Fear of Falling and Disability Trajectories in Older Women

University Of Minnesota, Minneapolis MN

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Abstract

[unreadable] DESCRIPTION (provided by applicant): Older adults have rated their greatest fear to be that of falling. This fear is understandable as falling is the leading cause of injurious death, and a major contributor to severe injury, and institutionalization for older adults. An exaggerated concern about falling can result in an unhealthy fear of falling (FOF), even among older adults who have not fallen. This fear manifests as excessive activity restrictions leading to physical deconditioning and subsequent disability. Current understanding about how FOF develops is limited by use of cross-sectional and longitudinal designs involving two data collection periods. As a result, little is known about how FOF changes over time, what predicts these changes (i.e., falling), and how these changes vary among individuals. Additionally, it is unclear if FOF results in greater levels of disability. The long-term objective of this research is to identify how fear of falling develops and to determine its role in the disablement process, so health care providers can develop strategies designed to meet the National Institute of Nursing Research's goal of preventing or delaying the development of disability in older women. The goals of the proposed research are to describe the trajectory of FOF, identify personal characteristics influencing this trajectory and determine its relationship with disability trajectories. The Disablement Process Model which conceptualizes disability as a process resulting from the interaction of pathology, impairments, functional limitations and disability provides the theoretical framework to guide hypothesis testing using growth curve modeling. The proposed study will be a secondary analysis of data collected over 2-years during an NINR/NIH funded randomized, single-blinded controlled trial titled "A Fall Prevention Program for High Risk Elderly Women (FEPP)" (R01 NR5107, PI: Jean F. Wyman). FEPP enrolled 272 cognitively intact, non-exercising community-dwelling older women at high risk for falls. Participants were randomly assigned to a fall prevention (treatment) group or health education (control) group. Participants in the fall prevention group were asked to walk 30 minutes daily, five days a week and to perform balance and strength exercises twice weekly, and received personalized fall risk reduction recommendations from a registered nurse. Endpoints were at baseline, 12-weeks, 1- and 2-years post intervention. The knowledge gained from this study has implications for achieving Healthy People 2010 objectives targeting the reduction of fall related injuries and preventing or delaying the development of disabilities in high risk older women. [unreadable] [unreadable] [unreadable]