Fear of Falling Linked to Future Falls in Elderly

Fran Lowry

August 20, 2010

August 20, 2010 — Seniors who have an irrationally high fear of falling are at increased risk for future falls, irrespective of their actual physiological risk, according to a new study published online today by the British Medical Journal.

"Both falls and fear of falls can substantially reduce quality of life and independence and so contribute to the placement of an elderly person into institutionalized care," write Kim Delbaere, PhD, from the University of New South Wales, Sydney, Australia, and colleagues. "However, the complex nature of psychological risk factors for falling and the limited background information on this phenomenon hamper its inclusion in falls prevention programmes."

Excessive fear of falling can cause seniors to limit their participation in physical and social activities, so that they become physically deconditioned, socially isolated, and depressed. In contrast, an inappropriately low fear of falling can cause seniors to take risks that are beyond their true ability to cope, the authors write.

The aim of this study was to expand understanding about irrational fear — either too much or too little — and to study its effect on the risk for future falls.

The study included 500 seniors aged 70 to 90 years living in Sydney. Their mean age was 77.9 years, and 54% were women. All underwent extensive medical, physiological, and neuropsychological assessment.

The investigators used the Physiological Profile Assessment (PPA) to determine participants' physiological (actual) fall risk and the Falls Efficacy Scale International to determine their perceived risk of falling. Participants were followed up monthly for falls for 1 year.

The researchers found that actual and perceived fall risk were both independent predictors of future falls. The risk for falls significantly increased with a higher PPA score (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.06 - 1.61; P = .011) and a higher Falls Efficacy Scale International score (OR, 1.05; 95% CI, 1.02 - 1.08; P = .001).

The researchers then split the study participants into 4 groups — vigorous, anxious, stoic, and aware — according to the disparity between their actual and perceived risk.

Most of the participants had an accurate perception of their risk of falling. Those in the vigorous group, who had low actual and perceived fall risk, were considered at low risk for future significant falls, and those in the aware group, who had high actual and perceived fall risk, were deemed to be at high risk for future significant falls.

However, about a third of the study cohort either underestimated or overestimated their risk for falls.

The anxious group had a low actual risk but high perceived risk; this was related to depressive symptoms (P = .029), neurotic personality traits (P =.026), and decreased executive functioning (P = .010).

In contrast, the stoic group had a high actual but low perceived fall risk, which was protective against falling and was related through a positive outlook on life (P = .001) and continuation of physical activity and community participation (P = .048).

"Overall, it seems that high levels of perceived fall risk may lead to future falls, independent of physiological risk, and that the disparity between physiological and perceived fall risk contributes to fall risk mainly through psychological pathways," the study authors write. "This indicates that measures of both physiological and perceived fall risk should be included in fall risk assessments."

Limitations of the study include the use of the PPA, which is an estimate and may result in measurement error, and the fact that the data used to develop the psychological profiles of the participants were self-reported, the authors note. Also, the population studied were healthy community-dwelling elders; results, therefore, cannot be generalized to those with cognitive impairment or others at particularly high risk of falling such as patients with Parkinson’s disease.

They conclude that fall risk assessments should include measures of both actual and perceived risk, and that this may assist in designing specific interventions to prevent falls in the elderly.

The study was supported by the Australian National Health and Medical Research Council.

BMJ. Published online August 20, 2010.