Psychological Factors Associated With Fear of Falling & Fear of Falling Avoidance Behavior in Older Adults

PURPOSE: Falls are a significant cause of fatal and non-fatal injuries among older adults (Moreland et al., 2020). Fear of falling (FOF) and fear of falling avoidance behavior (FFAB) have been associated with fall risk and may play an important role in fall prevention (Gazibara et al., 2017). Psychological factors, such as depression and anxiety, have been associated with FOF and FFAB and may serve as targets for preventing or treating FOF and FFAB (Painter et al., 2012). However, further research is needed across national samples to understand better the relationship between depression and anxiety with FOF and FFAB. The primary objective of this study was to examine psychological factors associated with FOF and FFAB among older adults. We also aimed to examine the characteristics of older adults reporting FOF and FFAB and the relationship with fall history.

DESIGN: A retrospective cross-sectional design using public-use data files from the National Health and Aging Trends Study (NHATS; Wave 9, n = 4,977).

METHOD: Participant responses for perceived overall health condition, worrying about falling (i.e., FOF), limiting activity due to worries about falling (i.e., FFAB), and depression and anxiety using the 4-item Patient Health Questionnaire were retrieved along with demographic variables. Logistic regression models were used to examine the relationship of psychological measures with FOF and FFAB above and beyond perceived overall health conditions. Participant characteristics of those without FOF or FFAB, with FOF only, and those with FFAB were compared using chi-square statistics and post hoc pairwise comparisons. Lastly, logistic regression models were used to determine the relationship of FOF and FFAB above and beyond perceived overall health condition with fall history.

RESULTS: Compared to older adults without FOF or FFAB, those with FOF or FFAB were older, had more falls, experienced more frequent depression and anxiety, and perceived their overall health as poorer (ps <.001). Increased fall history, more frequent depression and anxiety, and poorer perceived overall health were significantly higher among older adults with FFAB than FOF only (ps <.001). Perceived overall health, depression, and anxiety explained a significant amount of variance in FOF (p <.001) and FFAB (p <.001). Additionally, poorer perceived overall health (ORs = 6.32,1.39, 3.08), FOF (ORs = 1.37, 2.18, 1.65), and FFAB (ORs = 2.62, 3.12, 3.21) were associated with increased odds of falls in the last month, year, and recurrent falls, respectively, with FFAB having a stronger association than FOF.

CONCLUSION: This study provides further evidence that depression, anxiety, FOF, and FFAB are prevalent among older adults. Data from this national sample indicate that poorer perceived overall health and increased frequency of depression and anxiety may increase the odds of FOF and FFAB, with higher levels of each associated with avoidance behavior. Additionally, poorer perceived overall health, FOF, and FFAB may increase the odds of falls, with FFAB having a stronger association than FOF, indicating potential treatment targets for occupational therapy practitioners.

IMPACT STATEMENT: From a clinical perspective, the psychological factors associated with FOF, FFAB, and increased falls identified in this study are potentially mitigable. These findings demonstrate that depression, anxiety, FOF, and FFAB are prevalent among older adults and strengthen previous research indicating a significant relationship between these variables, underscoring the importance of occupational therapy practitioners addressing these concerns.

References

Choi, N. G., Gell, N. M., DiNitto, D. M., Marti, C. N., & Kunik, M. E. (2020). Depression and activity-limiting fall worry among older adults: Longitudinal reciprocal relationships. International Psychogeriatrics, 32(4), 495–504. https://doi.org/10.1017/S1041610219000838

Gazibara, T., Kurtagic, I., Kisic-Tepavcevic, D., Nurkovic, S., Kovacevic, N., Gazibara, T., & Pekmezovic, T. (2017). Falls, risk factors and fear of falling among persons older than 65 years of age. Psychogeriatrics, 17(4), 215–223. https://doi.org/10.1111/psyg.12217

Moreland, B., Kakara, R., & Henry, A. (2020). Trends in nonfatal falls and fall-related injuries among adults aged ≥65 Years - United States, 2012-2018. MMWR Morbidity and Mortality Weekly Report, 69(27), 875–881. https://doi.org/10.15585/mmwr.mm6927a5

Painter, J. A., Allison, L., Dhingra, P., Daughtery, J., Cogdill, K., & Trujillo, L. G. (2012). Fear of falling and its relationship with anxiety, depression, and activity engagement among community-dwelling older adults. American Journal of Occupational Therapy, 66(2), 169–176. https://doi.org/10.5014/ajot.2012.002535