance health outcomes in older adults. Future research should focus on diverse samples and evaluate the feasibility of implementing fall prevention interventions within Saudi Arabia's healthcare systems., (© 2024. The Author(s).)

Fall is the leading cause of disability and mortality due to unintentional injury in older adults. The aim of this study was to determine the prevalence and risk factors associated with knee pain, fear of falling, and quality of life among community-dwelling older adults in Northern Thailand. A cross-sectional study was conducted among older adults aged 60 and over. A total of 369 participants were enrolled from April to May 2024. Oxford knee score, a short version of the Falls Efficacy Scale International (FES-I) and World Health Organization quality of life-BREF-Thai, was measured. The results showed that the mean age was 69.4 years and 47 (12.7%) had a history of falls in the previous year. The prevalence of fear of falling was 39.3% for low, 22.5% for moderate, and 38.2% for high concern. Age, marital status, alcohol, history of falls, hypertension, arthritis, and osteoporosis were associated with fear of falling. After adjusting to age, gender, body mass index, education, marital status, smoking, alcohol, history of falls, and chronic disease, osteoarthritis of the knee was positively associated with increasing fear of falling (β: 0.361; p <0.001), while quality of life was negatively associated with fear of falling (β: -0.064; p <0.011). In conclusion, the identified determinants of fear of falling among the elderly indicated the need for fear of falling prevention programs targeting not only individual lifestyles but also chronic diseases. This study provides useful information that might help to develop and adopt effective policies for fear of falling control in Thailand., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s).)

Introduction: Multiple sclerosis (MS) is the most common chronic inflammatory disease of the central nervous system. The progressive impairment of gait is one of the most important pathognomic symptoms which are associated with falls and fear of falling (FOF) in people with MS (pwMS). 60 % of pwMS show a FOF, which leads to restrictions in mobility as well as physical activity and reduces the quality of life in general. Therefore, early detection of FOF is crucial because it enables early implementation of rehabilitation strategies as well as clinical decision-making to reduce progression. Qualitative and quantitative evaluation of gait pattern is an essential aspect of disease assessment and can provide valuable insights for personalized treatment decisions in pwMS. Our objective was to identify the most appropriate clinical gait analysis methods to identify FOF in pwMS and to detect the optimal machine learning (ML) algorithms to predict FOF using the complex multidimensional data from gait analysis., Methods: Data of 1240 pwMS was recorded at the MS Centre of the University Hospital Dresden between November 2020 and September 2021. Patients performed a multidimensional gait analysis with pressure and motion sensors, as well as patient-reported outcomes (PROs), according to a standardized protocol. A feature selection ensemble (FS-Ensemble) was developed to improve the classification performance. The FS-Ensemble consisted of four filtering methods: Chi-square test, information gain, minimum redundancy maximum relevance and ReliefF. Gaussian Naive Bayes, Decision Tree, k-Nearest Neighbor, and Support Vector Machines (SVM) were used to identify FOF., Results: The descriptive analysis showed that 37 % of the 1240 pwMS had a FOF (n = 458; age: 51 ± 16 years, 76 % women, median EDSS: 4.0). The FS-Ensemble improved classification performance in most cases. The SVM showed the best performance of the four classification models in detecting FOF. The PROs showed the best F1 scores (Early Mobility Impairment Questionnaire F1 = 0.81 ± 0.00 and 12-item Multiple Sclerosis Scale F1 = 0.80 ± 0.00)., Conclusion: FOF is an important psychological risk factor associated with an increased risk of falls. To integrate a functional early warning system for fall detection into MS management and progression monitoring, it is necessary to detect the relevant gait parameters as well as assessment methods. In this context, ML strategies allow the integration of gait parameters from clinical routine to support the initiation of early rehabilitation measures and adaptation of course-modifying therapeutics. The results of this study confirm that patients' self-assessments play an important role in disease management., Competing Interests: Declaration of competing interest All authors declare no conflicts of interests., (Copyright © 2024. Published by Elsevier B.V.)

Objective: Patients on hemodialysis are highly susceptible to falls and fractures. Amplified apprehension regarding the fear of falling (FOF) constitutes a risk factor that restricts physical activity and escalates the probability of falls among the elderly population. This study aimed to elucidate the association between falls and FOF and physical activity in patients on hemodialysis., Methods: A prospective cohort study was conducted across 9 centers. FOF was assessed using the Falls Efficacy Scale-International (FES-I). Physical activity was assessed using the Japanese version of the International Physical Activity Questionnaire short form. Subsequently, falls were monitored over a duration of 1 year. Logistic regression analysis was performed to evaluate the relationship between falls and FOF and physical activity. In addition, in the receiver operating characteristic analysis, the cutoff value of FES-I that predicts falls was determined using the Youden Index. A restricted cubic spline curve was utilized to analyze the nonlinear association between falls and the FES-I., Results: A total of 253 patients on hemodialysis (70.0 [59.0-77.0] years old; 105 female [41.5%]) were included in the analysis. During the 1-year observation period, 90 (35.6%) patients experienced accidental falls. The median FES-I score was 36.0 (24.0-47.0) points, and patients with higher FES-I scores had more falls. Following adjusted logistic regression analysis, FES-I exhibited an independent association with falls (OR = 1.04; 95% CI = 1.01-1.06), but physical activity was not. The area under the receiver operating characteristic curve was 0.70 (95% CI = 0.64-0.77), and the FES-I threshold value for distinguishing fallers from non-fallers was determined as 37.5 points (sensitivity 65.6%, specificity 35.0%). A nonlinear relationship between falls and FES-I was observed., Conclusion: FOF was associated with the incidence of falls in patients on hemodialysis., Impact: The evaluation and implementation of interventions targeting the FOF may mitigate the risk of falls., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: Cardiometabolic diseases (CMDs) have been individually associated with fall-related outcomes, but their combined effect on fear of falling (FOF) has not been investigated. This study aims to examine the association between cardiometabolic multimorbidity and FOF in older adults., Methods: Data from the National Health and Aging Trends Study, 4,295 community-dwelling older adults ≥ 65 years were analyzed in this longitudinal study. CMDs were assessed at baseline, including heart disease, diabetes, stroke, and hypertension. FOF was evaluated by asking participants if they worried about falling in the past month. Data were analyzed using multi-adjusted logistic regression., Results: Cardiometabolic multimorbidity was associated with a higher risk of FOF. The combination of heart disease and diabetes showed the highest risk of FOF (OR = 3.47, 95 % CI: 1.63-7.40)., Conclusions: These findings underscore the need for targeted interventions to mitigate the combined impact of cardiometabolic multimorbidity on FOF in older adults., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: As a geriatric syndrome, sarcopenia may exacerbate static postural control and increase fall risk among older adults. The Romberg test, a simple method to assess static postural control, has the potential to predict fall, but has rarely been used to assess static postural control and fall risk in sarcopenic older adults., Research Question: How does sarcopenia increase fall risk by affecting static postural control?, Methods: Forty-four older adults performed the Romberg test and were included for analyses. Romberg parameters, including Center of Pressure (CoP), Center of Mass (CoM) and Displacement Angle (DA), were collected under eyes-open/eyes-closed conditions. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Fall risk was assessed using the Morse Elderly Fall Risk Assessment Scale (MFS), and fear of falling was evaluated using the Falls Efficacy Scale-International (FES-I). Multivariate linear regression models were conducted to examine the associations of sarcopenia with Romberg test parameters, fear of falling, and fall risk., Results: Sarcopenic older adults had higher scores of both fear of falling and fall risk (P<0.001 and =0.006, respectively), and worse static postural control parameters (P values ranging from <0.001-0.043) than healthy controls, demonstrated by the multivariate linear regression models. Most of the Romberg test parameters were significantly associated with fear of falling score, especially under eyes-closed condition, and fear of falling was further associated with higher fall risk score (β=0.90, P=0.001). Meanwhile, the presence of sarcopenia also significantly increased fall risk score (β=10.0, P<0.001)., Significance: Sarcopenia may increase fall risk in older adults via worsen static postural control ability and increase fear of falling. Paying attention and making efforts to prevent sarcopenia may help to alleviate postural control dysfunction, decrease fear of falling, so as to reduce fall risk and prevent severe injuries caused by fall accidents., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The independent predictive power of fatigue for community integration has not been investigated, although there is an increasing amount of literature that recognizes the importance of fatigue in people with stroke., Objectives: To examine the correlation between community integration and fatigue, walking endurance, and fear of falling; and to quantify the relative contribution of fatigue to community integration in people with stroke., Methods: This was a cross-sectional study with 75 community-dwelling people with stroke. Data were collected using the Community Integration Measure (CIM), Fatigue Assessment Scale (FAS), 6-minute walk test (6MWT), and Survey of Activities and Fear of Falling in the Elderly (SAFE). Multiple linear regressions (forced entry method) were used to quantify the relative power of the FAS score to predict community integration in a model covering distance in the 6MWT and the SAFE score., Results: After controlling for age, the CIM score significantly correlated with the scores for FAS ( r =-0.48, p  < 0.001), 6MWT distance ( r  = 0.24, p  = 0.039), and SAFE ( r =-0.39, p  = 0.001). The entire model, including age, FAS score, 6MWT distance, and SAFE score, explained 26.1% of the variance in the CIM scores (F [4, 70] = 7.52, p  < 0.001). The FAS scores independently explained 10.6% of the variance in the CIM scores., Conclusions: This study suggests that fatigue is an independent predictor of community integration among people with stroke, taking into account walking endurance and fear of falling.

Purpose: To identify the factors associated with the fear of falling (FOF) and fall-related injuries (FRI) among full-time wheelchair and motorized mobility scooter (WC/S) users with various health conditions., Methods: This cross-sectional study included participants (≥18 years old) who used WC/S for at least one year for ≥ 75% of mobility and had a history of ≥ 1 fall in the past three years. Logistic regression models identified factors associated with FOF (yes/no) and FRI (yes/no) during the past year. Data on demographics, prior falls, mental health, environmental accessibility, and WC/S usage were used as independent variables., Results: Among 156 participants, 96% reported at least one fall within the past year, among whom 94.6% reported FOF, and 74% reported FRI within the same period. FOF was associated with fall incidence in the past year (OR = 17.75, p  = 0.001). FRI was associated with higher levels of anxiety (OR = 1.15, p  = 0.003) and fewer hours of WC/S use per week (OR = 0.98, p  = 0.012)., Conclusion: This study highlights the high prevalence of FOF and FRI among WC/S users who had falls. The findings emphasized the relation between prior fall experiences and FOF and underscored the significance of addressing anxiety symptoms and WC/S usage in relation to FRI.

Background: Approximately 40-70% of older adults who have experienced falls develop fear of falling (FOF), with the incidence rate in nursing home residents reaching as high as 79.4%. An increasing number of studies have focused on the effect of the Otago Exercise Programme (OEP) on reducing FOF among older adults, yet comprehensive analysis is lacking due to regional and demographic variations. Therefore, this study integrates the relevant literature to provide evidence supporting interventions aimed at alleviating FOF among older adults., Objective: To evaluate the impact of OEP on FOF in older adults through meta-analysis., Methods: We searched ten databases using computer systems, covering all records up to May 1, 2024. Two researchers independently conducted the literature screening, bias risk assessment, and data extraction. We performed data analysis using RevMan 5.3 and Stata 15.0 software, assessed result stability through sensitivity analysis, and examined publication bias with funnel plots and Egger's test., Results: Sixteen RCTs were included. Meta-analysis revealed that the OEP significantly reduced FOF among older adults [SMD = 0.96, 95%CI (0.68, 1.23), P < 0.00001]. Subgroup analysis revealed that interventions lasting more than 16 weeks [SMD = 1.12, 95%CI (0.75, 1.49), P < 0.00001], with a frequency of more than twice a week [SMD = 0.99, 95%CI (0.64, 1.35), P < 0.00001], and for older adults in community and nursing institutions [SMD = 1.03, 95%CI (0.50, 1.57), P = 0.0002] were more effective. A comparison of the 16-week and 24-week interventions revealed that the latter had better outcomes [SMD = 0.87, 95%CI (0.66, 1.08), P = 0.0004]., Conclusion: Current evidence indicates that OEP effectively reduces FOF among older adults. It is recommended that interventions last for more than 24 weeks, occur more than twice a week, and suitable for application among older adults in community settings or elder care institutions., (© 2024. The Author(s).)

Objective: Sedentary behavior, falls, and fear of falling (FoF) are specific concerns for people with MS (pwMS). Considering the relatively high incidence and potential linkage, it is surprising that this triple relationship has as yet not been extensively investigated in pwMS. Thus, the present study aimed to examine the correlates of sedentary behavior with FoF and falls in pwMS., Methods: Fifty pwMS, 30 women, were admitted to this cross-sectional study. Primary outcome measures included physical activity and sedentary behavior metrics measured by accelerometry, fall status, and FoF. Additional measures included mobility clinical tests, cognition, perceived fatigue, depression, and anxiety. The sample was divided into two subgroups according to the daily Metabolic Equivalent of Task (MET) rate scores; <1.5 was defined as sedentary, ≥1.5 were defined as non-sedentary. Multivariate analysis of variance and linear regression analyses assessed the relationships by using an alpha of 0.05., Results: Sixty-four percent of the sample were classified as sedentary. The sedentary subgroup reported more FoF than the non-sedentary subgroup (32.5 (S·D. = 11.3) vs. 29.9 (S.D. = 9.5); however, no differences were found in fall status between the subgroups. No differences were found for depression, anxiety, cognition, and perceived fatigue between the subgroups. Furthermore, according to the linear regression analysis, FoF explained 23.9% of the variance pertaining to the daily MET rate when controlling for age, gender, disease duration, and disability., Conclusions: Clinicians are encouraged to incorporate the issue of FoF during standard management, which may represent an opportunity to improve care and reduce sedentary behavior in pwMS., Competing Interests: Declaration of competing interest All authors have completed the Unified Competing Interest form and declare no competing interests to report., (Copyright © 2023. Published by Elsevier Inc.)

Background: Impairments in real-world gait quality and quantity are multifaceted for individuals with multiple sclerosis (MS), encompassing mobility, cognition, and fear of falling. However, these factors are often examined independently, limiting insights into the combined contributions they make to real-world ambulation., Research Question: How do mobility, cognition, and fear of falling contribute to real-world gait quality and quantity in individuals with MS?, Methods: Twenty individuals with MS underwent a series of cognitive assessments, including the Paced Auditory Serial Addition Test (PASAT), Symbol Digits Modalities Test (SDMT), Stroop Test, and the Selective Reminding Test (SRT). Participants also completed the Falls Efficacy Scale - International (FES-I) and walking impairment using the Patient Determined Disease Steps (PDDS). Following the in-lab session, participants wore an inertial sensor on their lower back and asked to go about their typical daily routines for three days. Metrics of gait speed, stride regularity, time spent walking, and total bouts were extracted from the real-world data., Results: Significant correlations were found between both real-world gait speed and stride regularity and the SDMT, FES-I, and PDDS. Backward linear regression analysis was conducted for gait speed and stride regularity, with PDDS and SDMT included in the final model for both metrics. These variables explained 63% of the variance in gait speed and 69% of the variance in stride regularity. Results were not significant for gait quantity after adjusting for age and sex., Significance: The study's results provide insight regarding the roles of cognition, walking impairment, and fear of falling on real-world ambulation. Deeper understanding of these contributions can inform the development of targeted interventions that aim to improve walking. Additionally, the absence of significant correlations between gait metrics, cognition, and fear of falling with gait quantity underscores the need for further research to identify factors that increased walking in this population., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aims: To examine how perceived balance problems are associated with self-reported falls in the past month after controlling for known correlates of falls among older adults., Background: Approximately 30% of adults age 65 and older fall each year. Most accidental falls are preventable, and older adults' engagement in fall prevention is imperative. Limited research suggest that older adults do not use the term 'fall risk' to describe their risk for falls. Instead, they commonly use the term 'balance problems'. Yet, commonly used fall risk assessment tools in both primary and acute care do not assess older adults' perceived balance., Design and Method: The Health Belief Model and the concept of perceived susceptibility served as the theoretical framework. A retrospective, cross-sectional secondary analysis using data from the National Health and Aging Trends Study from year 2015 was conducted. The outcome variable was self-reported falls in the last month., Results: A subsample of independently living participants (N = 7499) was selected, and 10.3% of the sample reported a fall. Multiple logistic regression analysis revealed that the odds of reporting a fall in the past month was 3.4 times (p < .001) greater for participants who self-reported having a balance problem compared to those who did not. In contrast, fear of falling and perceived memory problems were not uniquely associated with falls. Using a mobility device, reporting pain, poor self-rated health status, depression and anxiety scores were also associated with falling., Conclusion and Implications: Older adults' perceived balance problem is strongly associated with their fall risk. Perceived balance may be important to discuss with older adults to increase identification of fall risk. Older adults' perceived balance should be included in nursing fall risk assessments and fall prevention interventions. A focus on balance may increase older adults' engagement in fall prevention., (© 2024 John Wiley & Sons Ltd.)