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Background: Social frailty is associated with Fear of Falling (FoF) and health-related quality of life (HrQoL). However, how social frailty simultaneously influences FoF and HrQoL remains unclear. The study aims to understand the links between social frailty, FoF, and HrQoL in older adults and the mediating role of FoF in the relations between social frailty and HrQoL. Methods: In this cross-sectional survey, 1,933 community-dwelling older adults from Changhua County, Taiwan, were interviewed using a self-administrated questionnaire. In total, 1,251 participants with complete data were included for analysis. Data were analyzed using the SPSS PROCESS macro. A simple mediation was employed using social frailty as the independent variable, FoF as the mediator variable, and HrQoL as the outcome variable. Results: Social frailty was associated with HrQoL and indirectly with HrQoL through FoF, and FoF was directly associated with HrQoL. Of the 5-item social frailty index, "going out less frequently" was correlated with HrQoL and indirectly with HrQoL through FoF. Individuals who felt unhelpful toward family or friends had the worst physical HrQoL and did not talk to someone daily had the most negative influence on mental HrQoL. Conclusions: Social frailty can directly and indirectly, through FoF decrease HrQoL. It also emphasizes the importance of social connectivity in reducing the risk of falls. This study points to the need for social connectivity and fall prevention programs as essential components of strategies to enhance the health and well-being of community-dwelling older adults. [ABSTRACT FROM AUTHOR]

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).)

Aims: To explore the risk factors of falls and the gender differences based on demographic and disease characteristics, physical capability, and fear of falling in older adults with diabetes visiting outpatient clinics in Taiwan. Design: Cross‐sectional design. Methods: A total of 485 patients with type 2 diabetes aged between 65 and 80 years were recruited from three endocrine outpatient clinics in Taiwan. Demographic and disease characteristics, fall history in the previous one year and fear of falling were collected by a self‐reported questionnaire. Calf circumference, handgrip strength, one‐leg standing and time up‐and‐go tests were all performed to assess the physical capability of participants. Data were collected from May 2019 to May 2020. Results: Female gender (OR = 1.75), handgrip strength (OR = 2.43) and fear of falling (OR = 3.38) were important risk factors of falls overall, although fear of falling (OR = 4.69) was the only important risk factor of falls in males, while handgrip strength (OR = 3.48) and fear of falling (OR = 2.86) were important risk factors of falls in females. The sensitivity of simultaneous screening handgrip strength and fear of falling were 85.7, 86.4 and 86.2 in males, females and older adults overall with diabetes, respectively. Conclusion: Fear of falling was an important risk factor of falls in both genders, especially in males. Handgrip strength was an important risk factor of falls specifically for females. By simultaneously screening fear of falling and handgrip strength, risk of falls in older adults with diabetes at outpatient clinics could be identified in a more timely manner. Impact Nurses could periodically and simultaneously assess fear of falling and handgrip strength of older adults with diabetes at outpatient clinics. For those are identified at risk of falls on either fear of falling or handgrip strength, nurses could provide corresponding interventions to reduce the fear of falling or improve muscle strength to prevent such falls. [ABSTRACT FROM AUTHOR]

Aim Little is known about the association between fear of falling (FOF) and the risk of mortality. The aim of the present study was to investigate the association between FOF and mortality among community-dwelling older adults. Methods A total of 3814 older adults aged 65 years and older living in the Shih-Pai area in Taiwan participated in this 7-year follow-up longitudinal study. A structured questionnaire was used to record participants' FOF, history of falling, demographic characteristics, medical conditions, history of insomnia, depression symptoms and subjective health from 1999 to 2002. Follow-up all-cause mortality data were obtained from the National Death Registry of the Department of Health to identify the occurrence of deaths from the initial interview through to 31 December 2008. Results At the baseline assessment, the mean age of the participants was 73.8 ± 5.8 years, 56.4% were men and 53.4% had FOF. Cox regression showed that participants with FOF had an increased risk of mortality (aHR 1.16, 95% CI 1.02-1.33) after adjusting for sex, history of falling, age, body mass index, marital status, education level, smoking status, alcohol use, living status, chronic condition, depression and subjective health. Furthermore, FOF was a significant risk factor for male participants (aHR 1.17, 95% CI 1.00-1.38), but had a marginal risk for female participants (aHR 1.24, 95% CI 0.95-1.60) after adjusting for other risk factors, as in the full model except for sex. Conclusions The findings of the present study suggest that FOF is a significant risk factor of mortality, especially in older male adults. Further research on the mechanism and effects of fear of falling on mortality is necessary. Geriatr Gerontol Int 2017; 17: 2216-2223. [ABSTRACT FROM AUTHOR]

Objectives:Although the fear of falling is common among elderly residents in long-term care facilities, interventions developed for fear of falling management is very rare. Of these limited interventions, most were exercise interventions with only limited testing. The cognitive-behavioural intervention can decrease the fear of falling; however no intervention of the kind was developed and assessed to decrease fear of falling among the elderly in long-term care facilities. The purpose of this study was to examine the effectiveness of cognitive-behavioural strategies either with or without exercise in reducing fear of falling among elderly residents in nursing homes. Method:A prospective randomized control trial was conducted in six nursing homes in northern Taiwan. Seventy-five elderly participants were randomly assigned to one of the three groups: the comparison group, the cognitive-behavioural strategies with or without exercise group. The fear of falling, falls, depressive inclination, mobility, and muscle strength of extremities were collected at the two-month and five-month follow-up sessions, in which the progress of the patients were assessed. Results:The mixed model analysis revealed that elderly adults in the combination experimental group had significant improvements compared with the other two groups on fear of falling, depressive inclination, mobility, and muscle strength at five months. The incidences of falls, post intervention, in both experimental groups were significantly lower than those in the comparison group. Conclusions:The results suggest that the combination intervention helped elderly residents manage their fear of falling and falls, decrease their depressive inclination, and enhance their mobility and muscle strength. [ABSTRACT FROM PUBLISHER]

Older people living in long-term care facilities remain largely inactive, and therefore promoting exercise in this population is necessary. This study evaluated the efficacy of a mindfulness-based exercise program in older residents of a long-term care facility in Taiwan. A convenience sample of 72 older residents of a long-term care facility were recruited and assigned to either an experimental group or a control group. The experimental group (n = 36) participated in an 8-week mindfulness-based exercise program, and the control group (n = 36) received routine care. The generalized estimating equation showed significantly larger improvements in a fear of falling, exercise self-efficacy, dynamic balance, and muscle strength in the experimental group than in the control group from baseline to the end of the intervention and 3 months after the end of the intervention. This study provides a reference for how to improve exercise practice in older people living in long-term care facilities., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: The Falls Efficacy Scale-International (FES-I) is a commonly used questionnaire to evaluate concerns about falling. We adapted a Taiwan Chinese version (FES-I TC ) and evaluated its reliability and validity in community-dwelling elderly individuals. The discriminative validity was tested in relation to several known risk factors for fear of falling (FOF)., Methods: The questionnaire was adapted through translation, back-translation, and expert review processes. A convenience sample of 135 community-dwelling elderly individuals (at least 60 years old) completed the adapted questionnaire, and 31 of them had a retest within 7-10 days. Cronbach's α and an intraclass correlation coefficient (ICC) were used to evaluate the internal consistency and test-retest reliability. Principal component factor analysis was performed to assess the factor-construct validity. The discriminative validity was tested in relation to demographic features, fall-related history and performances on three functional tests: timed up and go, four-stage balance and 30-s chair stand tests. Effect sizes were computed. Correlation coefficients between physical functional performance and FES-I TC scores were computed. Receiver operating characteristic curves were used to determine the cutoff point for the score to differentiate high and low concern of falling., Results: The FES-I TC questionnaire had high internal consistency (Cronbach's α = 0.94) and excellent test-retest reliability (ICC = 0.94). Principal component factor analysis yielded a two-factor model, with several items requiring high demand on postural control loading on factor 2. FES-I TC scores discriminated individuals with different ages, reporting FOF, reporting falls in the past year and using walking aids. However, FES-I TC scores did not differ between the participants who were at risk of falling and those who were not at risk based on functional test performance and there was no correlation found between them., Conclusion: The FES-I TC was highly reliable and had adequate construct and discriminative validity. The lack of correlation between FES-I TC scores and functional test performance implied the presence of FOF even in individuals with good functional performance. Further follow up studies are warranted to verify the predictive validity of the FES-I TC ., (© 2022. The Author(s).)

Aim. To examine the effectiveness of cognitive-behavioural strategies with/without intense Tai Chi exercise in reducing fear of falling among community-dwelling elderly adults. Background. Fear of falling is a major health problem among community-dwelling older persons. The prevalence of this fear ranges from 29% to 77%, indicating the importance of developing effective strategies to reduce fear of falling among elderly adults. Methods. Data were collected from January to December 2007. A randomized controlled trial with three groups (control, cognitive-behavioural and cognitive-behavioural with Tai Chi). Participants were assessed at baseline for demographic data, falls-related history, and fear of falling. Data on these variables plus falls, mobility, social support behaviour and satisfaction, and quality of life were also collected at 2 and 5 months after interventions. Results. Participants in the three groups differed significantly in both measures of fear of falling (F = 20.89, P < 0.001; F = 6.09, P < 0.001) and mobility (F = 30.33, P < 0.001), social support behaviour and satisfaction (F = 3.32, P < 0.05 and F = 6.35, P < 0.001, respectively), and quality of life (F = 16.66, P < 0.001). In addition, participants who received the cognitive-behavioural intervention with Tai Chi had significantly lower fear of falling scores (P < 0.001) and higher mobility (P < 0.001), social support satisfaction (P < 0.01) and quality of life (P < 0.001) than the cognitive-behavioural alone and control groups at 5 months. The three groups did not differ significantly in falls. Conclusion. The results of this trial suggest that the cognitive-behavioural intervention with Tai Chi exercise helped community-dwelling elderly adults to enhance their mobility, to manage their fear of falling and to increase their quality of life. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the relationship among falls, fear of falling (FOF), and health-related quality of life (HRQOL) in elderly people living in the community. The study was a community-based surveillance with residents aged 65 or over in Taipei, Taiwan. Data were collected in face-to-face interviews. Of the 4,056 participants, the prevalence of falls was 13.8% and the prevalence of FOF among women (62.6%) was significantly higher than that among men (46.2%). Adjusted by covariate factors, fear of falling was identified as a major factor related to HRQOL in the elderly and should be emphasized to assist the improvement of HRQOL in geriatrics. [ABSTRACT FROM AUTHOR]

It is important to determine the effect of adherence to a tai chi program on falls and related functional outcomes in older people. This study examined the effect of a community-based tai chi program on injurious falls, balance, gait, and fear of falling among people aged 65 years and older in Taiwan. Subjects and Methods. In 6 rural villages in Taichung County, 1,200 subjects participated in the initial assessment. During a 1-year intervention period, all study villages were provided with education on fall prevention. Two villages had been provided tai chi exercise (n = 472 participants or "tai chi villagers"), and 4 villages served as control villages (n = 728 participants or "control villagers"). Injurious falls were ascertained by telephone interviews every 3 months over a 2-year study period; additionally, balance, gait, and fear of falling were assessed in 2 follow-up assessments. Results. Eighty-eight subjects, 83 from the tai chi villages and 5 from the control villages, participated and practiced in the tai chi program (the group labeled "tai chi practitioners"). After the tai chi program, injurious falls among the control villagers significantly declined by 44% (adjusted rate ratio [RR] = 0.56; 95% confidence interval [CI] = 0.36-0.92). Compared with the results for the control villagers, the decline was 31% greater (RR = 0.69; 95%CI = 0.30-1.56) among the tai chi villagers and 50% greater (RR = 0.5; 95%CI = O.11-2.17) among the tai chi practitioners; the results did not reach statistical significance. Furthermore, compared with the scores for the control villagers, the scores for the tai chi practitioners increased by 1.8 points (95% CI = 0.2-3.4) on the Tinetti Balance Scale and increased by 0.9 point (95%CI = 0.1-1.8) on the Tinetti Gait Scale. No significant changes in the fear of falling were detected among the tai chi practitioners, tai chi villagers, and control villagers. Discussion and Conclusion. Tai chi can prevent a decline in functional balance and gait among older people. However, the reduction in injurious falls attained with tai chi did not reach statistical significance; the statistical inefficiency may have resulted partly from the large decline in injurious falls in control villagers. Finally, the unexpected effect of educational intervention on reducing injurious falls in different settings needs to be further examined. Lin MR, Hwang HF, Wang YW, etal. Community-based tai chi and its effect on injurious falls, balance, gait, and fear of falling in older people. [ABSTRACT FROM AUTHOR]

Abstract: Development of the geriatric fear of falling measure (GFFM) was based on a previous qualitative study of Taiwanese community-dwelling elders. Relevant parameters or items for assessing subscales were identified and tested in a three-stage process: item development, content validity testing and reliability testing. The GFFM was tested on two groups of community-dwelling elders in Taiwan ( and 384) to examine validity and reliability. Good test–retest, internal consistency and inter-rater reliability were found. Confirmatory factor analysis and good overall model fits supported construct validity of the GFFM. Although these data are preliminary, the GFFM could be used as a quick screening instrument to evaluate fear of falling and an outcome indicator of nursing interventions. [Copyright &y& Elsevier]

Abstract: Fear of falling (FF) can have multiple adverse consequences in the elderly. Although there are various fall prevention programs, little is known of FF and its associated characteristics. This study examined FF-associated physical and psychosocial factors in older Chinese men living in a veterans home in southern Taiwan. Subjects with a recent episode of delirium, of bed-ridden or wheelchair-bound status, severe hearing impairment or impaired cognition were excluded. Overall, 371 residents (mean age 82.1±5.11 years, all males) participated. The prevalence of FF was 25.3%. Univariate analysis revealed that subjects in the FF group were older age, having lower education level, poorer sitting and standing balance, poorer activities of daily living (ADL), more depressive symptoms, higher chances of using walking aids, neurologic diseases, and a history of fall within the past 6 months. Logistic regression showed that depressive symptoms (odds ratio=OR=6.73, 95%CI: 3.03–14.93, p <0.001), activities of daily living (OR=2.48, 95%CI: 1.08–5.71, p =0.033), history of fall in the past 6 months (OR=2.47, 95%CI: 1.04–5.9, p =0.041), and neurological diseases (OR=2.75, 95%CI: 1.15–6.56, p =0.023) were all independent risk factors for FF. [Copyright &y& Elsevier]