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Objectives: To investigate the effect of vestibular rehabilitation exercises supported with virtual reality containing real-life environments on dizziness, static and dynamic balance, functional mobility, fear of falling, anxiety, and depression in elderly patients with dizziness. Methods: In this prospective randomized controlled study, 32-patients aged 65-years and older who applied to the otorhinolaryngology clinic with dizziness complaint randomly assigned to 2 groups. In Group 1 (n = 16), vestibular rehabilitation program, supported with virtual reality, and in Group 2 (n = 16), conventional vestibular rehabilitation program was applied 30-min a day, 5 sessions per week, 15 sessions in total for 3 weeks. Subjects were evaluated with The Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), Berg Balance Test (BBT) and Timed Up & Go Test (TUG), Falls Efficacy Scale-International (FES-I), Postural Stability Test (PST), Geriatric Depression Scale (GDS), Hamilton Anxiety Scale (HAS) at baseline, at the end of the treatment and 6-months after the treatment. Results: Statistically significant improvements were seen in the DHI emotional subscale and TUG in Group 1 compared to Group 2 at the end of the treatment in elderly with dizziness (p < 0.05). Also, there were significant improvements in the VSS, all DHI subgroups, and total scores, BBT, HAS in Group 1 compared to Group 2 at the 6-months after the treatment (p < 0.05). Conclusion: The application of vestibular rehabilitation in a virtual reality environment can lead to additional improvements especially in dizziness symptoms, disability, balance, and mobility in the elderly with chronic dizziness. © 2021 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial

This study investigated how a fear of falling affects perceptions and behavioral intentions toward age-friendly home modification (AFHM) in older parents and adult children by integrating the theory of planned behavior (TPB) to explain AFHM decision-making processes and the protection motivation theory to explain the impact of a fear of falling on AFHM intention. The target population comprised older parents (≥75 years old) and adult children (45–64 years old) in Busan, South Korea (N = 600). The participants completed a self-administered questionnaire in March 2022. Independent t-test and path model analyses were conducted to compare primary constructs between older parents and adult children and analyze the relationships among a fear of falling, TPB components, and AFHM intention. Results showed that both groups had positive attitudes toward AFHM. However, adult children showed significantly higher rates of having a fear of falling, lower perceived behavioral control, and higher AFHM intention than older parents. The proposed research models were partially supported in the older-parent group and fully supported in the adult-children group. Adult children play a critical role in AFHM, along with older adults who are directly involved in an aging society. AFHM-supporting programs, including monetary and human-force assistance, education, related public advertisements, and an active AFHM market, should be expanded.

Background. The Motoric Cognitive Risk (MCR) syndrome is defined in non-demented older adults by cognitive complaints and slow gait. Individuals with MCR are at higher risk of dementia and other poor clinical outcomes, such as falls. However, no data are available as regards functional mobility alterations associated with MCR. The main purpose of the present study is to quantitatively investigate such an aspect using the instrumented Timed-Up-and-Go (iTUG) test carried out using a wearable inertial measurement unit (IMU). Methods. Fifty-one women aged over 65 years underwent a geriatric and neuropsychologic assessment (which included the Mini Mental State Examination, MMSE and Addenbrooke’s Cognitive Examination Revised, ACE-R), instrumented gait analysis and iTUG performed using an IMU located on the lower back. Based on subjective cognitive complaints and slow gait, they were assigned either to the MCR (n = 24) or non-MCR (n = 27) group. IMU data allowed calculation of overall and sub-phases iTUG times.Results. Women with MCR were characterized by a significantly higher body mass and body mass index, lower normalized handgrip strength, and similar values of MMSE compared to non-MCRs. A trend was observed in terms of lower overall and sub-domain ACE-R score. They also performed iTUG at a significantly slower speed (22.4 s vs 14.1 of the non-MCR group, p < 0.001) and exhibited increased sub-phase times (29 to 31% higher with respect to non-MCRs).Conclusions. The findings of the present study suggest that the MCR syndrome impairs functional mobility, probably due reduced muscular strength and coordination, fear of falling and increased instability. The instrumental evaluation of functional mobility appears useful in the management of women with MCR, particularly in monitoring the progression of the motor impairments, verifying the effectiveness of interventions targeted in alleviating the impact on daily life of mobility limitations associated with MCR and in defining tailored rehabilitation programs.

Larissa Franciny de Souza,1 Jaquelini Betta Canever,1 Bruno de Souza Moreira,2 Ana Lúcia Danielewicz,1 Núbia Carelli Pereira de Avelar1 1Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Araranguá, Santa Catarina, Brazil; 2René Rachou Institute, Oswaldo Cruz Foundation (Fiocruz Minas), Belo Horizonte, Minas Gerais, BrazilCorrespondence: Bruno de Souza MoreiraRené Rachou Institute, Oswaldo Cruz Foundation (Fiocruz Minas), Augusto de Lima Avenue 1715, Barro Preto, Belo Horizonte, Minas Gerais, 30190-002, Brazil, Tel +55 31 3349-7707, Email brunosouzamoreira@gmail.comBackground/Objective: Fear of falling (FoF) and frailty are common problems in older adults. FoF can lead to self-imposed restriction of activities and then further decline in physical capacities that predispose older adults to frailty. Evaluating the association of these two geriatric syndromes may be the first step for understanding their complex relationship and might ultimately lead to establishing therapeutic goals and guiding treatments for older adults with frailty. This systematic review was conducted to provide evidence regarding the association between FoF and frailty.Methods: All the articles that provided information on the association between FoF and frailty were selected from PubMed, Scopus, CINAHL, and EMBASE in search of relevant papers. Articles reporting information on the association between FoF (exposure) and frailty (outcome), with older adults (age ≥ 60 years) living in the community (ie, living either at home or in places of residence that do not provide nursing care or rehabilitation) were included. Only original articles with observational design (cross-sectional or longitudinal/cohort) were included. The methodological quality of included articles was evaluated independently by the two assessors through the Newcastle-Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) critical appraisal checklist for longitudinal and cross-sectional studies, respectively.Results: The initial searches found 4,342 articles, of which 10 articles were included in this review: 7 cross-sectional and 2 longitudinal studies, and 1 study with cross-sectional and longitudinal analyses. The total sample was composed of 6,294 community-dwelling older adults (61.8% women). Among the longitudinal studies, adjusted odds ratios ranged from 1.18 (95% CI = 1.02; 1.36) to 9.87 (95% CI = 5.22; 18.68), while the adjusted odds ratios of the cross-sectional studies ranged from 1.04 (95% CI = 1.02; 1.07) to 7.16 (95% CI = 2.34; 21.89).Conclusion: FoF increases the risk of frailty in community-dwelling older adults. The knowledge of this association is of utmost importance in clinical practice, since it can help health professionals in the development of rehabilitation, prevention, and health promotion protocols. In addition, these findings can contribute to the development of public health policies and actions aimed at reducing the FoF and consequently the frailty.Prospero: CRD42021276775.Keywords: fear of falling, frailty, older adults, systematic review, geriatric syndromes

Copyright © The Author(s) 2023. Purpose: Concerns about falling are common in older adults and often cause activity restriction. This can lead to physical deconditioning, falls and social isolation. However, not every concerned older adult will restrict their activities. This 12-month longitudinal study investigated the physical and psychosocial factors that predict the new onset of activity restriction due to concerns about falling in older people. Methods: Participants were 543 older adults (Mage = 80.3 ± 4.4 years, range: 75–98) who did not report activity restriction due to concerns about falling at Timepoint-1 (negative response to the following question: “Do concerns about falling stop you going out-and-about?”). Participants completed a battery of physical and psychological assessments at Timepoint-1. Using binary logistic regression, we then assessed which of these variables predicted whether participants reported having started restricting their activity due to concerns about falling at the 12-month follow-up (Timepoint 2). Results: 10.1% of the sample started to restrict activity due to concerns about falling at Timepoint 2. Three key predictors significantly predicted activity restriction group status at 12-month follow-up: greater frailty at Timepoint-1 (Fried Frailty Index; OR = 1.58, 95% CI 1.09–2.30), experiencing a fall between Timepoint-1 and 2 (OR = 2.22, 95% CI 1.13–4.38) and poorer functional mobility at Timepoint-1 (Timed up and Go; OR = 1.08, 95% CI 1.01–1.15). Conclusions: Frailty, experiencing a fall and poorer functional mobility all predicted the onset of activity restriction due to concerns about falling. Clinicians working in balance and falls-prevention services should regularly screen for frailty, and patients referred to frailty services should likewise receive tailored treatment to help prevent the development of activity restriction due to concerns about falling. TJ Ellmers is supported by a Wellcome Trust Sir Henry Wellcome Postdoctoral Fellowship 222747/Z/21/Z.

Fear of falling (FoF) after hip fracture is highly prevalent, and has been associated with diminished functional recovery. A treatment program for FoF after hip fracture was developed, for the inpatient geriatric rehabilitation setting (the FIT-HIP intervention, a multi-component cognitive behavioral intervention).The first studies of this thesis evaluated the effects and feasibility of the FIT-HIP intervention. Also, coping strategies used by patients with FoF were explored. The final study in this thesis evaluated the long-term course of FoF after fracture.The FIT-HIP intervention was not effective to reduce FoF and improve functional recovery after hip fracture. The (early) timing of the intervention, and a limited level of FoF may have contributed to the lack of treatment effect. Possibly not all FoF that is present very shortly after hip fracture (

Background: Fear of falling (FOF) is common in Parkinson’s disease (PD) and associated with distinct gait changes. Here, we aimed to answer, how quantitative gait assessment can improve our understanding of FOF-related gait in hospitalized geriatric patients with PD. Methods: In this cross-sectional study of 79 patients with advanced PD, FOF was assessed with the Falls Efficacy Scale International (FES-I), and spatiotemporal gait parameters were recorded with a mobile gait analysis system with inertial measurement units at each foot while normal walking. In addition, demographic parameters, disease-specific motor (MDS-revised version of the Unified Parkinson’s Disease Rating Scale, Hoehn & Yahr), and non-motor (Non-motor Symptoms Questionnaire, Montreal Cognitive Assessment) scores were assessed. Results: According to the FES-I, 22.5% reported low, 28.7% moderate, and 47.5% high concerns about falling. Most concerns were reported when walking on a slippery surface, on an uneven surface, or up or down a slope. In the final regression model, previous falls, more depressive symptoms, use of walking aids, presence of freezing of gait, and lower walking speed explained 42% of the FES-I variance. Conclusion: Our study suggests that FOF is closely related to gait changes in hospitalized PD patients. Therefore, FOF needs special attention in the rehabilitation of these patients, and targeting distinct gait parameters under varying walking conditions might be a promising part of a multimodal treatment program in PD patients with FOF. The effect of these targeted interventions should be investigated in future trials.

Background\ud \ud Falls are a major cause of morbidity among older people. A multifaceted podiatry intervention may reduce the risk of falling. This study evaluated such an intervention.\ud \ud Design\ud \ud Pragmatic cohort randomised controlled trial in England and Ireland. 1010 participants were randomised (493 to the Intervention group and 517 to Usual Care) to either: a podiatry intervention, including foot and ankle exercises, foot orthoses and, if required, new footwear, and a falls prevention leaflet or usual podiatry treatment plus a falls prevention leaflet. The primary outcome was the incidence rate of self-reported falls per participant in the 12 months following randomisation. Secondary outcomes included: proportion of fallers and those reporting multiple falls, time to first fall, fear of falling, Frenchay Activities Index, Geriatric Depression Scale, foot pain, health related quality of life, and cost-effectiveness.\ud \ud Results\ud \ud In the primary analysis were 484 (98.2%) intervention and 507 (98.1%) control participants. There was a small, non statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73 to 1.05, p = 0.16). The proportion of participants experiencing a fall was lower (49.7 vs 54.9%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00, p = 0.05) as was the proportion experiencing two or more falls (27.6% vs 34.6%, adjusted odds ratio 0.69, 95% CI 0.52 to 0.90, p = 0.01). There was an increase (p = 0.02) in foot pain for the intervention group. There were no statistically significant differences in other outcomes. The intervention was more costly but marginally more beneficial in terms of health-related quality of life (mean quality adjusted life year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314) and had a 65% probability of being cost-effective at a threshold of £30,000 per QALY gained.\ud \ud Conclusion\ud \ud There was a small reduction in falls. The intervention may be cost-effective.\ud \ud Trial Registration\ud \ud ISRCTN ISRCTN68240461

Background and Purpose: Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders, and is treated effectively with particle repositioning maneuvers (PRM). The aim of this study was to assess the influence of BPPV and treatment effects of PRM on gait, falls, and fear of falling. Methods: Three databases and the reference lists of included articles were systematically searched for studies comparing gait and/or falls between (1) people with BPPV (pwBPPV) and controls and (2) pre- and posttreatment with PRM. The Joanna Briggs Institute critical appraisal tools were used to assess risk of bias. Results: Twenty of the 25 included studies were suitable for meta-analysis. Quality assessment resulted in 2 studies with high risk of bias, 13 with moderate risk, and 10 with low risk. PwBPPV walked slower and demonstrated more sway during tandem walking compared with controls. PwBPPV also walked slower during head rotations. After PRM, gait velocity during level walking increased significantly, and gait became safer according to gait assessment scales. Impairments during tandem walking and walking with head rotations did not improve. The number of fallers was significantly higher for pwBPPV than for controls. After treatment, the number of falls, number of pwBPPV who fell, and fear of falling decreased. Discussion and Conclusions: BPPV increases the odds of falls and negatively impacts spatiotemporal parameters of gait. PRM improves falls, fear of falling, and gait during level walking. Additional rehabilitation might be necessary to improve gait while walking with head movements or tandem walking. Video Abstract available for more insights from the authors (see the Supplemental Digital Content Video, available at: https://links.lww.com/JNPT/A421). 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Academy of Neurologic Physical Therapy, APTA. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0(CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Background Fear of falling (FOF) is prevalent among older adults and associated with adverse health outcomes. Over recent years a substantial body of research has emerged on its epidemiology, associated factors, and consequences. This scoping review summarizes the FOF literature published between April 2015 and March 2020 in order to inform current practice and identify gaps in the literature. Methods A total of 439 articles related to FOF in older adults were identified, 56 selected for full-text review, and 46 retained for data extraction and synthesis. Results The majority of included studies were cross-sectional. Older age, female sex, previous falls, worse physical performance, and depressive symptoms were the factors most consistently associated with FOF. Studies that measured FOF with a single question reported a significantly lower prevalence of FOF than those using the Falls Efficacy Scale, a continuous measure. FOF was associated with higher likelihoods of future falls, short-term mortality, and functional decline. Conclusions Comparisons between studies were limited by inconsistent definition and measurement of FOF, falls, and other characteristics. Consensus on how to measure FOF and which participant characteristics to evaluate would address this issue. Gaps in the literature include clarifying the relationships between FOF and cognitive, psychological, social, and environmental factors.

Background and purpose Fear of falling is associated with poor physical health and influences postural stability during whole-body movement. The ability to recover from lateral balance loss is required to prevent falls; however, the relationship between lateral balance recovery and fear of falling has not been established. This study aimed to investigate whether fear of falling is associated with the stepping threshold for lateral balance recovery. Methods This study included 56 ambulatory, community-dwelling women aged 65 years or older. We determined the single-step threshold as the maximum lean magnitude normalized with body weight from which participants could be suddenly released and still recover balance using a single side step. The short-form Falls Efficacy Scale International was used as a measure of fear of falling. Results and discussion The single-step threshold significantly correlated with age (rs = -0.603) and the short-form Falls Efficacy Scale International score (rs = -0.439). Ordinal regression analysis revealed that age (odds ratio, 0.826; 95% confidence interval, 0.742-0.920) and the short-form Falls Efficacy Scale International score (odds ratio, 0.811; 95% confidence interval, 0.680-0.966) were significantly associated with the single-step threshold, such that older age and greater fear of falling each independently predicted that failure to recover balance with a single step would occur at a lower percentage of body weight. Conclusions Greater fear of falling was associated with reduced ability to recover from lateral balance loss in addition to aging. Future studies should explore whether evidence-based interventions to reduce fear of falling combined with perturbation training might lead to improved ability to recover from balance loss.

Purpose Well-adapted and validated well-being (WB) instruments for the nursing home population are scarce. To our knowledge, the Laurens Well-Being Inventory for Gerontopsychiatry (LWIG) is a practical and reliable well-being assessment tool that has never been validated for German nursing home populations. Therefore, the purpose of our study was to (1) translate and cross-culturally adapt the LWIG to a German context and (2) test the reliability and validity of the German LWIG in a group of older nursing home residents using the Rasch model. Methods This study has a cross-sectional, descriptive study design. Cross-cultural adaption of the LWIG-GER from English to German was performed according to a standardized method. The data obtained from 104 long-term nursing home residents (57 women, 47 men) aged 60–99 years (mean 79.5, standard deviation ±9.11) were analyzed for psychometric testing (exploratory and confirmatory factor analysis, item fit, McDonald’s ω, convergent validity, and known-group validity, Rasch). Results The final LWIG-GER consists of 19 items with three subscales, including “psychological WB”, “social WB”, and “physical WB”. The LWIG-GER showed good overall reliability with McDonald’s ω of 0.83; the LWIG-GER dimensions’ scores were significantly correlated with depression, functional performance, activities, fear of falling, and education. Conclusions Our findings suggest that the German language version of the LWIG is a reliable and valid tool for measuring WB in nursing home residents. Furthermore, we propose that the LWIG-GER questionnaire can broaden and deepen our understanding of residents’ perception of quality of care and their environment.

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseIt is unclear which parameters of physical activity and sedentary behaviour are important for healthy ageing, and to what extent. This Review aimed to synthesise, quantify, and compare the strength of the associations between physical activity and sedentary behaviour with clinically relevant outcomes. Systematic reviews describing community-dwelling adults older than 60 years and reporting standardised associations of objectively measured physical activity and sedentary behaviour with mortality, activities of daily living, frailty, falls and fear of falling, muscle strength and power, and global cognition, were included. Standardised associations were expressed as standardised regression coefficients (βs) and compared within and across outcome domains. Six systematic reviews were included with sample sizes ranging from 7696 to 43 796 (mean or median age 60–92 years). Higher physical activity and lower sedentary behaviour were most strongly associated with better chair stand test performance and lower body muscle strength, and least with falls and hand grip strength. Number of steps was the most strongly and most consistently associated with clinical outcomes. Conferring to a wide array of positive outcomes, steps provide a clinically relevant target that shows practical ease. Future recommendations should promote steps regardless of ability, encouraging that some physical activity is better than none, or, as the present findings show, that every step counts.

Background Hemodialysis (HD) patients are at a high risk of falls and fractures. The amount of physical activity (PA) they perform may be limited by psychosomatic factors associated with fear of falling, leading to frailty progression. This study aimed to clarify the relationship between fear of falling and PA in patients undergoing HD. Methods This cross-sectional study included 46 HD patients. Fear of falling was evaluated using the Modified Falls Efficacy Scale (MFES). A 3-axis accelerometer was used to measure PA, including number of steps; 1 to 1.9 METs = static PA, 2 to 2.9 = light PA, and 3 or more = moderate to vigorous PA (MVPA). We examined correlation of MFES with each type of PA. Factors affecting fear of falling were determined using multiple regression analysis. Results The median MFES was 9.2 (7.4, 10.0). MFES was associated with the number of steps (r = 0.608, p 0.001), light PA (r = 0.421, p = 0.004), and MVPA (r = 0.546, p 0.001). Eighteen participants (39.1%) experienced at least one fall in a year and had lower MFES than the non-fall group (fall group: 7.4 [5.1, 9.0] vs. non-fall group: 9.7 [8.5, 10.0], p 0.001). Multiple regression analysis showed that MFES was independently associated with the number of steps (B = 279.7, 95% confidence interval [CI] = 90.5–469.0, p = 0.005) and MVPA (B = 3.52, 95% CI = 1.14–5.90, p = 0.005), respectively. Conclusions Fear of falling was associated with amount of PA among patients undergoing HD. Interventions that target the fear of falling may be effective in reducing HD patients’ fall risk by enhancing PA.

The aim of this systematic review (SR) and meta-analysis was to assess what type of exercise is associated with fall risk reduction among apparently healthy adults aged 50 and older. We conducted a SR by searching for randomized controlled trials (RCTs) included in Cochrane SRs published until October 2019. Five SRs that compared exercise versus any type of control included 32 RCTs. The outcomes examined were falls, fallers, fractures, and fear of falling. A random effects-based meta-analysis by type of exercise was performed. Almost all the interventions were effective for fall rate reduction, with a major effect for three-dimensional exercise, strength/resistance exercises, and mixed exercises. The number of fallers was reduced by three-dimensional exercise and mixed exercises. Fall-related fractures were generally reduced by all types of exercises considered all together, but none singly resulted in statistically effective fracture prevention. Fear of falling was slightly decreased with endurance exercises.

INTRODUCTION Kinesiophobia is a common symptom associated with high disability, and has been observed in patients with migraine. However, the association between kinesiophobia and clinical factors in this population is unknown. OBJECTIVE To assess the fear of falling, dizziness disability, and migraine disability in patients with migraine, considering the presence of kinesiophobia. METHODS Eighty patients with migraine completed the Tampa Scale for Kinesiophobia and were divided into two groups according to the questionnaire cutoff point: migraine without kinesiophobia (MoK, n = 39) and migraine with kinesiophobia (MK, n = 41). Fear of falling, dizziness disability, and migraine disability were assessed in both groups using validated questionnaires. RESULTS The MK group presented higher scores on dizziness disability, fear of falling, and migraine disability compared to the MoK (p

PURPOSE The clinical benefits of microprocessor-controlled prosthetic knees (MPKs) in community ambulators have been well-established. A systematic review in limited community ambulators published in 2014 found benefits in safety, performance-based, and patient-reported outcomes. This work updates the previous analysis to the current state of the published evidence. METHODS Systematic review and meta-analysis of the effect of MPKs in limited community ambulators. RESULTS Thirteen research projects presented in 15 publications were identified. Overall validity was "high" in nine studies, "moderate" in three, and "low" in one. The literature described a total of 2366 patients, with 704 classified as limited community ambulators. The use of MPKs in limited community ambulators led to a reduction in falls (SMD g: -0.59; 95% confidence interval (CI) [-0.85, -0.32; I2=0%]), fear of falling (SMD g: 1.2; 95%CI [0.55, 1.85; I2=80%]), risk of falling as indicated by the TUG (SMD g: -0.45, 95%CI [-0.87, -0.02; I2=0%]), an improvement in mobility grade (0.51; 95%CI [0.47,0.55]), self-selected walking speed (SMD g: 0.47; 95%CI [0.14,0.81; I2=0%]), and patient-reported ambulation (MD 9.32; 95%CI [3.61, 15.02; I2=7%]), and utility (MD 7.76; 95%CI [2.05-13.47; I2=0%]). Other outcomes exhibited trends in favor of MPK use or remained insensitive. No outcome was identified favoring non-MPKs. CONCLUSIONS These results suggest that MPKs may be considered a valuable therapeutic option in limited community ambulators with a transfemoral amputation.Implications for rehabilitationAbove knee amputees may be treated with a large variety of artificial exo-prosthetic knee components.Microprocessor-controlled prosthetic knees have proven to be advantageous and cost effective for community ambulators.The current analysis shows similar effects in safety, mobility, and patient perception also for limited community ambulators.Microprocessor-controlled prosthetic knees are a viable therapeutic option for limited community ambulators.

Background The effect of lumbar spinal stenosis (LSS) and peripheral vascular disease (PVD), which occurs with similar degenerative conditions, when seen together, has not been studied. The aim of this study is to examine and compare the relationship between pain, balance, disability, fear of falling, and kinesiophobia in LSS patients with intermittent vascular claudication (IVC). Methods Seventy-two patients diagnosed with LSS using magnetic resonance imaging participated in this study. Thirty-five patients with IVC symptoms and showing vascular lesions by lower extremity venous and arterial Doppler ultrasonography imaging were included in the IVC-LSS group. The pain, static balance, dynamic balance, disability, fear of falling, and kinesiophobia were evaluated using the numeric rating scale, single leg stance test, Time Up and Go (TUG), the Oswestry Disability Index (ODI), Fall Efficacy Scale-International (FES-I), and Tampa Scale for Kinesiophobia (TSK), respectively. Results Age and female sex were found to be higher in the IVC-LSS group (P = 0.024; P = 0.012). The IVC-LSS group had a shorter single leg stance time and TUG test duration, pain intensity, ODI, FES-I, and TSK scores were higher than patients with LSS (P = 0.001). Pain, fear of falling, and kinesiophobia were moderately correlated with disability in the IVC-LSS group. No relationship was found between pain and dynamic balance. Also, the pain was not related to kinesiophobia. Conclusions The findings indicated that IVC causes loss of balance and an increase in pain, disability, fear of falling, and kinesophobia in patients with LSS.

Introducción: La pérdida de equilibrio es un factor importante para sufrir una caída en adultos mayores, esto representa un problema mundial a nivel de salud; el miedo a caerse y el bajo nivel de equilibrio son obstáculos para realizar ejercicio físico; sin embargo realizar ejercicios de Frenkel son necesarios para el control motor. Objetivo: Determinar la efectividad de los ejercicios de Frenkel para mejorar el equilibrio en adultos mayores. Material y Métodos: Se realizó una investigación cuasi-experimental, con una población de 30 adultos mayores de 65 a 75 años con problemas de equilibrio que firmaron el consentimiento informado. Recibieron un protocolo de ejercicios de Frenkel durante 30 minutos; en el primer mes ejercicios en decúbito supino, en el segundo mes en sedestación y en el tercer mes en bipedestación; para la recolección de la información se realizó una evaluación antes y después de la intervención con el Test de Tinetti. El análisis estadístico de los resultados fue con el programa SPSS mediante frecuencias, porcentajes, pruebas de chi-cuadrado y Wilcoxon. Resultados: En la primera evaluación el 100% de la población tenía problemas de equilibrio, marcha, un riesgo alto de caída y riesgo de caída. Luego de la intervención mejoró el equilibrio y disminuyó significativamente el riesgo de caídas. En las pruebas de chi-cuadrado antes y después de la evaluación del equilibrio se obtuvo P=0,010; de la marcha P=0,018; se aceptan las hipótesis nulas porque es mayor a 0,05, si hay diferencia significativa. En la prueba de Wilcoxon P=0,000 lo cual comprobó que los ejercicios de Frenkel son efectivos en adultos mayores. Conclusión: Es importante realizar ejercicios de Frenkel para mejorar el equilibrio en adultos mayores ya que estos ayudan a evitar caídas.

Background: Multiple Sclerosis (MS) is one of the most common diseases of the Central Nervous System (CNS). Numerous studies have reported Fear of Falling (FOF) among MS patients. FOF is a factor limiting physical activity. Regular physical activity is very important for maintaining good health and preventing the complications of MS patients and can make these people more active and reduce FOF. Objectives: The aim of the present study was to do a meta-analyze about the effect of exercise programs on FOF among MS patients Materials & Methods: Primary sources were obtained from 9 databases including, PubMed, EMBASE, SCOPUS, LILACS, CINAHL, CENTRAL, Web of Science, PEDro, and Google Scholar, from inception until April 2021. Data analysis was carried out using Comprehensive Meta-Analysis ver. 2. Results: Nine studies with 350 participants were included in the review. The results of the meta-analysis showed the effect of exercise programs on the FOF among MS patients. The Hedges’ adjusted Effect Size (ES) regarding the effects of exercise programs on FOF among MS patients was -0.15 (95%CI: -0.52 - 0.22). The results of the meta-analysis showed no significant difference between the effect of exercise programs on FOF among MS patients (p=0.44). Conclusion: It was found that all exercise programs have a significant effect on FOF among MS patients. There was no statistically significant difference between exercise programs regarding which exercise programs led to a higher reduction in FOF among these patients; however, Pilates and virtual reality exercises were more effective than other exercise programs.

The objective of this review is to explore existing literature related to fear of falling activity avoidance behavior and identify what is known about this phenomenon in people with Parkinson's disease.Falling and fear of falling are significant concerns for persons with Parkinson's disease. Fear of falling is a significant problem over and above falling itself and can lead to activity avoidance. Activity-avoidance behavior is a risk factor for increased falls and can lead to further functional decline. A better understanding of the fear of falling and the associated avoidance behavior can inform screening, evaluation, and interventions to decrease fall risk and improve activity engagement and quality of life for persons with Parkinson's disease.This review will consider studies published in English that include individuals diagnosed with Parkinson's disease experiencing fear of falling that impacts activity engagement with no limit on participant age or time of publication.JBI methodology will be used to conduct this scoping review. A three-step search strategy will be utilized. The databases to be searched include MEDLINE (PubMed), Embase (Elsevier), Scopus (Elsevier), APA PsycINFO (EBSCO), CINAHL (EBSCO), Papers First (OCLC), and ProQuest Dissertations and Theses (ProQuest). Two independent reviewers will screen the titles, abstracts, and full text of the selected studies. Data collection will be performed with a tool developed by the researchers based on the standardized tool from JBI SUMARI. Data will be presented in a comprehensive narrative summary.

Giriş: Bu çalışmanın amacı geriatrik bireylerde kinezyofobi ile denge, düşme korkusu ve mobilite arasındaki ilişkiyi incelemektir. Gereç-Yöntem: Çalışmaya 65-88 yaş arası 41 geriatrik birey dahil edildi. Bireylerin sosyo-demografik bilgileri ve mini mental test skorları kaydedildikten sonra kinezyofobi, denge, düşme korkusu ve mobilite düzeyleri anketler ile değerlendirildi. Kinezyofobi, Tampa Kinezyofobi Ölçeği (TKÖ); denge, Berg Denge Ölçeği (BDÖ); düşme korkusu, Tinetti Düşme Etkinlik Ölçeği (TDEÖ) ve mobilite düzeyleri Zamanlı Kalk Yürü Testi (ZKYT) ile belirlendi. Bulgular: Katılımcıların 33’ünde (%70.5) kinezyofobi varlığı tespit edildi. Değerlendirme sonucunda kinezyofobi ile düşme korkusu (p=0.001, r=0.514) ve mobilite (p=0.002, r=0.468) arasında istatistiksel olarak anlamlı, pozitif yönlü orta şiddette; kinezyofobi ile denge arasında istatistiksel olarak anlamlı, negatif yönlü yüksek şiddette ilişki saptanmıştır (p

Context Qualitative research suggests that falls can have a negative psychosocial impact on the lives of individuals with spinal cord injury (SCI). However, it is unclear whether these qualitative findings are supported by quantitative psychosocial metrics. This paper examines whether falling and/or having a fear of falling impacts participation, autonomy, and life satisfaction among individuals with SCI. Methods Falls and fear of falling were tracked over six months using a survey and phone check-ins conducted approximately every three to four weeks. The Life Satisfaction 9 and Impact on Participation and Autonomy Questionnaires were administered at baseline and after six months. Responses on the questionnaires were statistically compared between fallers and non-fallers as well as participants with and without a fear of falling during the tracking period. Findings Of the 65 community-dwelling adults with chronic SCI, 38 were categorized as fallers (aged 54.29 ± 13.73, 19.55 ± 14.20 years post-SCI, AIS A-D) and 27 were non-fallers (aged 57.78 ± 12.21, 17.93 ± 17.24 years post-SCI, AIS A-D). Our results revealed no significant differences between fallers and non-fallers in their perceived participation, autonomy, or life satisfaction at baseline or after six months. At the last check-in, 34 participants denied a fear of falling, while 31 had a fear of falling. Perceived autonomy outdoors (P=0.02), total life satisfaction (P=0.04), satisfaction with life as a whole (P=0.00) and self-care (P=0.01) differed between participants with and without a fear of falling after six months. Conclusion Fear of falling, rather than falls, may impact participation, autonomy, and life satisfaction in the SCI population.

Fear of falling (FoF) results in social, functional, physical, and psychological symptoms, including secondary disorders, such as depression and general anxiety disorder (GAD). A vicious cycle develops, where symptoms maintain and reinforce FoF and its consequences, including increasing the risk of falling. In this position paper, we suggest screening for FoF using the falls efficacy scale international (FES-I) questionnaire. The presence of a high score ( 23) warrants an investigation into frailty and exclusion of depression and GAD, during the clinical interview. Stratifying frailty, based on the Fried frailty criteria will guide treatment options based on the most significant health concerns. Frail older adults should first receive physiotherapy and exercise interventions, as physical disabilities are their most significant characteristic, while pre-frail and non-frail older adults should receive multicomponent interventions, consisting of cognitive behavioral therapy (CBT) with physical exercise. The non-frail with predominantly GAD and depression should receive specialized CBT interventions. Currently, only exercise interventions are available for FoF treatment in Switzerland. Although some exercise interventions use CBT elements, such as goal setting and reflections on behavior and feelings, they are not systematically used, are not part of a quality-assured procedure, and do not address the psychological-cognitive aspects of FoF. As the pre-frail and non-frail are the largest groups to use these services, adapting current exercise programs by incorporating a CBT component would be the most practical means to provide optimized care.Sturzangst führt zu sozialen, funktionellen, körperlichen und psychischen Symptomen, einschließlich sekundärer Störungen, wie Depression und generalisierte Angststörung (GAS). Es entsteht ein Teufelskreis, bei dem die Symptome die Sturzangst und ihre Folgen, einschließlich der Erhöhung des Sturzrisikos, aufrechterhalten und verstärken. In diesem Positionspapier schlagen wir vor, ein Screening auf Sturzangst mit dem Fragebogen Falls Efficacy Scale International (FES-I) durchzuführen. Das Vorhandensein eines hohen Wertes ( 23) rechtfertigt eine Untersuchung auf Gebrechlichkeit und erfordert den Ausschluss von Depression und GAS im Rahmen eines klinischen Interviews. Die Stratifizierung der Gebrechlichkeit, basierend auf den Fried-Kriterien für Gebrechlichkeit, leitet die Behandlungsoptionen basierend auf den wichtigsten Gesundheitsproblemen. Gebrechliche ältere Erwachsene sollten zuerst Physiotherapie und Bewegungsinterventionen erhalten, da körperliche Einschränkungen ihr wichtigstes Merkmal sind, während nicht gebrechliche ältere Erwachsene und solche mit Vorstufen von Gebrechlichkeit eine Multikomponenten-Intervention erhalten sollten, bestehend aus kognitiver Verhaltenstherapie (CBT) mit körperlicher Bewegung. Nicht gebrechliche Menschen mit überwiegend GAD und Depressionen sollten spezielle CBT-Interventionen erhalten. Derzeit sind in der Schweiz nur Bewegungsinterventionen für die Behandlung von Sturzangst verfügbar. Obwohl einige Übungsinterventionen CBT-Elemente verwenden, wie z. B. Zielsetzung und Reflexion über Verhalten und Gefühle, werden diese nicht systematisch eingesetzt, sind nicht Teil eines qualitätsgesicherten Verfahrens und gehen nicht auf die psychologisch-kognitiven Aspekte von Sturzangst ein. Da Personen ohne bzw. mit Vorstufen von Gebrechlichkeit die größten Gruppen darstellen, die diese Dienste in Anspruch nehmen, wäre die Anpassung aktueller Trainingsprogramme durch Einbindung einer CBT-Komponente das praktischste Mittel, um eine optimierte Versorgung zu gewährleisten.

Background Physical function worsens with older age, particularly for sedentary and socially isolated individuals, and this often leads to injuries. Through reductions in physical activity, the COVID-19 pandemic may have worsened physical function and led to higher fall-related risks. Methods A nationally representative online survey of 2006 U.S. adults aged 50-80 was conducted in January 2021 to assess changes in health behaviors (worsened physical activity and less daily time spent on feet), social isolation (lack of companionship and perceived isolation), physical function (mobility and physical conditioning), and falls (falls and fear of falling) since March 2020. Multivariable logistic regression was used to assess relationships among physical activity, social isolation, physical function, falls, and fear of falling. Results Among respondents, 740 (36.9%) reported reduced physical activity levels, 704 (35.1%) reported reduced daily time spent on their feet since March 2020, 712 (37.1%) reported lack of companionship, and 914 (45.9%) social isolation. In multivariable models, decreased physical activity (adjusted risk ratio, ARR: 2.92, 95% CI: 2.38, 3.61), less time spent on one's feet (ARR: 1.95, 95% CI: 1.62, 2.34), and social isolation (ARR: 1.51, 95% CI: 1.30, 1.74) were associated with greater risks of worsened physical conditioning. Decreased physical activity, time spent daily on one's feet, and social isolation were similarly associated with worsened mobility. Worsened mobility was associated with both greater risk of falling (ARR: 1.70, 95% CI: 1.35, 2.15) and worsened fear of falling (ARR: 2.02, 95% CI: 1.30, 3.13). Worsened physical conditioning and social isolation were also associated with greater risk of worsened fear of falling. Conclusion The COVID-19 pandemic was associated with worsened physical functioning and fall outcomes, with the greatest effect on individuals with reduced physical activity and social isolation. Public health actions to address reduced physical activity and social isolation among older adults are needed.

An older patient who has had total knee replacement surgery may be afraid about falling. Fear of falling following TKR and its effects on physical activity have received little attention. The purpose of this study was to see if there was a link between physical activity and fear of falling in individuals with TKR. The PASE Scale is used to measure physical activity. The fall efficacy scale is reliable measure for assessing fear of falling. The objective of the current study was to assess physical activity and fear of fall and to find Correlation of physical activity with fear of fall in patients with TKR. This research was conducted in the Physiotherapy OPD, in AVBRH Hospital in Wardha. The results of 60 TKR patients were studied. The PASE scale and the FES were used to measure physical activity and fear of falling, respectively. This study significantly showed that the correlation between PASE and FES was negative which means that there is Fear of Fall among participants who undergone TKR which was associated with decrease in physical activity score. Most of the studies indicated that there is decrease in physical activity in patients with TKR but very few studies indicated fear of fall in the patients. Therefore, the current study is being carried out which could help to reach the conclusion to find whether there is any correlation between physical activity and fear of fall in patients undergone TKR.

PURPOSE To compare demographics, self-reported symptom burden, Health-Related Quality of Life (HRQL), and Self-Efficacy for Exercise (SEE) between participants and non-participants of Rock Steady Boxing (RSB), a non-contact boxing program for individuals with Parkinson's disease (PD) that focuses on agility, balance, and speed training. MATERIALS AND METHODS Adults with PD who had heard of RSB completed a 20 min, 61-question electronic survey including the Parkinson's Disease Questionnaire-39 (PDQ-39) and the Self-Efficacy for Exercise (SEE) scale. Differences between participants and never-participants were analyzed using chi-squared test, fisher's exact test and Wilcoxon test. RESULTS Of 2054 individuals enrolled in the survey, 1709 were eligible for analysis. 1333 were current participants, 166 previous-participants, and 210 never-participants. RSB participants were median age 69, 59% male, and 97% Caucasian. The majority of current participants reported that RSB improved their social life (70%), fatigue (63%), fear of falling (62%), depression (60%), and anxiety (59%). Compared to previous and never-participants, current participants had better median PDQ-39 scores (36 and 32 vs 25, p

BACKGROUND: Aquatic exercise can improve strength, flexibility, and aerobic function while safely providing partial weight-bearing support through viscosity and buoyancy. OBJECTIVE: The aim of the present study was to compare the effects of water-based exercise with land-based exercise before and after a 10-week exercise intervention and again at one-year follow-up. METHODS: Eighty participants aged 65 years and older were randomly assigned to either a water- or a land-based 10-week exercise program. Assessment included the Senior Fitness Test (SFT), the Modified Falls-Efficacy Scale, and the 36-Item Short-Form Health Survey (SF-36). Hip and knee strength was also measured. All assessments were completed at three time points: pre- (T1), post- (T2), and at 1-year follow-up (T3). RESULTS: Significant differences were observed between the two groups on three parameters: the SFT timed up-and-go test; lower hip muscle strength in extension, adduction, and external rotation; and quality of life (QoL) measured by the SF-36 (p< 0.05). No significant differences were observed in the SFT chair stand test, dominant arm curl test, two-minute step test, chair sit-and-reach test, back scratch test, and Modified Falls-Efficacy Scale. CONCLUSION: Aquatic exercise provided greater improvement of physical health and QoL among older people than land-based exercise.

Falling experiences and the fear of falling in relation to subjective cognitive decline (SCD) was examined in middle-aged Koreans. A nationwide cross-sectional study was conducted using data from the 2019 Korea Community Health Survey. The final analysis included 92,323 individuals aged 40-64 years who had available data on SCD and falls. A multivariate regression model was applied to examine the independent effect of SCD on falls. Approximately 10.7% of participants had experienced a fall in the previous 12 months. Stepwise multivariate regression analysis showed that SCD was independently associated with a falling experience (adjusted odds ratio [95% confidence interval], 1.16 [1.53-1.70]); individuals with SCD were more likely to experience falling (13.9% vs. 9.14%, p < 0.001) and had more fear of falling (2.33% vs. 1.74%, p < 0.001). In conclusion, SCD is independently associated with falls in the middle-aged, which highlight the clinical need to investigate cognitive deficits among this population.

Falls efficacy is a widely studied construct. The understanding of falls efficacy has evolved over time. Falls efficacy was initially perceived to be suitably used as a measure of fear of falling. However, further research suggested that falls efficacy and fear of falling are distinct constructs, and therefore, would be inappropriate to be used as a proxy. Instead, some researchers posited that falls efficacy is synonymous with balance confidence. Falls efficacy has been conventionally understood as the perceived ability of individuals to perform activities without losing balance or falling. A recently conducted systematic review by the authors on existing falls efficacy related measures had revealed a fresh perspective of recognising falls efficacy as a perceived ability to manage a threat of a fall. Falls efficacy, with a broadened interpreted construct, relates to the individual's perceived self-efficacy of performing necessary actions needed in different scenarios, including pre-fall, near-fall, fall-landing and completed fall. The conventional interpretation of falls efficacy needs a rethinking of perspective. An extended understanding of falls efficacy would provide an integral approach towards improving the agency of individual to deal with falls and would enhance person-centred care.

The primary aim was to determine if somatosensory impairments alter the association between falls history and glaucoma severity. A secondary aim was to identify the activities of daily living that cause increased concern related to falling in glaucoma and their association with glaucoma severity. Established questionnaires about falls and fear of falling (FoF) were mailed to participants diagnosed with glaucoma. Ninety-eight participants responded. Self-reported feet numbness and tingling symptoms were used to determine the presence of somatosensory impairments. Self-reported falls in glaucoma are associated with visual field deficits in both eyes, particularly in the presence of somatosensory impairments. In addition, increased FoF levels are linked with worse visual field deficits in both eyes, especially when performing challenging walking tasks. Somatosensory impairments alter the relationship between falls risk and visual field deficits in glaucoma. This information may be helpful in identifying older workers at an increased risk of falling.

The aim of this research (Motor control Home ergonomics Elderlies' Prevention of falls; McHeELP study) was to develop a novel intervention combining motor control home-based exercises and a home ergonomic safety-improvement strategy in order to reduce falls in frail ambulatory older adults. A randomized controlled trial of a novel intervention is proposed including motor control exercises and home ergonomic assessment and modification in older adults who have at least one fall experience. Participants are randomized to control or intervention group in a 1:1 ratio. Participants will be assessed three times: at baseline, at 3rd month (end of intervention period) and again at 6th month (follow-up measurement). The primary outcome is of the effect on functional mobility using the Timed Up and Go test. Secondary outcomes include assessments of functionality, fear of falling and quality of life. This will be the first study to develop an exercise intervention approach that combines home-based motor control exercise intervention with home assessment and modification. This study is expected to explore a low-cost, easy-to-popularize, and effective exercise intervention approach for improving functional mobility and prevent falls among older adults.

Some factors increase the fear of falling in frail older adults. Our aim is to quantify the influence of these factors. This cross-sectional study involved 229 community-dwelling prefrail and frail older adults aged 70 years and older. Fear of falling was moderate in 38.9% of our sample and high in 12.2%. Higher values were observed in women, those living alone, and those meeting criteria for slowness and feelings of exhaustion. A linear regression showed that being a woman, a history of falls, and depressive symptoms were related to higher fear of falling, while high levels of independence in basic and instrumental activities of daily living, along with good gait and balance, were associated with lower fear of falling. Screening for depressive symptoms and fear of falling in the comprehensive geriatric assessment of frail community-dwelling older adults could help to support preventive strategies.

Falls are common in Assisted Living Facilities (ALFs). We evaluated the feasibility, acceptability, and preliminary impact of student-led Fall Prevention Care Management (FPCM) on reducing fall risks in ALFs. Residents who were age ≥65, had a fall in the previous year Or considered high fall risk at the facility, and who had a MoCA cognition score>15 were enrolled. The FPCM interventions were semi-structured to facilitate students' learning while addressing participants' unique fall risks. Twenty-five older adults in the U.S. completed the study (recruitment rate: 55%; retention rate: 64%). Participants rated the study as 87.16 (100 = excellent), and likelihood to recommend the study to others was 80.85 (100 = most likely). Participants were 84% female, mean age 88.6 years old. Fall risks such as fear of falling decreased from 16.05 to 15.12 (p = .022), fall prevention behaviors increased from 2.94 to 3.07 (p = .048), and the level of confidence to prevent falls increased from 63.38 to 78.35 (p = .015). Students commonly provided education and coaching on fall prevention strategies, and addressed emotional and behavioral aspects of fall prevention. With improvement with recruitment and retention, student-led FPCM intervention is a promising approach for fall prevention in ALF.

The aim of this study was to analyze the association between multimorbidity and fear of falling among hospitalized older adults. This is a quantitative study with an analytical sectional design, conducted with 83 individuals aged 60 years or older, hospitalized for falls in a referral hospital for emergency treatment in Brazil. Data collection took place through the application of a questionnaire containing socioeconomic and health information as well as characteristics of the fall. The logistic regression analysis revealed that older people who reported multimorbidity are 3.16 times more likely to be afraid of falling than older people who did not report multimorbidity, regardless of sex, age, frailty, and the number of falls in the last year. These results could aid in improving hospital approaches in relation to multimorbidity and fear of falling, decreasing preventable hospitalizations due to falls.

Background Understanding the physical and mental changes in community‐dwelling elderly people is very important during the coronavirus disease 2019 (COVID‐19) pandemic when considering preventive measures. The purpose of this study was to clarify the changes of physical function and anxiety for activities of daily living in community‐dwelling older adults, focusing on locomotor function during the COVID‐19 pandemic. Methods The study participants were 127 older people who participated in successive surveys, in the summers of 2019 and again in 2020, after the state of emergency. The Locomo 25 questionnaire, Geriatric Depression Scale‐15 (GDS‐15) questionnaire, medical history, and number of people living together were self‐reported. The Locomo 25 covers six aspects of physical pain, movement‐related difficulty, usual care, daily activity, social activities, and anxiety. Results The paired samples t‐test revealed that Locomo 25 total scores in 2020 were significantly higher than those in 2019. The GDS‐15 score showed no significant difference. The comparison of scores for each item of the Locomo 25 revealed significantly higher scores in 2020 on Q21 (‘difficult to perform sports activity’, P = 0.0021), Q22 (‘restricted from meeting own friends’, P

Tam Metin / Full Text WOS:000680831400005 ESCI To investigate level of kinesiophobia and related factors in postmenopausal women with osteoporosis (OP) and osteopenia (OPN).Materials and Methods: A total of 60 female patients with postmenopausal OP, 60 female patients with postmenopausal OPN and60 age- and gender-matched controls were enrolled in this study. Demographic data (age, weight, height, body mass index, educationallevel, employment status, disease duration and menopause duration) of the participants were recorded. In all participants, the level ofkinesiophobia, fear of falling, psychological status, health-related quality of life and osteoporosis self-efficacy were evaluated using the Tampascale of kinesiophobia (TSK), falls efficacy scale-international (FES-I), hospital anxiety and depression scale (HADS), quality of life questionnaireof the European Foundation for Osteoporosis-41 (QUALEFFO-41) and osteoporosis self-efficacy scale (OSES), respectively.Results: Postmenopausal patients with OP and OPN had higher levels of kinesiophobia than controls (p0.05). In addition, a positive correlation was found betweenTSK score and FES-I, HADS, QUALEFFO-41 scores and duration of menopause, and a negative correlation between OSES scores in patientswith OP and OPN (p0,05). OP ve OPN’li hastalarda TKÖ skoru ile UDES, HADÖ, QUALEFFO-41 skorları, menopoz süresi arasında pozitif, OEYÖ skorları arasında negatif korelasyon vardı (p

Fear of falling is common among older adults with spinal diseases. The purpose of the current study was to examine fear of falling and related factors in this population. A total of 138 participants were recruited and completed survey questionnaires along with the Timed Up & Go Test. Participants were 73.7 years old on average, 52% had fall experience, and 56% were taking more than four medications. Multivariate regression analyses revealed that the use of sleeping pills, residence type, pain, activities of daily living, gait ability, and gait efficacy were significant predictors of fear of falling. Findings suggest that a fall prevention intervention for older adults with spinal diseases should include pain management, functional improvement, and gait rehabilitation with a focus on gait performance and gait efficacy. In addition, it is important to improve living environment and sleep hygiene, which are conducive to falls. [ Journal of Gerontological Nursing, 47 (8), 29–35.]

© 2021 American Congress of Rehabilitation MedicineObjective: To evaluate the risk factors associated with 30- and 90-day hospital readmissions in geriatric rehabilitation inpatients. Design: Observational, prospective longitudinal inception cohort. Setting: Tertiary hospital in Victoria, Australia. Participants: Geriatric rehabilitation inpatients of the REStORing Health of Acutely Unwell AdulTs (RESORT) cohort evalutated by a comprehensive geriatric assessment including potential readmission risk factors (ie, demographic, social support, lifestyle, functional performance, quality of life, morbidity, length of stay in an acute ward). Of 693 inpatients, 11 died during geriatric rehabilitation. The mean age of the remaining 682 inpatients was 82.2±7.8 years, and 56.7% were women. Interventions: Not applicable. Main Outcome Measures: Thirty- and 90-day readmissions after discharge from geriatric inpatient rehabilitation. Results: The 30- and 90-day unplanned all-cause readmission rates were 11.6% and 25.2%, respectively. Risk factors for 30- and 90-day readmissions were as follows: did not receive tertiary education, lower quality of life, higher Charlson Comorbidity Index and Cumulative Illness Rating Scale (CIRS) scores, and a higher number of medications used in the univariable models. Formal care was associated with increased risk for 90-day readmissions. In multivariable models, CIRS score was a significant risk factor for 30-day readmissions, whereas high fear of falling and CIRS score were significant risk factors for 90-day readmissions. Conclusions: High fear of falling and CIRS score were independent risk factors for readmission in geriatric rehabilitation inpatients. These variables should be included in hospital readmission risk prediction model developments for geriatric rehabilitation inpatients.

Cervical dystonia (CD) is a neurological movement disorder causing the neck to move involuntarily away from the neutral position. CD is a network disorder, involving multiple brain areas and, therefore, may impair movement in parts of the body other than the neck. This study used clinical assessments to investigate walking, balance and upper limb function (UL) in people with CD; the reliability of scoring these assessments and examined for relationship between CD severity, usual exercise and clinical assessments. We conducted a prospective observational cohort study of participants with isolated, focal, idiopathic CD. Participants were assessed by experienced physiotherapists and completed three questionnaires and eight clinical assessments of fear of falling, balance confidence, walking, balance, UL function and usual exercise. Results were compared to published data from healthy adults and other neurological populations. Twenty-two people with mild to moderate CD participated. Fear of falling, gross UL function and usual exercise were worse in people with CD compared with healthy adults, while walking, balance and distal UL function were similar to healthy populations. All assessments were reliably performed by physiotherapists, and we found no correlations between the severity of dystonia or usual exercise and performance on the physical assessments. Routine performance of clinical assessment of walking and balance are likely not required in people with mild to moderate CD; however, fear of falling and gross upper limb function should be assessed to determine any problems which may be amenable to therapy.

Purpose To explore how perceptions of fall risk influence decisions to undertake activities in people with Parkinson's disease who have fallen, along with their care-partners. Materials and methods This qualitative study used semi-structured interviews to collect data from eight people with moderate to severe Parkinson's Disease and freezing of gait (including those with cognitive impairments) and their care-partners. An inductive approach to thematic analysis was used to analyse the data. Results Four main, interconnected themes emerged, and a framework was developed to illustrate these connections. Weighing up the risks and benefits reflected the constant tension between assessing the likelihood of falling and potential benefit of any activity; Being fearful heightened the perceived risk resulting in a tendency to avoid or modify activities; Desire to lead a normal life heightened the perceived benefit of any activity, leading towards risk taking behaviour; It's a part of Parkinson's provided the context in which the decision-making process took place, with the reality of a progressive disorder influencing choices and contributing to a belief that falls were inevitable. Conclusions There is a complex interaction between perceptions of fall risk and behaviour. An understanding of these interactions will assist therapists to tailor individualised fall prevention interventions.IMPLICATIONS FOR REHABILITATIONPeople are constantly weighing up the risks and benefits of activities while balancing fear of falling and a desire to lead a normal life in the context of Parkinson's disease.The resulting activity choices vary along a continuum from avoiding activities to taking risks, with a common approach to minimise the risk and then embrace the activity.Therapists can help people with Parkinson's and their care-partners to determine what level of risk is acceptable for them when balancing risk with quality of life.Understanding how people decide if they will undertake an activity that poses a risk of falling will allow therapists and patients to co-design fall prevention and management interventions based on the patient's values and priorities.

Objectives Fear of falling is common among older adults and can increase fall-risk through premature activity restriction. Exergames, an emerging tool in fall prevention, combine exercise with interactive and adaptive game elements. This review examines the extent to which exergame interventions reduce fear of falling among community-dwelling older adults. Method: Guided by the PRISMA methodology, we reviewed peer-reviewed studies that were published in English between 2006 and 2019 and employed a comparative design to test the effect of exergames on fear of falling in community-dwelling older adults. Two reviewers screened the literature and extracted data on the exergame platform, participants, study design, and results. A modified PEDro scale was used to assess study quality. Disagreements were resolved through discussion with the third reviewer. Results: Our literature search resulted in 23 eligible studies on exergame interventions where fear of falling was the primary or secondary outcome. Most interventions (35%) occurred within hospitals and were delivered via a Wii-based system (61%). Fear of falling was most commonly measured using the Falls Efficacy Scale, the Activities-specific Balance Scale and their modified versions. A total of 15 of the 23 studies reported statistically significant changes in fear of falling. Quality assessment showed 10 studies to be rated as 'good.' Conclusion: This review showed that exergame may have a positive effect in reducing fear of falling in community-dwelling older adults. The finding provides a direction for clinical practice in the research area of intervention on fear of falling in older adults.

Falls and fear of falling (FOF) are very pervasive and debilitating problems among older adults globally. Their occurrence, expression and risk factors vary considerably across environments, cultures, races and socio-demographics. Therefore, there is need for availability of culturally- and environmentally-specific interventions to tackle them. However, there is hardly any fall and FOF intervention that is tailor-made to suit older adults in middle/low-income countries. To develop educational intervention guideline for addressing falls and FOF in an African context. This was a qualitative study involving older adults (≥ 65 years) with significant FOF (as measured on the Short Falls Efficacy Scale International) and their caregivers purposively recruited from conveniently selected semi-urban community and assisted-living facility in South-east Nigeria. Data were analyzed using General Inductive Approach. Using the results as a guide, local content and information from literature were used to develop an environment-specific intervention protocol for addressing FOF and falls. The drafted intervention guideline was then pilot-tested on ten older adults using adaptive design. Risks of falls and FOF were elevated among sampled older adults by unhealthy environments, habits and behaviours/dispositions, poverty, nonchalance and misconceptions probably due to ignorance. The guideline was well-accepted by the older adults. An environment- and cultural-specific intervention protocol for addressing FOF and falls among older adults in a low/middle-income country has been made available. The protocol was well-accepted by the older adults and should be used by clinicians and public health experts to tackle falls and FOF in this group.

Background Falls and fall-related fractures are highly prevalent among older people and are a major contributor to morbidity and costs to individuals and society. Only one small pilot trial has evaluated the effectiveness of a home hazard assessment and environmental modification in the UK. This trial reported a reduction in falls as a secondary outcome, and no economic evaluation was undertaken. Therefore, the results need to be confirmed and a cost-effectiveness analysis needs to be undertaken. Objective To determine the clinical effectiveness and cost-effectiveness of a home hazard assessment and environmental modification delivered by occupational therapists for preventing falls among community-dwelling people aged ≥ 65 years who are at risk of falling, relative to usual care. Design This was a pragmatic, multicentre, modified cohort randomised controlled trial with an economic evaluation and a qualitative study. Setting Eight NHS trusts in primary and secondary care in England. Participants In total, 1331 participants were randomised (intervention group, n = 430; usual-care group, n = 901) via a secure, remote service. Blinding was not possible. Interventions All participants received a falls prevention leaflet and routine care from their general practitioner. The intervention group were additionally offered one home environmental assessment and modifications recommended or provided to identify and manage personal fall-related hazards, delivered by an occupational therapist. Main outcome measures The primary outcome was the number of falls per participant during the 12 months from randomisation. The secondary outcomes were the proportion of fallers and multiple fallers, time to fall, fear of falling, fracture rate, health-related quality of life and cost-effectiveness. Results The primary analysis included all 1331 randomised participants and indicated weak evidence of a difference in fall rate between the two groups, with an increase in the intervention group relative to usual care (adjusted incidence rate ratio 1.17, 95% confidence interval 0.99 to 1.38; p = 0.07). A similar proportion of participants in the intervention group (57.0%) and the usual-care group (56.2%) reported at least one fall over 12 months. There were no differences in any of the secondary outcomes. The base-case cost-effectiveness analysis from an NHS and Personal Social Services perspective found that, on average per participant, the intervention was associated with additional costs (£18.78, 95% confidence interval £16.33 to £21.24), but was less effective (mean quality-adjusted life-year loss –0.0042, 95% confidence interval –0.0041 to –0.0043). Sensitivity analyses demonstrated uncertainty in these findings. No serious, related adverse events were reported. The intervention was largely delivered as intended, but recommendations were followed to a varying degree. Limitations Outcome data were self-reported by participants, which may have led to inaccuracies in the reported falls data. Conclusions We found no evidence that an occupational therapist-delivered home assessment and modification reduced falls in this population of community-dwelling participants aged ≥ 65 years deemed at risk of falling. The intervention was more expensive and less effective than usual care, and therefore it does not provide a cost-effective alternative to usual care. Future work An evaluation of falls prevention advice in a higher-risk population, perhaps those previously hospitalised for a fall, or given by other professional staff could be justified. Trial registration Current Controlled Trials ISRCTN22202133. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 46. See the NIHR Journals Library website for further project information.

Objectives: Falling is common among the elderly which can lead to dependency, reduced self-efficacy, depression, reduced quality of life, and impose costs on the individual, family and society. The present study aims to evaluate the effect of a collaborative care training program on fear of falling in the elderly. Methods & Materials: This quasi-experimental study was conducted on 72 older people aged 71.34±7.47 years referred to the comprehensive health centers in Isfahan, Iran in 2019, who were selected using a convenience sampling method. They were randomly divided into two groups of training and control. The intervention group participated in a collaborative care program for 12 weeks, while the control group participated in two 60-minute educational sessions. The data were collected using a demographic form and the Falls Efficacy Scale International questionnaire completed before, immediately, and three months after intervention. The entry criteria included: Age >60 years, no psychological problems, not participating in previous studies, and experiencing a fall. On the other hand, the exit criteria included: Decreased consciousness after entering the study, unwillingness to continue, and death. SPSS software v. 21 was used for data analysis by chi-square test, Mann–Whitney U test, independent t-test, and repeated measures ANOVA. Results: In the training group, the mean scores of fear of falling were significantly different between the three evaluation times (P

Background Bladder dysfunction is the most common autonomic disturbance in people with MS (PwMS). Only a few studies have examined the relationship between bladder dysfunction and falls in PwMS. Bladder dysfunction has been deemed only a secondary outcome measure, and classified by a gross measure providing a limited perspective of this disturbing symptom. Furthermore, no study to date has focused on the relationship between bladder dysfunction and balance performance in PwMS. Research question Determine the relationship between bladder dysfunction with balance, falls and fear of falling in women with MS. Methods The study was observational, including 44 women with MS, mean age 46.3 (SD = 5.7), all with at least a mild bladder dysfunction. Outcome measures included the Urinary Incontinence Quality of Life Scale (I-QoL), Bladder Control Scale (BLCS), Timed Up and Go Test (TUG), Four Square Step Test (FSST), Falls Efficacy Scale International (FES-I), Falls status, and posturography. Results Participants performed the TUG in 14.1 s (S.D. = 11.1), and the FSST in 20.5 s (S.D. = 22.4). A relatively large proportion (68.2 %) of women was classified as fallers. However, no differences were found between those classified as fallers (n = 30) or non-fallers (n = 14) in terms of the I-QoL and the BLCS, controlling for age, EDSS and number of vaginal deliveries. Significant correlations scores were found between the I-QoL, BLCS and FES-I (rho ∼0.47), while controlling for age, EDSS and number of vaginal deliveries. No associations were demonstrated between the bladder dysfunction outcome scores and either the TUG and/or FSST. Significance Women afflicted with MS and suffering from bladder dysfunction tend to fall and present with more balance difficulties compared with disability-matched PwMS. Nevertheless, once bladder dysfunction is detected, the perceived severity of the condition is not associated with balance and prevalence of falling, but rather on fear of falling.

This pre-registration concerns secondary analyses of data from two RCTs of cognitive behavioral interventions in community-dwelling older adults: ISRCTN43792817 and NCT01358032. In each dataset, we investigate whether a number of variables are moderators of the effects on concerns about falling.

This is the registration for the scoping review on the fear of falling literature. This scoping review has not been registered before.

Maintaining function in older adults is key to the quality of life and longevity. This study examined the potential impact of falls on accelerating further deterioration over time in gait, balance, physical activity, depression, fear of falling, and motor capacity in older adults. 163 ambulatory older adults (age = 76.5 ± 7.7 years) participated and were followed for 6 months. They were classified into fallers or non-fallers based on a history of falling within the past year. At baseline and 6 months, all participants were objectively assessed for gait, balance, and physical activity using wearable sensors. Additional assessments included psychosocial concerns (depression and fear of falling) and motor capacity (Timed Up and Go test). The fallers showed lower gait performance, less physical activity, lower depression level, higher fear of falling, and less motor capacity than non-fallers at baseline and 6-month follow-up. Results also revealed acceleration in physical activity and motor capacity decline compared to non-fallers at a 6-month follow-up. Our findings suggest that falls would accelerate deterioration in both physical activity and motor performance and highlight the need for effective therapy to reduce the consequences of falls in older adults.

After bariatric surgery, individuals improve walking characteristics related to fall risk. However, little is known about psychosocial factors, such as gait self-efficacy and fear of falling, after surgery. Our objectives were to (1) examine how weight loss affects psychosocial factors and gait four and eight months after bariatric surgery, as well as (2) determine if there is a relationship between gait self-efficacy and fear of falling. Fourteen adults scheduled to undergo bariatric surgery completed three visits: before surgery, four and eight months after surgery. Gait self-efficacy was measured with the Modified Gait Efficacy Scale, and fear of falls was measured with the Tinetti Falls Efficacy Scale. Gait measures were collected during five conditions: initial baseline and final baseline on flat ground, and crossing obstacles of three heights. Gait self-efficacy or fear of falling did not change after surgery. However, both four and eight months after surgery, higher gait self-efficacy and lower fear of falling were correlated with longer and faster steps during all conditions (all ps < 0.05). Focusing interventions on psychosocial measures related to gait may yield longer lasting improvements in walking after surgery, ultimately resulting in a decreased fall risk and higher quality of life.