Advertisement

Impact of Fear of Falling in Long Term Care: An Integrative Review

      Abstract

      Long term care elders with fear of falling may restrict their activity resulting in declines in function and excess disability. To further explore this problem, a review of the literature was conducted. The search yielded 26 studies on the epidemiology of fear of falling in nursing homes and assisted living as well as intervention studies in these settings. Fear of falling is common, affecting more than 50% of long term care elders and is associated with negative outcomes, including falls, functional impairments, depression, and poor quality of life. Longitudinal studies are rare. There were few intervention studies, with most testing exercise programs, including balance training, such as t’ai chi, and little research testing other approaches. Few conclusions can be drawn about interventions, as most sample sizes were small and the interventions and measurement varied widely. Additional research is needed to identify long term care residents most in need of intervention, and the best ways to reduce fear of falling and its consequences.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tinetti M.E.
        • Powell L.
        Fear of falling and low self-efficacy: A case of dependence in elderly persons.
        J Gerontol. 1993; 48: 35-38
        • Lach H.W.
        Incidence and risk factors for developing fear of falling in older adults.
        Public Health Nurs. 2005; 22: 45-52
        • Delbaere K.
        • Crombez G.
        • Vanderstraeten G.
        • et al.
        Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study.
        Age Ageing. 2004; 33: 368-373
        • Deshpande N.
        • Metter E.J.
        • Laurentani F.
        • et al.
        Activity restriction induced by fear of falling and objective and subjective measures of physical function: A prospective cohort study.
        J Am Geriatr Soc. 2008; 56: 615-620
        • Zijlstra G.A.
        • van Haastregt J.C.
        • van Eijk J.T.
        • et al.
        Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people.
        Age Ageing. 2007; 36: 304-309
        • Chang S.
        Beliefs about self-care among nursing home staff and residents in Taiwan.
        Geriatr Nurs. 2009; 30: 90-98
        • Fitzgerald T.G.
        • Hadjistavropoulos T.
        • MacNab Y.C.
        Caregiver fear of falling and functional ability among seniors residing in long-term care facilities.
        Gerontology. 2009; 55: 460-467
        • Stathi A.
        • Simey P.
        Quality of life in the fourth age: Exercise experiences of nursing home residents.
        J Aging Phys Act. 2007; 15: 272-286
        • Chen K.M.
        • Hsu Y.C.
        • Chen W.T.
        • et al.
        Well-being of institutionalized elders after Yang-style Tai Chi practice.
        J Clin Nurs. 2007; 16: 845-852
        • Franzoni S.
        • Rozzini R.
        • Boffelli S.
        • et al.
        Fear of falling in nursing home patients.
        Gerontology. 1994; 40: 38-44
        • Gillespie S.M.
        • Friedman S.M.
        Fear of falling in new long-term care enrollees.
        J Am Med Dir Assoc. 2007; 8: 307-313
        • Nowalk M.P.
        • Prendergast J.M.
        • Bayles C.M.
        • et al.
        A randomized trial of exercise programs among older individuals living in two long-term care facilities: The FallsFree program.
        J Am Geriatr Soc. 2001; 49: 859-865
        • Resnick B.
        Functional performance of older adults in a nursing home setting.
        Clin Nurs Res. 1998; 7: 230-246
        • Schoenfelder D.P.
        A fall prevention program for elderly individuals: Exercise in long-term care settings.
        J Gerontol Nurs. 2000; 26: 43-51
        • Schoenfelder D.P.
        • Rubenstein L.M.
        An exercise program to improve fall-related outcomes in elderly nursing home residents.
        Appl Nurs Res. 2004; 17: 21-31
        • Sharaf A.Y.
        • Ibrahim H.S.
        Physical and psychosocial correlates of fear of falling: Among older adults in assisted living facilities.
        J Gerontol Nurs. 2008; 34: 27-35
        • Donat H.
        • Ozcan A.
        Comparison of the effectiveness of two programmes on older adults at risk of falling: Unsupervised home exercise and supervised home exercise.
        Clin Rehabil. 2007; 21: 273-283
        • Warnke A.
        • Meyer G.
        • Bender R.
        • Muhlhauser I.
        Predictors of adherance to the use of hip protectors in nursing home residents.
        J Am Geriatr Soc. 2004; 52: 340-345
        • Southard V.
        A randomized control trial of the application of efficacy training to balance assessment.
        Phys Occup Ther Geriatr. 2006; 25: 51-66
        • Blanchard R.A.
        • Myers A.M.
        • Pearce N.J.
        Reliability, construct validity, and clinical feasibility of the Activities-Specific Fall Caution Scale for residential living seniors.
        Arch Phys Med Rehabil. 2007; 88: 732-739
        • Chou K.L.
        • Yeung F.K.
        • Wong E.C.
        Fear of falling and depressive symptoms in Chinese elderly in nursing homes: Fall efficacy and activity level as mediator or moderator?.
        Aging Ment Health. 2005; 9: 255-261
        • Yeung F.K.
        • Chou K.L.
        • Wong E.C.
        Characteristics associated with fear of falling in Hong Kong Chinese elderly residing in care and attention homes.
        Clin Gerontol. 2006; 29: 83-98
        • Tinetti M.E.
        • Richman D.
        • Powell L.
        Falls efficacy as a measure of fear of falling.
        J Gerontol B Psychol Sci Soc Sci. 1990; 45: P239-P243
        • Gusi N.
        • Adsuar J.C.
        • Corzo H.
        • et al.
        Balance training reduces fear of falling and improves dynamic balance and isometric strength in institutionalized older people: A randomized trial.
        J Physiotherapy. 2012; 58: 97-104
        • Kato C.
        • Ida K.
        • Kawamura M.
        • et al.
        Relation of falls efficacy scale (FES) to quality of life among nursing home female residents with comparatively intact cognitive function.
        Nagoya J Med Sci. 2008; 70: 19-27
        • Lach H.W.
        • Ball L.J.
        • Birge S.J.
        The Nursing Home Falls Self-Efficacy scale: Development and testing.
        Clin Nurs Res. 2012; 21: 79-91
        • Resnick B.
        A prediction model of aerobic exercise in older adults living in a continuing-care retirement community.
        J Aging Health. 2001; 13: 287-310
        • Resnick B.
        • Galik E.
        • Gruber-Baldini A.L.
        • Zimmerman S.
        Satisfaction with assisted living: The unexplored role of physical activity.
        Geriatr Nurs. 2010; 31: 197-205
        • Resnick B.
        • D’Amado C.
        Factors associated with exercise among older adults in a continuing care retirement community.
        Rehab Nurs. 2011; 36: 47-53
        • Ozcan A.
        • Donat H.
        • Gelecek N.
        • et al.
        The relationship between risk factors for falling and the quality of life in older adults.
        BMC Public Health. 2005; 5: 90
        • Brill P.A.
        • Matthews M.
        • Mason J.
        • et al.
        Improving functional performance through a group-based free weight strength training program in residents in two assisted living facilities.
        Phys Occup Ther Geriatr. 1998; 15: 57-69
        • Resnick B.
        • Galik E.
        • Gruber-Baldini A.L.
        • et al.
        Implementing a restorative care philosophy of care in assisted living: Pilot testing of Res-Care-AL.
        J Am Acad Nurse Pract. 2009; 21: 123-133
        • Gentleman B.
        • Malozemoff W.
        Falls and feelings: Description of a psychosocial group nursing intervention.
        J Gerontol Nurs. 2001; 27: 35-39
        • Cumming R.G.
        • Salkeld G.
        • Thomas M.
        • et al.
        Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission.
        J Gerontol Med Sci. 2000; 55: M299-M305
        • Friedman S.M.
        • Williamson J.D.
        • Lee B.H.
        • et al.
        Increased fall rates in nursing home residents after relocation to a new facility.
        J Am Geriatr Soc. 1995; 43: 1237-1242
        • Friedman S.M.
        • Munoz B.
        • West S.K.
        • et al.
        Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention.
        J Am Geriatr Soc. 2002; 50: 1329-1335
        • Fakouri C.
        • Lyon B.
        Perceived health and life satisfaction among older adults: The effects of worry and personal variables.
        J Gerontol Nurs. 2005; 31: 17-24
        • Kulmala J.
        • Vilnanen A.
        • Sipila S.
        • et al.
        Poor vision accompanied with other sensory impairments as a predictor of falls in older women.
        Age Ageing. 2009; 38: 162-167
        • Jorstad E.C.
        • Hauer K.
        • Becker C.
        • et al.
        Measuring the psychological outcomes of falling: A systematic review.
        J Am Geriatr Soc. 2005; 53: 501-510
        • Harada N.
        • Chiu V.
        • Damron-Rodriguez J.
        • et al.
        Screening for balance and mobility impairment in elderly individuals living in residential care facilities.
        Phys Ther. 1995; 75: 462-469
        • Tennstedt S.
        • Howland J.
        • Lachman M.
        • et al.
        A randomized controlled trial of an intervention to reduce fear of falling and associated activity restriction in older adults.
        J Gerontol B Psychol Sci Soc Sci. 1998; 53: P384-P392
        • Zijlstra G.A.
        • van Haagstregt J.C.
        • Ambergen T.
        • et al.
        Effects of a multicomponent cognitive behavioral intervention on fear of falling and activity avoidance in community-dwelling older adults: Results of a randomized controlled trial.
        J Am Geriatr Soc. 2009; 57: 2020-2028
        • Zijlstra G.A.
        • van Haastregt J.C.
        • van Rossum E.
        • et al.
        Interventions to reduce fear of falling in community-living older people: A systematic review.
        J Am Geriatr Soc. 2007; 55: 603-615
        • Osnes E.K.
        • Lofthus C.M.
        • Meyer H.E.
        • et al.
        Consequences of hip fracture on activities of daily life and residential needs.
        Osteoporos Int. 2004; 15: 567-574