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Mon S. Bryant, Diana H. Rintala, Jyh-Gong Hou and Elizabeth J. Protas

Aim:

To investigate the relationships between falls, fear of falling, and activity limitations in individuals with Parkinson’s disease (PD).

Design/methods:

Cross-sectional study of individuals with mild to moderate PD (N = 83). Associations among demographic data, fall frequency, disease severity, motor impairment, ability to perform activities of daily living (ADL), Activities Balance Confidence Scale, Iowa Fatigue Scale, Comorbidity Index, and Physical Activity Scale for Elders were studied.

Results:

Frequent fallers had more ADL limitations than nonfallers (p < .001) and rare fallers (p = .004). Frequent fallers reported a lower percentage of ability to perform ADL than nonfallers (p = .003). Frequent fallers and rare fallers were less physically active than nonfallers (p = .015 and p = .040, respectively). Frequent fallers and rare fallers reported a higher level of fear of falling than nonfallers (p = .031 and p = .009, respectively).

Conclusions:

Falls and fear of falling were associated with more ADL limitations and less physical activity after adjusting for physical impairments.

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Lise Kronborg, Thomas Bandholm, Henrik Palm, Henrik Kehlet and Morten Tange Kristensen

Early mobilization following hip fracture surgery reduces medical complications and mortality, but may increase the risk of falling. The aim was to objectively measure the physical activity (time spent upright) the first week after hip fracture surgery and relate it to functional performance and fear of falling at discharge. The 24-hr upright time was measured for a median of six days using a thigh-worn accelerometer in 37 patients (mean 80 years ± 8.4) and increased from median 13 (IQR 6–31) min to 46 (11–107) min at day 7. More upright time at discharge was associated with less fear of falling (r = –.48, p = .01, n = 27), which also was associated with fast gait speed (r = –.50, p = .02, n = 23) and a faster Timed Up and Go test time (r = .54, p < .01, n = 22), indicating a need for further studies on motivation and limitations for more physical activity following hip fracture surgery.

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Kazuhiro Harada, Hyuntae Park, Sangyoon Lee, Hiroyuki Shimada, Daisuke Yoshida, Yuya Anan and Takao Suzuki

This study examined associations between perceived neighborhood environment and physical activity among frail older adults and whether these associations are moderated by fear of falling. Participants were 238 frail older adults. Daily step counts and duration of moderate-to-vigorous physical activity were measured using an accelerometer. Participants completed the abbreviated Neighborhood Environment Walkability Scale; fear of falling and demographic and health-related factors were measured by a questionnaire. The interaction between crime safety and fear of falling was significantly associated with step count (p = .009) and moderate-to-vigorous physical activity (p = .018) in multiple regression analysis. Stratified according to fear of falling, crime safety was significantly associated with steps (p = .007) and moderate-to-vigorous physical activity (p = .030) in the low fear of falling group. The results suggest that crime safety is associated with physical activity among frail older adults, and this association is moderated by fear of falling.

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Edward McAuley, Shannon L. Mihalko and Karl Rosengren

This study examined relationships among physical activity patterns, self-efficacy, balance, and fear of falling in older adults. Fifty-eight older adults (52-85 years) completed measures of physical activity, self-efficacy, and fear of falling. Subjects then performed the items found in the Berg Balance Scale (Berg, Wood-Dauphinee, Williams, & Maki, 1992). More physically active adults were less fearful of falling, had better balance, and had stronger perceptions of efficacy. Those with better balance were less fearful of falling, and females were more fearful than males. Balance and self-efficacy had significant independent effects on fear, whereas the contribution of history of physical activity was nonsignificant. The findings suggest that behavioral, social cognitive, and biological factors may be important correlates of fear of falling. Further support is provided for the utility of self-efficacy measures in the prediction of fear of falling, although reliance on any one measure to assess this construct may underestimate the role of self-efficacy.

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Dennis W. Klima, Roberta A. Newton, Emily A. Keshner and Adam Davey

Studies examining fear of falling among older adult men remain limited. The objectives of this study were to compare balance confidence in 2 age cohorts of older clergy and identify predictive determinants of balance confidence in a liturgical research initiative. Participants included 131 community-dwelling Roman Catholic priests age 60–97 yr living in religious communities in 10 mid-Atlantic states. Subjects completed the Activities-specific Balance Confidence Scale (ABC), Berg Balance Scale (BBS), timed up-and-go (TUG) test, and 15-item Geriatric Depression Scale (GDS). Younger priests (60–74 yr) demonstrated a significantly higher ABC score than the older cohort (75 and above yr) of priests (89.1 ± 12.6 vs.78.4 ± 13.9, p = .001). Confidence was significantly correlated with BBS (rho = .69, p < .01), TUG (r = –.58, p < .01), and GDS (r = –.39, p < .01) scores. A stepwise-regression model demonstrated that balance ability, mood, assistive-device use, and physical activity predicted 52% of the variance in balance confidence.

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Saija Karinkanta, Ritva Nupponen, Ari Heinonen, Matti Pasanen, Harri Sievänen, Kirsti Uusi-Rasi, Mikael Fogelholm and Pekka Kannus

This randomized, controlled trial evaluated the effects of exercise on health-related quality of life (HRQoL) and fear of falling (FoF) among 149 home-dwelling older women. The 12-mo exercise program was intended to reduce the risk of falls and fractures. HRQoL was assessed by the RAND-36 Survey, and FoF, with a visual analog scale, at baseline, 12 mo, and 24 mo. On all RAND-36 scales, the scores indicated better health and well-being. The exercise had hardly any effect on HRQoL; only the general health score improved slightly compared with controls at 12 mo (p = .019), but this gain was lost at 24 mo. FoF decreased in both groups during the intervention with no between-groups difference at 12 or 24 mo. In conclusion, despite beneficial physiological changes, the exercise intervention showed rather limited effects on HRQoL and FoF among relatively high-functioning older women. This modest result may be partly because of insufficient responsiveness of the assessment instruments used.

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Yanan Zhao, Pak-Kwong Chung and Tomas K. Tong

This study evaluated the effectiveness of the community-based Exercise for Balance Improvement Program (ExBP) in improving dynamic balance (DB) and static balance with compromised sensations and reducing fear of falling (FF) among older nonfallers. Sixty-one participants (70 ± 3 years) at risk for falling were randomly allocated to receive ExBP practice for 16 weeks, Tai Chi (TC), or no treatment (CON) with an 8-week follow-up. The ExBP group exhibited significant improvements in DB (2.18, 95% CI = 1.16–3.19), static balance with compromised vision and somatosensation (ECSS; 0.46, 95% CI = 0.06–0.85), and FF (8.65, 95% CI = 0.52–16.8). After the intervention, the ExBP group showed significantly more improvement than did the CON group in DB, static balance with compromised somatosensation, and ECSS. No significant difference was observed between the ExBP and TC groups. Therefore, the ExBP can be applied as an effective alternative exercise regimen for improving balance and fall efficacy for older nonfallers.

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Angela Papadimitriou and Mark Perry

Fall-related psychological concerns (FRPCs), such as the fear of falling, low confidence in maintaining balance, or reduced belief in the ability to avoid a fall, may affect up to 85% of older people ( Payette, Bélanger, Léveillé, & Grenier, 2016 ). FRPCs may have a significant impact on levels of

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José D. Jiménez-García, Fidel Hita-Contreras, Manuel de la Torre-Cruz, Raquel Fábrega-Cuadros, Agustín Aibar-Almazán, David Cruz-Díaz and Antonio Martínez-Amat

, Palvanen, Järvinen, & Parkkari, 2005 ). From a social point of view, falling generates psychological problems, such as fear of falling, depression, and apprehension about physical activity ( American Geriatrics Society and British Geriatrics Society, 2011 ; World Health Organization, 2015 ). Some of its

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Faith D. Lees, Phillip G. Clark, Claudio R. Nigg and Phillip Newman

Longer life expectancy, rapid population growth, and low exercise-participation rates of adults 65 and older justify the need for better understanding of older adults’ exercise behavior. The objectives of this focus-group study were to determine barriers to the exercise behavior of older adults. Six focus groups, three with exercisers and three with nonexercisers, were conducted at various sites throughout Rhode Island. The majority (n = 57) of the 66 individuals who participated were women, and all stated that they were 65 and older. Results from the focus-group data identified 13 barriers to exercise behavior. The most significant barriers mentioned by nonexercisers were fear of falling, inertia, and negative affect. Exercisers identified inertia, time constraints, and physical ailments as being the most significant barriers to exercise. Implications from these focus-group data can be useful in the development of exercise interventions for older adults, which could increase exercise participation.