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Both psychological factors and physical performance are associated with fall-related concerns
Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.ORCID-id: 0000-0002-2510-7571
Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.ORCID-id: 0000-0002-9813-2719
Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.ORCID-id: 0000-0003-3901-0364
Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.ORCID-id: 0000-0002-1682-8326
2018 (Engelska)Ingår i: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 30, nr 9, s. 1079-1085Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background Fall-related concern strongly correlates to activity avoidance in older people.  In this complex phenomenon, different terminology and instruments are often used interchangeably. Three main concepts make up fall-related concerns: fear-of-falling, consequence concern, and falls self-efficacy. It is suggested that fall-related concerns are mediated by psychological and physical factors.

Aims Our aims were to describe the prevalence of fall-related concerns and find explanatory factors for its most studied concept – falls self-efficacy – in an older population.

Methods We executed a cross sectional study on a random sample of 153 community dwelling older people (70 years or older). We used validated and reliable instruments as well as structured interviews to gather data on the three concepts of fall-related concerns and possible mediating factors. We then calculated descriptive statistics on prevalence and regression models for the total group, and men and women separately.

Results 70% of the total sample (80% of women and 53% of men) reported at least one of the three concepts of fall-related concern. For the total sample, fear-of-falling, morale and physical performance were associated factors with falls self-efficacy. For women, number of prescription medications was added. For men, physical performance and concerns for injury were associated.

Conclusion Fall-related concern is prevalent in large proportions with higher prevalence for women than for men. Important factors are fear of falling, morale, and physical performance. Gender differences in the emergence and variance of fall-related concern and the relation between physical performance and fall-related concern should be targeted in future research endeavors. 

Ort, förlag, år, upplaga, sidor
Springer, 2018. Vol. 30, nr 9, s. 1079-1085
Nyckelord [en]
aged, fall-related concerns, morale, ambulation, self-efficacy
Nationell ämneskategori
Sjukgymnastik
Forskningsämne
Fysioterapi
Identifikatorer
URN: urn:nbn:se:ltu:diva-67031DOI: 10.1007/s40520-017-0882-9ISI: 000441365800008PubMedID: 29264814Scopus ID: 2-s2.0-85038615621OAI: oai:DiVA.org:ltu-67031DiVA, id: diva2:1166612
Projekt
BAHRT
Anmärkning

Validerad;2018;Nivå 2;2018-08-17 (andbra)

Tillgänglig från: 2017-12-15 Skapad: 2017-12-15 Senast uppdaterad: 2023-09-05Bibliografiskt granskad
Ingår i avhandling
1. Losing control and developing concerns: The complexities of ageing postural control and fall-related concerns
Öppna denna publikation i ny flik eller fönster >>Losing control and developing concerns: The complexities of ageing postural control and fall-related concerns
2021 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Att tappa kontrollen och utveckla oro : Komplexiteterna av åldrande postural kontroll och fall-relaterad oro
Abstract [en]

With the world population shifting its proportions towards higher ages, it is imperative to increase healthspan rather than lifespan, both for the sakes of community sustainability as well as individual quality of life. One of the main means to obtain healthy ageing, is a concept called active ageing, as activity has shown to slow down the natural ageing process. 

Active ageing is threatened by a decline in balance performance and an increase of fall-related concerns, as activity curtailment is a major consequence. Fall-related concerns are prevalent in a large portion of the older population. Current understanding of its mechanisms is largely hypothesised, based on few observational studies in which single factors – mostly psychological – are researched. Postural control is the system that helps us maintain balance and control while moving or being still. Yet, the interactions between fall-related concerns and postural control are not very well described. Sensory input and processing have been identified as possibly an important part, but more in-depth investigations are needed.

To investigate the prevalence and factors that may play a part in fall-related concerns, 153 older adults (70 years and over) were visited in their home. During these visits questionnaires and clinical tests were administered (among them FES-I, PGCM, SPPB, MMSE). To investigate the relationship between fall-related concerns and postural control more thoroughly, 45 of the original sample were also tested in the movement laboratory. Several modalities of sensory function were recorded, as well as lower limb strength and quiet stance centre of pressure. 

The home visits showed that 70% of people 70 years and older, living in the community experience at least one of the constructs of fall-related concerns and that associated factors are of both psychological and physical nature (fear, morale, and physical performance). Large and significant differences between men and women were discovered not only in prevalence, but also for the associated factors. Hierarchical multivariate modelling of the laboratory data showed that an increase in sway size and velocity during open eyes quiet stance can explain a rise in fall-related concerns and that that relationship in turn can be explained by declines in specific parts of the postural control system (lower limb strength, reaction time, vision, and proprioception of the ankle, knee, and neck). The more in-depth methods of frequency domain and multivariate discriminant analysis revealed that older participants could be grouped in ‘declined and concerned’ and ‘not declined and not concerned.’ The first showing power in lower frequencies of the postural sway signal than the latter and showing an inability to adjust control strategy when closing their eyes. Finally, the changing and adapting postural control of older people was successfully modelled by applying dimension reduction, neural networks, and an internal feedback of 150ms. The model can predict postural corrections up to 1 second ahead of time. This gave more insight in key features of successful adaptation to an ageing system and provides a virtual environment for future model and theory testing. 

In conclusion, I have gained more understanding of the complexity and interaction of the different systems involved in the concern-and-balance relationship and have contributed to the field by showing methods that will improve the quality of analyses when testing, evaluating, and researching these phenomena. 

Ort, förlag, år, upplaga, sidor
Luleå University of Technology, 2021
Serie
Doctoral thesis / Luleå University of Technology 1 jan 1997 → …, ISSN 1402-1544
Nyckelord
ageing, postural balance, postural control, sensory and motor systems, fall-related concerns, fear of falling, neurological models
Nationell ämneskategori
Sjukgymnastik
Forskningsämne
Fysioterapi
Identifikatorer
urn:nbn:se:ltu:diva-83195 (URN)978-91-7790-775-6 (ISBN)978-91-7790-776-3 (ISBN)
Disputation
2021-05-20, E632 / Zoom, Luleå, 09:00 (Engelska)
Opponent
Handledare
Projekt
BAHRT
Forskningsfinansiär
Vetenskapsrådet, K2015-99X-22756-01-4
Tillgänglig från: 2021-03-08 Skapad: 2021-03-08 Senast uppdaterad: 2023-09-05Bibliografiskt granskad

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Pauelsen, MaschaNyberg, LarsRöijezon, UlrikVikman, Irene
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