Uncovering the Impact of Physical Function on Fall Risk in Older Adults with a Fear of Falling, with and without Activity Restriction
BY ALEXANDER GARBIN, PT, DPT, PHD
Approximately 25% of older adults fall each year and falls commonly result in injury and hospitalization. Many older adults suffer from a fear of falling, meaning they worry about falling while doing everyday activities like shopping or cleaning their home. Considerable research has shown that the presence of fear of falling increases the risk of future falls in older adults. Importantly, the presence of fear of falling in some older adults causes them to restrict their activities. This means they avoid activities they would typically do as they are afraid a fall might occur, which can result in a decline in their physical abilities.
While it is known that fear of falling and activity restriction increase fall risk, the manner in which they increase fall risk is still not fully understood. Gaining a better understanding of the factors that contribute to fall risk in older adults with a fear of falling will help guide interventions that can reduce falls in this population.
We previously revealed that reduced balance performance plays a significant role in fall risk among older adults with a fear of falling. In this current study, we analyzed data from the National Health and Aging Trends Study and Baltimore Longitudinal Study of Aging to understand how physical function (e.g. strength, proprioception) contributes to decreased balance performance and increased fall risk in older adults with a fear of falling, with and without activity restriction. Three main findings of our study are:
Physical function influences reduced balance and increased falls in older adults with a fear of falling.
The influence of physical function is even stronger in older adults who restrict their activities due to a fear of falling.
Older adults with a fear of falling experience reduced balance and increased fall risk that cannot be solely explained by their physical function, suggesting the involvement of other factors.
Understanding the role of physical function is crucial for supporting current and future intervention studies aiming to prevent falls in older adults with a fear of falling. Notably, some fall prevention interventions have focused on improving physical function through strengthening exercises while others have used a multifactorial approach. A multifactorial approach addresses physical function while also targeting additional domains including psychological well-being, environmental factors, and social factors. Our findings indicate that balance deficits and increased fall risk in older adults with a fear of falling are influenced by factors both related and unrelated to physical function. These findings suggest that fall prevention interventions should target multiple domains and therefore support a multifactorial approach.
Our future research aims to understand the specific factors related to physical function (i.e., leg strength, proprioception, range of motion) and unrelated to physical function (i.e., anxiety, depression, social support, environment). Understanding how these factors contribute to the increased fall risk experienced by older adults with a fear of falling will further support development of targeted fall prevention interventions.
By improving our understanding of the complex relationship between fear of falling, physical function, and fall risk, we can improve the well-being and safety of older adults. Through tailored interventions that address factors related to fall risk in older adults with a fear of falling, we can help this population maintain their independence and reduce their risk of falling.
Article details
Examining the Role of Physical Function on Future Fall Likelihood in Older Adults With a Fear of Falling, With and Without Activity Restriction
Alexander J. Garbin, PT, DPT, PhD & Beth E. Fisher, PT, PhD, FAPTA
First Published: April 23, 2023
DOI: 10.1177/08982643231170308
Journal of Aging and Health
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