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

We evaluated the effects of engaging in extemporaneous speech in healthy young adults while they walked in a virtual environment meant to elicit low or high levels of mobility-related anxiety. We expected that mobility-related anxiety imposed by a simulated balance threat (i.e., virtual elevation) would impair walking behavior and lead to greater dual-task costs. Altogether, 15 adults (age = 25.6 ± 4.7 yrs, 7 women) walked at their self-selected speed within a VR environment that simulated a low (ground) and high elevation (15 m) setting while speaking extemporaneously (dual-task) or not speaking (single-task). Likert-scale ratings of cognitive and somatic anxiety, confidence, and mental effort were evaluated and gait speed, step length, and step width, as well as the variability of each, was calculated for every trial. Silent speech pauses (> 150 ms) were determined from audio recordings to infer the cognitive costs of extemporaneous speech planning at low and high virtual elevation. Results indicated that the presence of a balance threat and the inclusion of a concurrent speech task both perturbed gait kinematics, but the virtual height illusion led to increased anxiety and mental effort and a decrease in confidence. The extemporaneous speech pauses were longer on average when walking, but no effects of virtual elevation were reported. Trends toward interaction effects arose in self-reported responses, with participants reporting more comfort walking at virtual heights if they engaged in extemporaneous speech. Walking at virtual elevation and while talking may have independent and significant effects on gait; both effects were robust and did not support an interaction when combined (i.e., walking and talking at virtual heights). The nature of extemporaneous speech may have distracted participants from the detrimental effects of walking in anxiety-inducing settings. [ABSTRACT FROM AUTHOR]

To examine whether immersive virtual reality (VR) can improve balance, gait, mobility and fear of falling in older people. MEDLINE, EMBASE, CINAHL, PsycINFO, ProQuest Central (Engineering and Computer Science) and reference lists of included articles. Randomised controlled trials that administered immersive VR training and assessed balance, gait and mobility outcomes in older adults without neurological disorders (mean age ≥ 65). Primary outcomes were standing balance (e.g. postural sway), multi-item balance scales (e.g. Berg Balance Scale), gait (e.g. gait speed) and mobility (e.g. Timed Up and Go test). Secondary outcomes comprised measures of enjoyment, fear of falling, adherence (e.g. dropout rate), feasibility/usability and adverse effects (e.g. motion sickness). Meta-analyses showed that immersive VR training significantly improved standing balance (SMD: 0.51, 95% CI:.15, 0.86, p = 0.005, I2 = 28% - 3 studies, n = 79) and performance on the Berg Balance Scale (MD: 2.36, 95% CI: 1.17, 3.56, p=0.0001, I2=0% - 4 studies, n = 190). No significant improvement in gait, mobility or fear of falling was found. Subgroup analyses revealed higher training doses (≥4.5 total hours) and VR interventions using non-head mounted displays were more likely to improve standing balance. No meta-analyses were conducted for enjoyment, adherence, feasibility/usability and adverse events. The findings indicate immersive VR has beneficial effects on balance, but not gait, mobility or fear of falling. Further research is required to examine these outcomes in trials that also include quantitative measurements of enjoyment, adherence, clinical feasibility, usability and adverse effects. • Immersive virtual reality (VR) can improve balance in older people. • At least 4.5 hours of total training dose was necessary to improve balance. • Immersive VR without a head-mounted display may be more effective. • Effects of VR training on gait, mobility and fear of falling were not clear. • More research is needed for enjoyment, adherence, usability and side effects. [ABSTRACT FROM AUTHOR]

Background: Vision impairment (VI) is associated with falls in older adults. However, past studies have relied on geographically constrained samples with limited generalizability or self‐reports of visual difficulty. To date, there have not been nationally representative studies on the association of objective measures of visual function and falls outcomes. Methods: We used cross‐sectional data from Round 11 of National Health and Aging Trends Study (NHATS), a nationally representative panel study of age‐eligible Medicare beneficiaries (N = 2951). We performed Poisson regression to calculate the prevalence and prevalence ratio (PR) of >1 fall in the past year, any fall in the past month, fear of falling (FoF), and activity limitation due to FoF as a function of distance visual acuity, near visual acuity, and contrast sensitivity. Models were adjusted for demographic and health covariates and were weighted to make nationally representative parameter estimates. Results: The weighted proportion of participants with VI was 27.6% (95% CI, 25.4%–29.9%). Individuals with any VI had a higher prevalence of falls compared with those without VI (18.5% vs. 14.1%, PR = 1.25, 95% CI 1.02–1.53). Specifically, contrast sensitivity impairment was associated with a higher prevalence of recurrent falls (20.8% vs. 14.7%; PR = 1.30, 95% CI 1.01–1.67) and recent falls (17.1% vs. 9.9%; PR = 1.40, 95% CI 1.01–1.94). This relationship existed even independent of near and distance visual acuity. Distance and near visual acuity were not significantly associated with falls. Having any VI was also associated with a higher prevalence of FoF (38.4% vs. 30.5%, PR = 1.17, 95% CI 1.02–1.34). Conclusion: The prevalence of falls is associated with poor contrast sensitivity but not with near or distance visual acuity. Findings suggest greater collaboration between geriatricians and eye care providers may be warranted to assess and address fall risk in older adults with VI. [ABSTRACT FROM AUTHOR]

Old age is a period of increased dependency, increased risk of accidents and decreased physical abilities. With the increase in the elderly population and falls, the necessity of a holistic approach to the problems of the elderly has become even more important. Falls, which are an important cause of injury in older adults, are caused by the interaction of individual and environmental factors. The most common cause of falls in the elderly is physical factors including the architectural features of houses, gardens, social environment areas and other structures or the internal design features of the spaces. An individual's physical perception of a space determines the knowledge of the experience associated with that space and plays an important role in the evaluation of the space. These evaluations affect the mobility of the person in the space or environment. Fear of falling, which occurs after a fall or the possibility of a fall, is the emergence of a state of anxiety that causes avoidance and reduction of activity in the elderly. We will present an overview of the expansions and meaningful interaction of perceived and designed space, the relationship between spatial perception and fear of falling, and living spaces that support the elderly's participation in the social environment. In this article, the importance of functional and usable spaces in public or private spaces will be discussed in the context of the spatial perception of the elderly in the context of reducing the fear of falling and therefore the fear of falling, and the importance of never falling will be emphasized. In improving the quality of life of the elderly, the perception of the past about the space can have an impact on the future and strategies can be created to support this positively. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare the fear of falling in patients with ankylosing spondylitis (AS) and healthy controls. The relationship between the fear of falling and spinal mobility, balance parameters, functional capacity, pain, and disease activity was also evaluated in patients. The study sample included 40 AS patients and 50 gender-age-matched healthy controls. Falls Efficacy Scale-International (FES-I), Berg Balance-Scale (BBS), and Short-Physical Performance Battery (SPPB) were evaluated in all participants. In patients, the Bath AS-Metrology Index (BASMI), pain-visual analog scale (VAS), Bath AS-Disease Activity Index (BASDAI), and Bath AS-Functional Index (BASFI) were assessed. The mean ages of the patients and controls were 45.73 ± 9.5 (18-63) and 42.28 ± 8.1 (26-56), respectively. Fear of falling scores were significantly higher, and BBS and SPPB scores were significantly lower in patients than in controls (p<0.001). There was a positive correlation between FES-I scores and VAS-pain, BASFI, and BASDAI-scores, and a negative correlation was found between FES-I scores and BBS and SPPB-scores (SPPB p<0.05, others p<0.001). BASMI scores were negatively correlated with BBS scores (p<0.05). In the regression analysis, positive correlation with FES-I was BASFI-scores (p<0.05). The results of this study showed that patients with AS may experience fear of falling even if there is no history of falls. Balance, disease activity, and, most importantly, functional capacity should be evaluated to reduce the fear of falling in these patients. [ABSTRACT FROM AUTHOR]

• We recruited residents from 27 nursing home in China. • Fear of falling directly and indirectly contributed to poor quality of life and depression. • We studied the mediating role using generalized structural equation modeling, activity restriction mediated the effect of the fear of falling on health outcomes. This study investigates the mediating role of activity restriction in the relationship between the fear of falling and health outcomes. This was a cross-sectional study with convenience sampling of 316 nursing home residents. Generalized structural equation modeling was conducted to test the mediating role. The results showed that residents with fear of falling were more likely to restrict their activities and residents who often or always restricted activities reported lower levels of quality of life and higher levels of depression. Severe activity restriction accounted for 75 % of the total effect of fear of falling on quality of life and 69 % of the total effect of fear of falling on depression. Fall prevention efforts should focus on strategies or interventions to reduce residents' excessive fear of falling and promote activity engagement. Physical and social activities will not only prevent future falls but also improve residents' quality of life and mental health. [ABSTRACT FROM AUTHOR]

Introduction: Fall Risk Appraisal (FRA), a process that integrates perceived and objective fall risk measures, serves as a crucial component for understanding the incongruence between fear of falling (FOF) and physiological fall risk in older adults. Despite its importance, scant research has been undertaken to investigate how habitual physical activity (PA) levels, quantified in Monitor-Independent Movement Summary (MIMS), vary across FRA categories. MIMS is a deviceindependent acceleration summary metric that helps standardize data analysis across studies by accounting for discrepancies in raw data among researchgrade and consumer devices. Objective: This cross-sectional study explores the associations between MIMS (volume and intensity) and FRA in a sample of older adults in the United States. Methods: We assessed FOF (Short Falls Efficacy Scale-International), physiological fall risk (balance: BTrackS Balance, leg strength: 30-s sit-tostand test) and 7-day free-living PA (ActiGraph GT9X) in 178 communitydwelling older adults. PA volume was summarized as average daily MIMS (MIMS/day). PA intensity was calculated as peak 30-min MIMS (average of highest 30 non-consecutive MIMS minutes/day), representing a PA index of higher-intensity epochs. FRA categorized participants into following four groups: Rational (low FOF-low physiological fall risk), Irrational (high FOF-low physiological fall risk), Incongruent (low FOF-high physiological fall risk) and Congruent (high FOF-high physiological fall risk). Results: Compared to rational group, average MIMS/day and peak 30-min MIMS were, respectively, 15.8% (p = .025) and 14.0% (p = .004) lower in irrational group, and 16.6% (p = .013) and 17.5% (p < .001) lower in congruent group. No significant differences were detected between incongruent and rational groups. Multiple regression analyses showed that, after adjusting for age, gender, and BMI (reference: rational), only irrational FRA was significantly associated with lower PA volume (β = −1,452.8 MIMS/day, p = .034); whereas irrational and congruent FRAs were significantly associated with lower “peak PA intensity” (irrational: β = −5.40 MIMS/day, p = .007; congruent: β = −5.43 MIMS/day, p = .004). Conclusion: These findings highlight that FOF is a significant barrier for older adults to participate in high-intensity PA, regardless of their balance and strength. Therefore, PA programs for older adults should develop tailored intervention strategies (cognitive reframing, balance and strength exercises, or both) based on an individual’s FOF and physiological fall risk. [ABSTRACT FROM AUTHOR]

Background and purpose: Fear of falling is considered an important factor in reducing the daily life activities of the elderly with diabetes. It seems that the fear of falling can play a decisive role in creating a sense of loneliness and social isolation in the elderly with diabetes by creating functional limitations and reducing the social activities of the elderly. Therefore, the direct relationship between fear of falling and social isolation and loneliness in diabetic elderly has not been investigated. The present study was conducted to determine the relationship between fear of falling social isolation and feelings of loneliness in elderly diabetics who were referred to health centers in Faridunknar City in 2023. Materials and methods: The current study was a descriptive-analytical study that was conducted crosssectionally on elderly people with type 2 diabetes referring to health centers in Faridonkanar City in 2023. In this study, 398 elderly people with diabetes participated, who were selected by simple random method. The research tools included the demographic information form, the international fall efficiency scale in the elderly, the emotional and social loneliness scale of adults, and the social isolation questionnaire of the Yazdi school. Data analysis was done using descriptive statistics and analytical statistics such as one-way analysis of variance, independent t-test, Pearson's correlation coefficient, and multiple linear regression in SPSS21 software. Results: The mean age of the participants was 67.6±28.6 years, with more than half of them being female (66.8%). The mean scores and standard deviations of fear of falling, social isolation, and loneliness in the elderly were 51.53±11.60, 48.66±6.30, and 64.53±2.96, respectively. 94.7% of the elderly participants had severe concerns about falling. There was a significant positive relationship between the fear of falling and feelings of loneliness (r=0.389, P=0.001) and social isolation (r=0.156, P=0.002). The results of the multivariable model also showed that for each unit increase in fear of falling score, there was a 0.05 increase in social isolation score in elderly diabetic patients (P≥0.05). Conclusion: The results of the present study showed that there is a significant relationship between the fear of falling and social isolation and loneliness. The more seniors are afraid of falling, the more they feel alone and socially isolated. Given that improving health in the elderly requires improving healthy lifestyles and controlling and managing psychological factors, including feelings of loneliness and social isolation. Knowing the factors related to them is considered one of the important pillars of interventions in target groups in the key concept of "healthy and successful aging ". Effective planning in this area requires full knowledge and awareness of the fear of falling in the elderly and eliminating the factors that can be related to it. For this reason, it is necessary to adopt appropriate intervention strategies to reduce the fear of falling and increase the sense of security in diabetic elderly to improve their participation and social presence. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: The aim was to synthesize evidence on the relationship between physical-activity interventions and FοF reduction in frail and pre-frail older adults. Findings: Muscle strengthening, balance improvement, and mobility training are effective in reducing the FoF of frail and pre-frail older adults. Message: Physical-activity interventions have a positive role in FoF reduction while improving the quality of life of frail and pre-frail older adults and promoting healthy aging. Background: Frailty in older adults leads to progressive deterioration of their physical condition and makes them prone to develop Fear of Falling (FoF). Physical-activity interventions appear to be effective in managing the components of frailty but there is no clear evidence to determine whether physical-activity may affect FoF in frail and pre-frail older adults. Objective: Τhis systematic literature review aims to synthesize evidence on the relationship between the physical interventions to ameliorate balance, strength, and mobility and FoF reduction in frail and pre-frail older adults. Methods: Studies assessing physical-activity interventions for frail and pre-frail older adults aged 60 years and older were identified in English through searches in PubMed, ScienceDirect, and Cochrane Central Register of Controlled Trials databases till February 2023. Study quality was assessed, and a qualitative synthesis of results was performed. Results: A total of 13 studies published were included. All of them were Randomized Control Trials and the most frequent assessment tool used to assess FoF (10 of 13 studies) was the Fall Efficacy Scale-International (FES-I). Six studies were assessed as having a low risk of bias. Cumulatively, the findings of this review indicate that physical-activity interventions are effective in reducing the FoF of frail and pre-frail older adults. Conclusion: The results are encouraging and recapitulate the positive role of physical interventions in FoF reduction. However, future research would benefit from longer follow-up periods, longer intervention duration, and participation of interdisciplinary teams. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: We conducted a mixed-method systematic review on factors related to concerns about falling and activity restriction among older adults after hip fracture. Findings: We identified several contributing factors related to the individual, formal care, environment, and social structure. We observed immutable factors that seem to worsen concerns and activity restriction, as well as modifiable factors that seem to help overcome fears and increase activity. Message: Management of concerns about falling and associated activity restriction after hip fracture needs a comprehensive approach that considers the various individual and external factors impacting fears and activity restriction in the community. Purpose: To investigate factors contributing to concerns about falling and activity restriction in the community among older adults who had a hip fracture. Methods: A mixed method systematic review with a convergent segregated approach. We searched Medline, Embase, PsycInfo, PEDRo, CINAHL and the Cochrane library. Results were synthesised narratively considering physical, psychological, environmental, care, and social factors and presented in tables. Critical appraisal was completed in duplicate. Results: We included 19 studies (9 qualitative, 9 observational, 1 mixed methods) representing 1480 individuals and 23 factors related to concerns about falling and activity restriction. Physical factors included falls history, comorbidities, balance, strength, mobility and functionality. Psychological factors included anxiety and neuroticism scores, perceived confidence in/control over rehabilitation and abilities, and negative/positive affect about the orthopaedic trauma, pre-fracture abilities and future needs. Environmental factors included accessibility in the home, outdoors and with transport. Social and care factors related to the presence or absence of formal and informal networks, which reduced concerns and promoted activity by providing feedback, advice, encouragement, and practical support. Conclusion: These findings highlight that to improve concerns about falling and activity restriction after hip fracture, it is important to: improve physical and functional abilities; boost self-confidence; promote positive affect; involve relatives and carers; increase access to clinicians, and; enhance accessibility of the home, outdoors and transport. Most factors were reported on by a small number of studies of varying quality and require replication in future research. [ABSTRACT FROM AUTHOR]

Introduction: Aging is a natural, irreversible physiological process that depends on genetic, environmental, and lifestyle factors. Many physiological, biological, psychological, and other factors play a major role. According to the World Health Organization, falls are the second leading cause of unintentional injury death in the world and represent a major global public health problem. Falls are most commonly caused by intrinsic and extrinsic risk factors. A comprehensive assessment of fall risk is critical to the development of effective fall prevention programs. The screening protocol is brief, easy to use, and multifactorial and allows the identification of risk factors for falls. The aim of this study is to investigate the importance of the presence of risk factors in the home environment and the impact on increasing the risk of falls in people in the third age. Methods: The study was conducted in the municipality of Podgorica. 109 elderly people from urban and rural areas were included in the study using the snowball method. The instruments used in our study are a standardized checklist for assessing risk factors in the home environment, inside and outside the home (HASSAT), and a self-assessment scale of one’s own concern about a possible falls efficacy scale international. The survey was conducted from the end of October to the end of November 2023. Results: There is a statistically significant difference in social and physical activities of daily living in the area of concern about falling. When analyzing the overall result of the fear of falling scale in relation to gender, a significant statistical difference is found. The analysis of the individual rooms in relation to the age of the respondents shows that there is a significant statistical difference. Conclusion: The results obtained show that the high risk of falling is present in all rooms of the home environment for people in their 3rd year of life and that fear of falling increases with age.

OBJECTIVE: Falls in older adults are associated with increased motor vehicle crash risk, possibly mediated by driving behavior. We examined the relationship of falls and fear of falling (FOF) with subsequent objectively measured driving habits. METHODS: This multi-site, prospective cohort study enrolled 2990 active drivers aged 65-79 (53% female). At enrollment, we assessed falls in the past year and FOF (Short Falls Efficacy Scale-International). Driving outcomes included exposure, avoidance of difficult conditions, and unsafe driving during one-year follow-up, using in-vehicle Global Positioning System devices. RESULTS: Past-year falls were associated with more hard braking events (HBE). High FOF was associated with driving fewer days, miles, and trips, driving nearer home and more HBE. Differences were attenuated and not significant after accounting for health, function, medications and sociodemographics. DISCUSSION: Differences in objectively measured driving habits according to past-year fall history and FOF were largely accounted for by differences in health and medications. Rather than directly affecting driving, falls and FOF may serve as markers for crash risk and reduced community mobility due to age-related changes and poor health.

Abstract Background Assessment of extrapulmonary comorbidities is essential in chronic obstructive pulmonary disease (COPD). Deterioration of balance and increasing fear of falling are two of the most significant extrapulmonary manifestations. Although pulmonary rehabilitation (PR) is well-known and effective for COPD patients, there is a need for alternative treatments to enhance balance and alleviate concerns about falling. This study aimed to investigate the effect of Body Awareness Therapy (BAT), in addition to the PR program, on balance and fear of falling in patients with COPD. Methods Forty-three patients were randomized into two groups: the BAT + PR group (BAT: once a week, 60 min + PR: 30 min, seven days of the week) or the PR group (PR: 30 min, seven days of the week) for eight weeks. Primary (balance, fear of falling) and secondary (dyspnea, muscle strength, functional capacity) outcomes were assessed at two different times: the baseline and end of the eight weeks. Results Significant improvements were found in dynamic balance (reaction time η2 = 0.777, movement velocity η2 = 0.789, endpoint excursion η2 = 0.687, maximal excursion η2 = 0.887), static balance on firm ground (eyes opened η2 = 0.679, eyes closed η2 = 0.705), dyspnea (η2 = 0.546), muscle strength (η2 = 0.803), and functional capacity (η2 = 0.859) of the BAT + PR group (p

Objective Proper physical activities play an important role in reducing disease and mortality in old age, and is one of the main causes of active aging; however, the fear of falling is a barrier to having proper physical activity. Due to the difference between the elderly living in urban and rural areas regarding the risk factors of fear of falling and the amount and type of physical activity, this study aims to investigate and compare the fear of falling, physical activity, and activities of daily living (ADL) in the elderly living in urban and rural areas of Konarak County, Iran. Materials & Methods In this analytical cross-sectional study, 350 elderly people aged ≥60 years, who were under the coverage of comprehensive rural and urban health service centers in Konarak, Sistan and Baluchestan province (224 from rural areas and 126 from urban areas) were selected using a random sampling method and based on the inclusion and exclusion criteria. In addition to recording their demographic information, their fear of falling, physical activity, and ADL were measured by the Persian version of falls efficacy scale-international (FES-I), Rapid Assessment of Physical Activity (RAPA), ADL scale, and Instrumental ADL scale (IADL), respectively. Results The mean overall age of the elderly was 68.48±7.84 years (69.53±8.29 years in the rural group and 66.62±6.61 years in the urban group), and there was a significant difference between the two groups in terms of age (P

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

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

Concerns about falling (CAF) affect daily life activities in older people; however, it is unclear whether gender moderates this relationship. The authors investigated the cross-sectional relationship between CAF and objectively measured physical activity (PA) and gait quality in 503 community-dwelling older men and women. About 448 people (age = 76.2 [SD 7.9] years, 296 females) contributed sufficient data on movement intensity, activity duration (bouts of walking, sitting, and standing), number of transitions between activities (sit-to-stand and sit-to-walk), number of steps and gait quality, quantified as walking speed, and sample entropy. Associations with the Iconographical Falls Efficacy Scale were tested. The authors found no significant moderation by gender. However, women participated in less PA than men and showed a more irregular walking pattern. Higher levels of CAF led to lower PA and poorer gait quality. Our findings suggest that prevention of CAF-related PA avoidance may be particularly important for women, who are less active and at higher risk of falls. [ABSTRACT FROM AUTHOR]

Introduction: Neuromodulation is a non-invasive technique that allows for the modulation of cortical excitability and can produce changes in neuronal plasticity. Its application has recently been associated with the improvement of the motor pattern in older adults individuals with sequelae from neurological conditions. Objective: To highlight the effects of non-invasive neuromodulation on the risk of falls and fear of falling in community-dwelling older adults. Methods: Systematic review conducted in accordance with the items of the Cochrane Handbook for Systematic Reviews of Interventions. Searches were carried out in electronic databases: CENTRAL, Clinical Trials, LILACS, PEDro, PubMed, Web of Science, between 13/06/2020 and 20/09/2023, including all indexed texts without language and publication date restrictions, randomized controlled clinical trials, which presented as their main outcome non-invasive neuromodulation for reducing the fear of falling and risk of falls in the older adults, regardless of gender. Results: An extensive search identified 9 eligible studies for qualitative synthesis from 8,168 potential articles. Rigorous filtering through automated tools, title/ abstract screening, and full-text evaluation ensured a focused and relevant selection for further analysis. Most studies (80%) used transcranial direct current electrical stimulation as an intervention, over the motor cortex or cerebellum area, with anodal current and monopolar electrode placement. The intensity ranged from 1.2 mA to 2 mA, with a duration of 20 min (80%). The profile of the research participants was predominantly individuals over 65 years old (80%), with a high risk of falls (60%) and a minority reporting a fear of falling (40%). The outcomes were favorable for the use of neuromodulation for the risk of falls in the older adults, through improvements in static and dynamic balance. Conclusion: The results may have limited applicability to direct outcomes related to the risk of falls, in addition to evidence regarding the difference or lack thereof in applicability between genders, fallers and non-fallers, as well as older adults individuals with low and high fear of falling. Systematic review registration: The protocol for this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) to obtain the identification of ongoing research (ID: 222429). [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the prevalence of fear of falling and associated factors in older adults with heart failure. Methods: A prospective, cross‐sectional study. The study included 100 geriatric patients who were hospitalised and treated in the cardiology department of our hospital with ventricular ejection fraction (LVEF) lower than 50% for at least 1 year. A series of geriatric assessments were performed by face‐to‐face interview on the day of admission. Electrocardiography (ECG) and transthoracic echocardiography (TTE) were also performed on the day of admission. Results: The median age of the patients was 72 years, and 72.0% were men. Falls Efficacy Scale scores indicated a fear of falling in 46 (46.0%) of the patients. Charlson Comorbidity Index (CCI) was significantly higher in patients with fear of falling (P < 0.001). Severe depression, severe clinical insomnia, daytime sleepiness, and malnutrition were significantly more frequent among patients with fear of falling. Fear of falling was associated with significantly lower LVEF (P = 0.001). The presence of severe depression increased the risk of fear of falling by 13.97 times (95% CI: 3.064–63.707; P = 0.001), and the presence of daytime sleepiness increased the risk by 3.49 times (95% CI: 1.012–12.037; P = 0.048). A one‐unit increase in CCI increased the risk of fear of falling by 1.56 times (95% CI: 1.093–2.238; P = 0.014). Conclusions: Heart failure patients with concomitant depression, sleep disorders, and high comorbidities have greater fear of falling. [ABSTRACT FROM AUTHOR]

Introduction: Peripheral neuropathy (PN) becomes more common with increasing life expectancy, but general population prevalence estimates are lacking. We investigated an epidemiological distribution of signs of PN among 2,996 community-dwelling participants in Good Aging in Skåne Study, age 60–97, and their impact on physical and autonomic function. Methods: Signs of PN were measured with Utah Early Neuropathy Scale (UENS). Associations between UENS and physical tests, pain, and dysautonomic phenomena were calculated for each sex, adjusted for age, with estimated marginal means (EMM) and odds ratios (ORs) in four UENS quantiles (Q1–Q4). Results: Participants in Q4 had worse EMM for: time to complete Timed Up and Go test (Q4–Q1: male 10.8–9.6 s; female 11.7–10.2 s), 15 m Walk test (Q4–Q1: male 11.1–9.9 s; female 11.2–10.4 s), and fewer repetitions in Step test (Q4–Q1: male 15.2–17.0 steps; female 14.5–15.8 steps). Higher OR of failing one-leg balance 60 s test {male 2.5 (confidence interval [CI] 95%: 1.7–3.8); female 2.1 (1.1–3.2)}, Foam Pad Balance test (male 4.6 [CI 95%: 3.2–6.7]; female 1.8 [1.3–2.6]), and lower physical quality of life were seen in Q4 compared to Q1. Participants in Q4 had higher OR for walking aid usage, falls, fear of falling, pain, and urinary incontinence, while in males, higher OR for orthostatic intolerance, fecal incontinence, and constipation. Conclusions: In a general population, 20–25% of older adults who have highest UENS scores, a sensitive measure of early PN, express slower gait, worse balance, lower quality of life, pain, falls and fear of falling, and autonomic symptoms. [ABSTRACT FROM AUTHOR]

Background and Aims Physical and mental disabilities and diseases increase with the onset of old age. On the other hand, the observation of older people who have considerably maintained their cognitive and physical abilities by changing their lifestyle rejects the belief that old age is always associated with profound physical and mental defects. In this regard, this study aimed to investigate the effectiveness of Tai Chi exercises on balance, fear of falling, working memory, and selective attention in older women. Methods The present study is an applied study in which 47 older women with a mean age of 62.91±0.580 years from Tehran City, Iran, announced their readiness to cooperate after responding to a cyberspace call. Of them, 40 eligible women were selected. After performing the pretest (static and dynamic balance tests, working memory and selective attention, and falling efficiency questionnaire), they were randomly divided into experimental and control groups. Then, the experimental group participated in the Tai Chi training program online for 8 weeks, and the control group performed their daily activities. Finally, the post-test was performed, and the results were recorded. Data analysis was performed by statistical method of analysis of covariance and combined analysis of variance using SPSS software at the level of P≤0.05. Results The results of the analysis of covariance showed that the effect of Tai Chi exercises on static balance (P=0.001), dynamic balance (P=0.001), fear of falling (P=0.001), working memory (P=0.022), and selective attention (P=0.002) was significant. Comparing the groups, the results showed that in all components studied, the participants in the experimental group performed better than the control group (P=0.001). Conclusion According to the findings, Tai Chi exercises are a useful way to improve balance, reduce fear of falling, enhance working memory, and increase selective attention in older women. [ABSTRACT FROM AUTHOR]

Background and Objectives: The Life-Space Assessment (LSA) serves as an assessment tool for evaluating mobility and participation in older adults. To date, no studies have investigated the validity and reliability of the LSA within Arabic-speaking communities. The purpose of this study was to examine the reliability and validity of an Arabic version of the LSA and to investigate the potential predictors of mobility restrictions in older Arabic-speaking adults. Materials and Methods: This study involved a cohort of 75 Arabic-speaking older adults (with a mean age of 67.2 ± 5.9). The LSA was administered twice, with a one-week interval, to assess its test–retest reliability. The internal consistency and test–retest reliability of the LSA were assessed using Cronbach's alpha and intra-class correlation coefficients (ICCs), respectively. The validity of the LSA was determined by analyzing its correlation with outcome measures related to the fear of falling, depression, quality of life, lower limb strength, physical performance, and gait speed. Results: The test–retest reliability of the LSA composite score demonstrated good results (ICC = 0.83). The validity of the LSA was supported by significant correlations between its scores and factors such as gender, education level, and all other outcome measures. Notably, being female and having a lower gait speed emerged as significant predictors of mobility restrictions in older Arabic-speaking adults, accounting for 49% of the variance (R2 = 49%) in the multiple logistic regression analysis conducted. Conclusions: The Arabic version of the LSA has proven to be a reliable and valid measure of mobility and participation among older Arabic-speaking adults. This study endorses the application of the Arabic LSA in both research and clinical settings involving older adults and emphasizes the need for further investigation to fully understand its psychometric features in other Arabic-speaking individuals afflicted with neurological and musculoskeletal conditions. [ABSTRACT FROM AUTHOR]

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The purpose of this study was to adapt Modified Falls Efficacy Scale (MFES) into Arabic and determine the reliability and validity of the instrument. The study was conducted in two phases: (i) translation and adaptation by the systematic approach of the 'forward-back' translation method and (ii) psychometric testing of the Arabic version of the Modified Falls Efficacy Scale among 207 community-dwelling older adults (≥ 60 years). The Arabic version of the Modified Falls Efficacy Scale demonstrated excellent internal consistency (Cronbach's alpha = 0.98) and test–retest reliability scores (ICC = 0.96, 95% CI; 0.95–0.97). And also showed strong correlations with both the Falls Efficacy International (r = −0.82) and the activities-specific Balance Confidence Scale (r = 0.87). Sampling adequacy for factor analysis was proven by a Kaiser–Meyer–Olkin value of 0.962. Goodness-of-fit (GFI) statistics for the model were in the acceptable range (Chi-Square/Degree of Freedom (CMIN/DF) = 2.59, Goodness-of-fit index (GFI) = 0.9, Comparative Fit Index (CFI) = 0.97, Root Mean Square Error of Approximation (RMSEA) = 0.79). The Arabic version of the Modified Falls Efficacy Scale has demonstrated excellent psychometric qualities to measure the level of fear of falling. Modified falls efficacy scale (MFES) is a commonly used scale for assessment of fear of fall in elderly The translated and adapted Arabic version of (A-MFES) will enhance the assessment of fear of fall in Arabic older adults, though it is a patient response scale This scale can assess the fear of falling in indoor and outdoor activities which makes this scale comprehensive in nature [ABSTRACT FROM AUTHOR]

Purpose: Individuals with multiple sclerosis (MS) experience fear of falling (FOF), which is associated with negative health and quality-of-life consequences. Prior research has used FOF and concern about falling (CAF) interchangeably, but persons with MS report that CAF and FOF represent separate constructs that lie on a continuum. Unfortunately, no scale exists to understand the differences between CAF and FOF. Therefore, we developed a novel questionnaire, the Concern and Fear of Falling Evaluation (CAFFE), in which respondents rank their CAF and FOF on a continuum across various activities. This study aims to describe the scale development process and examine its psychometric properties. Methods: In a single online survey, MS participants responded to demographic questionnaires, indicated whether they experience CAF and FOF, and completed the CAFFE. Psychometric evaluation of the CAFFE involved internal consistency, split-half cross validation, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). Results: Out of 1,025 respondents, 64.6% reported CAF and 47.2% reported FOF. The EFA yielded a two-factor solution encompassing activities in open (factor 1) and closed environments (factor 2). The CFA replicated this two-factor solution and the CAFFE demonstrated excellent internal consistency (a = 0.98). Conclusion: The 27-item CAFFE is a highly reliable and valid measure capturing the tipping point at which point CAF moves to FOF. Future research should seek to define the tipping point from the MS community, as CAF may be an adaptive mechanism, whereas FOF may be a maladaptive behavior. [ABSTRACT FROM AUTHOR]

The influence of internal focus (IF) on postural balance needs to be determined when assessing fall risk in older adults. Moreover, the mechanism through which IF is triggered should be elucidated. Does fear unrelated to threats to postural balance modulate IF during postural control? The participants were 16 community-dwelling older adults. We generated visual stimuli for neutral and fear conditions using the International Affective Picture System. Participants were assessed for postural control while standing on a stabilometer and looking at projected images. The IF allocated to postural control during task was assessed immediately after the task using the Conscious Movement Processing subscale of the Movement-Specific Reinvestment Scale (MSRS-CMP). Sympathetic activity was assessed using the mean low-frequency/high-frequency ratio (LF/HF), and posture was evaluated using the root mean square area (RMS-A), anteroposterior mean power frequency (MPF-AP), mediolateral MPF, and co-contraction index. Differences (Δ) in the MSRS-CMP, RMS-A and MPF between the neutral/fear conditions and control condition were calculated. Each index was also compared among the control, neutral, and fear conditions. The correlations between ΔMSRS-CMP and postural measures were evaluated. Equivalence tests were conducted to determine whether change of IF was different among conditions. The MSRS-CMP score did not differ significantly among conditions; equivalence was observed. The LF/HF and MPF-AP in the fear condition were higher than in the other conditions. The RMS-A in the fear condition was lower than in the neutral condition. ΔMSRS-CMP and ΔMPF-AP were significantly negatively correlated. The results of this study suggest that feelings of fear affect postural control but not the IF of attention. Taken together with previous research, the findings of this study suggest that consideration of the fear-inducing context may be useful in assessments of, and interventions for, older adults with a fall risk. • Fear-related visual stimuli do not enhance the internal focus of attention. • Stiffening behavior is elicited by fear-related visual stimuli during standing. • Although fear reduced body sway and increased frequency of sway, ankle muscle co-contraction was not observed. • Fear does not trigger an increase in internal focus, but affects postural control. [ABSTRACT FROM AUTHOR]

Background and Aims: Personality traits, such as neuroticism and extraversion, are emerging as important predictors of falls. Despite their significance, existing fall prevention programs often overlook these traits, creating a notable research gap. This study aims to conduct a comprehensive scoping review to explore the existing literature on the relationships among personality traits, falls, and fall‐related psychological concerns (FrPCs). Methods: This scoping review will adhere to the framework established by Arksey and O'Malley, incorporating extensions recommended by the Joanna Briggs Institute and using the PRISMA‐ScR checklist. A thorough search strategy will be employed, aligning with the population, concept, and context (PCC) selection criteria. Electronic databases, including MEDLINE, APA PsycINFO, Web of Science, CINAHL, and SPORTDiscus, will be searched from their inception to the present. Additionally, a manual search of the reference lists of identified and relevant full‐text articles will be conducted. Two independent reviewers will screen titles and abstracts, perform full‐text reviews, and extract data from pertinent articles. Discussion: Personality traits are increasingly recognized as influential predictors of falls and related psychological concerns. This review aims to make a substantial contribution to the existing literature by being the first to comprehensively explore and provide a descriptive synthesis of the relationship between personality traits and falls, as well as FrPCs in adults. It is hoped that the outcomes of this review will enhance our comprehension of the role of personality traits in falls, potentially informing future research and strategies for this critical area of study. Scoping Review Registration: This scoping review protocol was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/KR74X). [ABSTRACT FROM AUTHOR]

Objective Proper physical activities play an important role in reducing disease and mortality in old age, and is one of the main causes of active aging; however, the fear of falling is a barrier to having proper physical activity. Due to the difference between the elderly living in urban and rural areas regarding the risk factors of fear of falling and the amount and type of physical activity, this study aims to investigate and compare the fear of falling, physical activity, and activities of daily living (ADL) in the elderly living in urban and rural areas of Konarak County, Iran. Materials & Methods In this analytical cross-sectional study, 350 elderly people aged ≥60 years, who were under the coverage of comprehensive rural and urban health service centers in Konarak, Sistan and Baluchestan province (224 from rural areas and 126 from urban areas) were selected using a random sampling method and based on the inclusion and exclusion criteria. In addition to recording their demographic information, their fear of falling, physical activity, and ADL were measured by the Persian version of falls efficacy scale-international (FES-I), Rapid Assessment of Physical Activity (RAPA), ADL scale, and Instrumental ADL scale (IADL), respectively. Results The mean overall age of the elderly was 68.48±7.84 years (69.53±8.29 years in the rural group and 66.62±6.61 years in the urban group), and there was a significant difference between the two groups in terms of age (P<0.001). Pearson correlation test results showed that the FES-I score had a statistically significant negative relationship with the scores of ADL, IADL, and RAPA1 in total and in each group (P<0.001), but there was no statistically significant relationship between the FES-I score and the RAPA2 neither in total (P=0.40) and nor in rural (P=0.38) and urban (P=0.81) groups. Conclusion The fear of falling is significantly higher in the elderly living in rural areas of Konarak county compared to those living in urban areas. The RAPA1 and basic ADL of the elderly living in urban areas are higher compared to those living in rural areas, but there is no significant difference between them in RAPA2 and IADL. In addition, fear of falling has a significant relationship with physical activity of the elderly in overall and in rural and urban groups. [ABSTRACT FROM AUTHOR]

Objectives: Assess the influence of physical function on balance and future falls in older adults with fear of falling (FOF) and whether activity restriction modifies the contribution to falls. Methods: Analyses utilized data from Baltimore Longitudinal Study of Aging (n = 680) and National Health and Aging Trends Study (n = 4376) community-dwelling older adults. The role of physical function was examined by comparing balance performance and future fall odds before/after controlling for function in older adults with/without FOF. Fall likelihood analyses were repeated with FOF stratified by activity restriction. Results: When controlling for physical function, differences in balance and fall odds secondary to FOF/activity restricting FOF reduced but remained significant. Fall odds secondary to non-activity restricting FOF only slightly decreased. Discussion: Physical function contributes to balance and falls in older adults with FOF, more so in those restricting activity. Reduced balance and increased fall risk persists independent of function suggesting additional contributing factors. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Fear of falling (FoF) is common in patients with cognitive impairment. However, the role of sarcopenia and malnutrition, which are two important factors that cause falls, on FoF is unknown. The aim of this study was to explore the association between FoF and malnutrition and sarcopenia in older patients with dementia. METHODS: Two hundred and sixty-six dementia patients underwent comprehensive geriatric assessment. The Falls Efficacy Scale-International (FES-I) was applied to assign and classify FoF. Scores for the FES-I scale were categorized as ≥28, 20-27, or 16-19, representing high concern, moderate, and no or low concern about FoF, respectively. Mini Nutritional Assessment (MNA) scores <17, 17-23.5, or >23.5 were categorized as malnutrition, malnutrition risk, and well-nourished, respectively. Sarcopenia was defined using the SARC-F tool. SARC-F score ≥4 was categorized as sarcopenia. Serum folate, Vitamin B12, and Vitamin D deficiencies were also evaluated. The relationship between FoF groups and nutritional status, presence of sarcopenia, and micronutrient status was evaluated. RESULTS: The mean age was 80.83±6.61 years. The prevalence of moderate and high FoF in dementia patients was 51%. There was a significant difference in terms of cerebrovascular events, the history of falling, instrumental and basic activities of daily living (IADL and BADL), MNA, and SARC-F scores between the FoF groups (p<0.05). The association between sarcopenia and FoF persisted in multivariable analysis adjusted for MNA scores, cerebrovascular events, falls history, BADL, and IADL (OR=2.67, 95% CI: 1.50-4.50), but there was no significant association between malnutrition/micronutrient deficiencies and FoF (p>0.05). CONCLUSION: Sarcopenia is associated with the severity of FoF, but malnutrition or micronutrient deficiencies are not associated with the severity of FoF in older patients with dementia. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Several factors influence the quality of life (QoL) of older adults, particularly those on hemodialysis. Fear of falling and its resulting limitations are significant contributors. This study investigated the association between fear of falling and QoL in older hemodialysis patients in Tehran hospitals. Methods: A descriptive-correlational design was used with 197 older hemodialysis patients in Tehran hospitals (2021) recruited through convenience sampling. Data were collected using a demographic questionnaire, the Falls Efficacy Scale-International, and the Leiden International Psychogeriatric Assessment of Life Functions scale to assess QoL. Spearman's rank correlation was performed using SPSS-21 software. Results: The mean QoL score (54.68 ± 16.09) indicated a moderate level. The mean fear of falling score (35.29 ± 13.54) reflected a high level. A significant negative correlation (R = -0.63, p = 0.001) was found between fear of falling and QoL. Conclusion: Our findings suggest that increased fear of falling is associated with a decrease in QoL among older hemodialysis patients. Further research is warranted to explore interventions aimed at managing fear of falling, preventing falls, and ultimately improving QoL in this population. [ABSTRACT FROM AUTHOR]

Falls are well documented has being a major cause of accidental injury and deaths worldwide, especially among the elderly, with a higher probability of occurrence in the population over 60 years of age (WHO, 2021). Falls are preventable, but the consequences of falls can lead to injuries and may result in loss of independence. Decreased overall motor skills of the elderly, such as muscle strength, power, flexibility, agility, and endurance, cause walking difficulty (Spirduzo, Francis, Eakin & Stanford, 2005; Jeon M-Y, Choe M, 2002; Salzman, 2010), nevertheless, physical activity and exercise can contribute to maintaining quality of life, health, physical function and reducing falls among older people (Gillespie et al., 2012; Tricco, et al., 2017). Thus, the present study aims to analyze the association between fear of falling, eye-segmental coordination and dynamic balance in participants in a physical exercise program for the elderly. Sample consisted of 103 individuals (22 men and 81 woman) with a mean age of 71.3 (±5.9) years, participants of a gerontomotricity municipal program from 5 different locations, in the central region of Portugal. Wall Drop Punt Kick and Catch test was used to assess eye-segmental coordination, Foot Up and Go test to assess dynamic balance, and the Falls Efficacy Scale International questionnaire to assess the fear of falling. Results confirms that higher levels of eye-segmental coordination are correlated both with dynamic balance and the fear of falling (r = - 0.39, p < 0.001 & r = - 0.28, p < 0.01, respectively) and also, that dynamic balance correlates with the fear of falling (r = 0.46, p < 0.001). Interesting to note that age was not correlated with any of these 3 variables, despite its amplitude ranging from 57 to 85 years old. Differences between sex were only observed for eye-segmental coordination (men = 9.36, women = 4.61; p < 0.001). The years of participation in this program ranged from 0.1 a 17.5, but it showed no correlation with any studied variable (p > 0.05). With this study we could confirm that higher levels of fear of falling in the older population is related to lower levels of eye-segmental coordination and lower levels of dynamic balance, emphasizing the need to maintain or adopt active lifestyles that promote the development, or at least, avoid the decrease of human motor skills performance.

Introduction: Fall Risk Appraisal (FRA), a process that integrates perceived and objective fall risk measures, serves as a crucial component for understanding the incongruence between fear of falling (FOF) and physiological fall risk in older adults. Despite its importance, scant research has been undertaken to investigate how habitual physical activity (PA) levels, quantified in Monitor-Independent Movement Summary (MIMS), vary across FRA categories. MIMS is a device-independent acceleration summary metric that helps standardize data analysis across studies by accounting for discrepancies in raw data among research-grade and consumer devices.Objective: This cross-sectional study explores the associations between MIMS (volume and intensity) and FRA in a sample of older adults in the United States.Methods: We assessed FOF (Short Falls Efficacy Scale-International), physiological fall risk (balance: BTrackS Balance, leg strength: 30-s sit-to-stand test) and 7-day free-living PA (ActiGraph GT9X) in 178 community-dwelling older adults. PA volume was summarized as average daily MIMS (MIMS/day). PA intensity was calculated as peak 30-min MIMS (average of highest 30 non-consecutive MIMS minutes/day), representing a PA index of higher-intensity epochs. FRA categorized participants into following four groups: Rational (low FOF-low physiological fall risk), Irrational (high FOF-low physiological fall risk), Incongruent (low FOF-high physiological fall risk) and Congruent (high FOF-high physiological fall risk).Results: Compared to rational group, average MIMS/day and peak 30-min MIMS were, respectively, 15.8% (p = .025) and 14.0% (p = .004) lower in irrational group, and 16.6% (p = .013) and 17.5% (p < .001) lower in congruent group. No significant differences were detected between incongruent and rational groups. Multiple regression analyses showed that, after adjusting for age, gender, and BMI (reference: rational), only irrational FRA was significantly associated with lower PA volume (β = −1,452.8 MIMS/day, p = .034); whereas irrational and congruent FRAs were significantly associated with lower “peak PA intensity” (irrational: β = −5.40 MIMS/day, p = .007; congruent: β = −5.43 MIMS/day, p = .004).Conclusion: These findings highlight that FOF is a significant barrier for older adults to participate in high-intensity PA, regardless of their balance and strength. Therefore, PA programs for older adults should develop tailored intervention strategies (cognitive reframing, balance and strength exercises, or both) based on an individual’s FOF and physiological fall risk.

Background and purpose: Pedestrians are the most vulnerable people in the traffic system, and every year, thousands of pedestrians are injured or killed due to traffic accidents. The behavior of pedestrians is one of the human factors involved in traffic accidents. In the meantime, the damage is more in the age groups of 60 years and older. Therefore, the present study was conducted to determine the relationship between fear of falling and functional status with the traffic behavior of older pedestrians in Sari City. Materials and methods: The present study is a descriptive-analytical cross-sectional study conducted in Sari City in 2022-2023. The research population included all the older adults aged 60 years and above receiving care in the health centers of Sari City. Considering the inclusion and exclusion criteria and using multistage random sampling, 630 people were determined as the sample size. In order to collect information, a demographic characteristics questionnaire, Womac functional status questionnaire, fear of falling (FES), and traffic behavior were used. The data was analyzed using SPSS-22 statistical software. The significance level of the tests was considered to be 0.05. Results: The average age of the older participants was 67.34±7.61 years. 53.2% of the participants were male, and 71.4% were married. The mean and standard deviation of functional state scores, fear of falling, and traffic behavior were 56.65±17.62, 30.69±12.56, and 106.06±12.01, respectively. Correlation results showed that functional status has a significant inverse correlation with fear of falling (P

Abstract Background With reduced balance and mobility, older patients with stroke are more susceptible to fear of falling (FOF). A maladaptive form of FOF can cause excessive activity restriction, poor balance, and recurrent falls, forming a self-reinforcing vicious cycle. This study applied and adapted the FOF model to investigate the interaction between FOF and fall risk in older stroke patients. Methods A cross-sectional study was conducted among 302 older stroke patients aged 60 and over. All participants were invited to complete the FOF, fall risk, physical activity, and balance tests, which were measured by the Falls Efficacy Scale International (FES-I), Self-Rated Fall Risk Questionnaire (FRQ), the long-form International Physical Activity Questionnaire (IPAQ-LF) and the Four-Stage Balance Test (FSBT) respectively. Data were analyzed using structural equation modeling. Results The mean age of the respondents was 68.62 ± 7.62 years; 8.94% reported a high level of FOF, and 18.21% reported a moderate level of FOF. The structural equation model showed that FOF was directly associated with fall risk (β=-0.38, p

Abstract Background Fear of falling is a persistent concern about falls that commonly occur in older adults. Recently, it has been argued that fear of falling doesn’t simply mean a state of low falls efficacy, but is a concept distinct from falls efficacy. However, the two concepts are still indistinguishable. Therefore, it is necessary to understand the unique characteristics of the fear of falling. This study aims to analyze the concept of ‘fear of falling’ faced by older adults. Methods This study is designed as a concept analysis. A concept analysis was conducted by Walker & Avant’s eight-step concept analysis method. A total of 16 pieces of literature were selected by inclusion and exclusion criteria from those published in Pubmed and Scopus between 1993 and 2022 on 8 November 2022. Results Two antecedents, four attributes, and five consequences were identified. Apprehension caused by the unpredictable nature of falls, unease related to one’s vulnerability, high vigilance-related to the environment, and concern about potential harm after fall events were presented as attributes of fear of falling in older adults. There were two antecedents of fear of falling which were awareness of falls and near falls, and direct/indirect experience about falls and near falls. As consequences of fear of falling, protective effect, activities curtailment, reduction in radius of living, restricted freedom, and limited social activities were reported. Conclusion It was confirmed that falls and the fear-inducing process were fused to constitute the unique characteristics of the fear of falling. This can be presented as an important basis for future research on the fear of falling or dealing with various aspects of the fear of falling in the clinical field.

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

Abstract Background Fear of falling is associated with numerous negative health outcomes in older adults and can limit the rehabilitation process. Hypnosis is now recognized as an effective treatment for a variety of conditions, especially anxiety and pain, which can be integrated safely with conventional medicine. The objective of this study was to assess the feasibility and acceptability of a hypnosis intervention in hospitalized older adults to reduce fear of falling. Methods In this feasibility randomized controlled trial, 32 older patients, hospitalized in geriatric rehabilitation wards, were randomly allocated (1:1 ratio) to either an intervention group (hypnosis, 2 sessions, one per week, plus usual rehabilitation program) or a control group (usual rehabilitation program only). Clinical assessors and statistician were blinded to group allocation. Primary outcomes were recruitment rate, retention rate, and adherence to the intervention. Exploratory outcomes, analyzed according to the intention-to-treat principle, included impact of hypnosis on fear of falling (assessed by a new scale perform-FES), functional status, in-hospital falls, and length of hospital stay. Results Recruitment rate was 1.3 patients per week. The recruitment of the population sample was achieved in 5.5 months. The retention rate did not differ significantly between groups and a good adherence to the hypnosis intervention was achieved (77% of patients received the full intervention). No adverse event related to the hypnosis intervention was observed. Regarding exploratory clinical outcomes, no differences were found between groups on any outcome. Conclusion Hypnosis is feasible and well accepted in a geriatric hospitalized population undergoing rehabilitation. Further pilot work should be conducted, with an increased number of hypnosis sessions, before conducting a full-scale trial to conclude whether, or not, hypnosis is effective to reduce fear of falling. Trial registration NCT04726774.

Abstract 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.

IntroductionNeuromodulation is a non-invasive technique that allows for the modulation of cortical excitability and can produce changes in neuronal plasticity. Its application has recently been associated with the improvement of the motor pattern in older adults individuals with sequelae from neurological conditions.ObjectiveTo highlight the effects of non-invasive neuromodulation on the risk of falls and fear of falling in community-dwelling older adults.MethodsSystematic review conducted in accordance with the items of the Cochrane Handbook for Systematic Reviews of Interventions. Searches were carried out in electronic databases: CENTRAL, Clinical Trials, LILACS, PEDro, PubMed, Web of Science, between 13/06/2020 and 20/09/2023, including all indexed texts without language and publication date restrictions, randomized controlled clinical trials, which presented as their main outcome non-invasive neuromodulation for reducing the fear of falling and risk of falls in the older adults, regardless of gender.ResultsAn extensive search identified 9 eligible studies for qualitative synthesis from 8,168 potential articles. Rigorous filtering through automated tools, title/abstract screening, and full-text evaluation ensured a focused and relevant selection for further analysis. Most studies (80%) used transcranial direct current electrical stimulation as an intervention, over the motor cortex or cerebellum area, with anodal current and monopolar electrode placement. The intensity ranged from 1.2 mA to 2 mA, with a duration of 20 min (80%). The profile of the research participants was predominantly individuals over 65 years old (80%), with a high risk of falls (60%) and a minority reporting a fear of falling (40%). The outcomes were favorable for the use of neuromodulation for the risk of falls in the older adults, through improvements in static and dynamic balance.ConclusionThe results may have limited applicability to direct outcomes related to the risk of falls, in addition to evidence regarding the difference or lack thereof in applicability between genders, fallers and non-fallers, as well as older adults individuals with low and high fear of falling.Systematic review registrationThe protocol for this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) to obtain the identification of ongoing research (ID: 222429).

Abstract Background and Aims Personality traits, such as neuroticism and extraversion, are emerging as important predictors of falls. Despite their significance, existing fall prevention programs often overlook these traits, creating a notable research gap. This study aims to conduct a comprehensive scoping review to explore the existing literature on the relationships among personality traits, falls, and fall‐related psychological concerns (FrPCs). Methods This scoping review will adhere to the framework established by Arksey and O'Malley, incorporating extensions recommended by the Joanna Briggs Institute and using the PRISMA‐ScR checklist. A thorough search strategy will be employed, aligning with the population, concept, and context (PCC) selection criteria. Electronic databases, including MEDLINE, APA PsycINFO, Web of Science, CINAHL, and SPORTDiscus, will be searched from their inception to the present. Additionally, a manual search of the reference lists of identified and relevant full‐text articles will be conducted. Two independent reviewers will screen titles and abstracts, perform full‐text reviews, and extract data from pertinent articles. Discussion Personality traits are increasingly recognized as influential predictors of falls and related psychological concerns. This review aims to make a substantial contribution to the existing literature by being the first to comprehensively explore and provide a descriptive synthesis of the relationship between personality traits and falls, as well as FrPCs in adults. It is hoped that the outcomes of this review will enhance our comprehension of the role of personality traits in falls, potentially informing future research and strategies for this critical area of study. Scoping Review Registration This scoping review protocol was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/KR74X).

Background: Fall is a common health problem among elder and can have many physical and psychological consequences, including injuries, mobility problem, hospitalization, institutionalization, fear of falling again and even death. Objective: The aim of present study was to assess the frequency of fall, fear of fall and its related factors among Iranian elders by systematic review and meta-analysis. Methods: The data was gathered from the literature published in Scopus, Magiran, SID, PubMed, Google Scholar, Google, and Web of Science. The search strategy was done using the following combined text and MeSH terms included “elderly fall”, “accidental fall”, “prevalence of fall”, “fear of fall”, and “risk factor for fall”. Persian equivalents of these keywords were also searched in Iranian databases. The time span included articles published within 2007–2017. The data was analyzed using STATA (version 14) software and meta-regression. Results: The mean number of fall events among elders was 1.9 (95 % CI: 1.15–2.64, P = 0.072) within the past year. The fall rate was obtained 32 % (95 % CI: 0.30–0.34, P

PurposeIndividuals with multiple sclerosis (MS) experience fear of falling (FOF), which is associated with negative health and quality-of-life consequences. Prior research has used FOF and concern about falling (CAF) interchangeably, but persons with MS report that CAF and FOF represent separate constructs that lie on a continuum. Unfortunately, no scale exists to understand the differences between CAF and FOF. Therefore, we developed a novel questionnaire, the Concern and Fear of Falling Evaluation (CAFFE), in which respondents rank their CAF and FOF on a continuum across various activities. This study aims to describe the scale development process and examine its psychometric properties.MethodsIn a single online survey, MS participants responded to demographic questionnaires, indicated whether they experience CAF and FOF, and completed the CAFFE. Psychometric evaluation of the CAFFE involved internal consistency, split-half cross validation, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).ResultsOut of 1,025 respondents, 64.6% reported CAF and 47.2% reported FOF. The EFA yielded a two-factor solution encompassing activities in open (factor 1) and closed environments (factor 2). The CFA replicated this two-factor solution and the CAFFE demonstrated excellent internal consistency (α = 0.98).ConclusionThe 27-item CAFFE is a highly reliable and valid measure capturing the tipping point at which point CAF moves to FOF. Future research should seek to define the tipping point from the MS community, as CAF may be an adaptive mechanism, whereas FOF may be a maladaptive behavior.

Background and purpose: Pedestrians are the most vulnerable people in the traffic system, and every year, thousands of pedestrians are injured or killed due to traffic accidents. The behavior of pedestrians is one of the human factors involved in traffic accidents. In the meantime, the damage is more in the age groups of 60 years and older. Therefore, the present study was conducted to determine the relationship between fear of falling and functional status with the traffic behavior of older pedestrians in Sari City. Materials and methods: The present study is a descriptive-analytical cross-sectional study conducted in Sari City in 2022-2023. The research population included all the older adults aged 60 years and above receiving care in the health centers of Sari City. Considering the inclusion and exclusion criteria and using multistage random sampling, 630 people were determined as the sample size. In order to collect information, a demographic characteristics questionnaire, Womac functional status questionnaire, fear of falling (FES), and traffic behavior were used. The data was analyzed using SPSS-22 statistical software. The significance level of the tests was considered to be 0.05. Results: The average age of the older participants was 67.34±7.61 years. 53.2% of the participants were male, and 71.4% were married. The mean and standard deviation of functional state scores, fear of falling, and traffic behavior were 56.65±17.62, 30.69±12.56, and 106.06±12.01, respectively. Correlation results showed that functional status has a significant inverse correlation with fear of falling (P<0.001 and r=-0.22) and a positive significant correlation with traffic behavior (P<0.001 and r=0.32). No significant relationship was observed between fear of falling and traffic behavior. Gender, marital status, duration of walking, means of transportation, and age had a significant relationship with fear of falling and functional status (P<0.001). Walking time was significantly related to traffic behavior (P<0.001). Conclusion: According to the results of the study, the fear of falling and the physical condition of the older have an effect on their traffic behavior, which may increase the number of accidents in this group, so it is important to pay attention to this issue among drivers. [ABSTRACT FROM AUTHOR]