How are falls and fear of falling associated with objectively measured physical activity in a cohort of community-dwelling older men?

BMC Geriatrics

Peter H Whincup⁴  S Goya Wannamethee³  Richard W Morris³  Claudio Sartini³  Sarah Ash³  Lucy T Lennon³  Stewart Trost⁵  Ngaire Kerse²  Denise Kendrick¹  Steve Iliffe³  Barbara J Jefferis³ 

[1] Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK;Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand;Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London NW3 2PF, UK;Population Health Research Institute, St George’s, University of London, Cranmer Terrace, SW17 0RE London, UK;School of Human Studies, University of Queensland, Queensland, Australia

关键词: Older adults;    Accelerometer;    Physical activity;    Fear of falls;    Falls;   

Others  :  1089891
DOI  :  10.1186/1471-2318-14-114

 received in 2014-05-20, accepted in 2014-10-17,  发布年份 2014

【 摘 要 】

Background

Falls affect approximately one third of community-dwelling older adults each year and have serious health and social consequences. Fear of falling (FOF) (lack of confidence in maintaining balance during normal activities) affects many older adults, irrespective of whether they have actually experienced falls. Both falls and fear of falls may result in restrictions of physical activity, which in turn have health consequences. To date the relation between (i) falls and (ii) fear of falling with physical activity have not been investigated using objectively measured activity data which permits examination of different intensities of activity and sedentary behaviour.

Methods

Cross-sectional study of 1680 men aged 71–92 years recruited from primary care practices who were part of an on-going population-based cohort. Men reported falls history in previous 12 months, FOF, health status and demographic characteristics. Men wore a GT3x accelerometer over the hip for 7 days.

Results

Among the 12% of men who had recurrent falls, daily activity levels were lower than among non-fallers; 942 (95% CI 503, 1381) fewer steps/day, 12(95% CI 2, 22) minutes less in light activity, 10(95% CI 5, 15) minutes less in moderate to vigorous PA [MVPA] and 22(95% CI 9, 35) minutes more in sedentary behaviour. 16% (n = 254) of men reported FOF, of whom 52% (n = 133) had fallen in the past year. Physical activity deficits were even greater in the men who reported that they were fearful of falling than in men who had fallen. Men who were fearful of falling took 1766(95% CI 1391, 2142) fewer steps/day than men who were not fearful, and spent 27(95% CI 18, 36) minutes less in light PA, 18(95% CI 13, 22) minutes less in MVPA, and 45(95% CI 34, 56) minutes more in sedentary behaviour. The significant differences in activity levels between (i) fallers and non-fallers and (ii) men who were fearful of falling or not fearful, were mediated by similar variables; lower exercise self-efficacy, fewer excursions from home and more mobility difficulties.

Conclusions

Falls and in particular fear of falling are important barriers to older people gaining health benefits of walking and MVPA. Future studies should assess the longitudinal associations between falls and physical activity.

【 授权许可】

   
2014 Jefferis et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Roth M: Self-reported physical activity in adults. In Health Survey For England 2008, Volume 1. Physical Activity and Fitness. 1st edition. Edited by Mindell J, Hirani V. London: HMSO; 2009:21-88.
• [2]Nelson ME, Rejeski J, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C: Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 2007, 116:1094-1105.
• [3]Chief Medical Officers of England SWaNI: Start Active, Stay Active. A report on physical activity for health from the four home countries' Chief Medical Officers. London: Crown; 2011.
• [4]Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS: American College of Sports Medicine position stand: exercise and physical activity for older adults. Med Sci Sports Exerc 2009, 41:1510-1530.
• [5]Masud T, Morris RO: Epidemiology of falls. Age Ageing 2001, 30:3-7.
• [6]Scuffham P, Chaplin S, Legood R: Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health 2003, 57:740-744.
• [7]Tinetti ME, Williams CS: The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci 1998, 53A:M112-M119.
• [8]Jung D: Fear of falling in older adults: comprehensive review. Asian Nursing Research 2008, 2:214-222.
• [9]Austin N, Devine A, Dick I, Prince R, Bruce D: Fear of falling in older women: a longitudinal study of incidence, persistence, and predictors. J Am Geriatr Soc 2007, 55:1598-1603.
• [10]Murphy SL, Williams CS, Gill TM: Characteristics associated with fear of falling and activity restriction in community-living older persons. J Am Geriatr Soc 2002, 50:516-520.
• [11]Mendes da Costa E, Pepersack T, Godin I, Bantuelle M, Petit B, Leveque A: Fear of falling and associated activity restriction in older people. results of a cross-sectional study conducted in a Belgian town. Arch Pub Health 2012, 70:1. BioMed Central Full Text
• [12]Zijlstra GA, Van Haastregt JC, Van Eijk JT, Van RE, Stalenhoef PA, Kempen GI: 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.
• [13]Schepens S, Ananda S, Painter JA, Murphy SL: Relationship between fall-related efficacy and activity engagement in community-dwelling older adults: a meta-analytic review. Am J Occup Ther 2012, 66:137-148.
• [14]Scheffer AC, Schuurmans MJ, van DN, van der Hooft T, de Rooij SE: Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 2008, 37:19-24.
• [15]Bruce DG, Devine A, Prince RL: Recreational physical activity levels in healthy older women: the importance of fear of falling. J Am Geriatr Soc 2002, 50:84-89.
• [16]Cumming RG, Salkeld G, Thomas M, Szonyi G: Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. J Gerontol A Biol Sci Med Sci 2000, 55:M299-M305.
• [17]Deshpande N, Metter EJ, Lauretani F, Bandinelli S, Guralnik J, Ferrucci L: 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.
• [18]Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC: Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 2008, 56:2234-2243.
• [19]Gill DP, Zou GY, Jones GR, Speechley M: Injurious falls are associated with lower household but higher recreational physical activities in community-dwelling older male veterans. Gerontology 2008, 54:106-115.
• [20]Choi L, Liu Z, Matthews C, Buchowski MS: Physical Activity: Process Physical Activity Accelerometer Data. [0.1-1]. Nashville, TN: Leena Choi; 2011.
• [21]Davis MG, Fox KR, Hillsdon M, Sharp DJ, Coulson JC, Thompson JL: Objectively measured physical activity in a diverse sample of older urban UK adults. Med Sci Sports Exerc 2011, 43:647-654.
• [22]Copeland JL, Esliger DW: Accelerometer assessment of physical activity in active, healthy older adults. J Aging Phys Act 2009, 17:17-30.
• [23]Harris TJ, Owen CG, Victor CR, Adams R, Cook DG: What factors are associated with physical activity in older people, assessed objectively by accelerometry? Br J Sports Med 2009, 43:442-450.
• [24]Ganz DA, Higashi T, Rubenstein LZ: Monitoring falls in cohort studies of community-dwelling older people: effect of the recall interval. J Am Geriatr Soc 2005, 53:2190-2194.
• [25]Resnick B, Jenkins LS: Testing the reliability and validity of the self-efficacy for exercise scale. Nurs Res 2000, 49:154-159.
• [26]van Marwijk HW, Wallace P, de Bock GH, Hermans J, Kaptein AA, Mulder JD: Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale. Br J Gen Pract 1995, 45:195-199.
• [27]Luo N, Johnson JA, Shaw JW, Coons SJ: A comparison of EQ-5D index scores derived from the US and UK population-based scoring functions. Med Decis Making 2007, 27:321-326.
• [28]Aguilar-Farias N, Brown WJ, Peeters GM: ActiGraph GT3X + cut-points for identifying sedentary behaviour in older adults in free-living environments. J Sci Med Sport 2014, 17:293-299.
• [29]Clemes S, Connelly J, Konstantinidis T, Koivula R, Edwardson C, Yates T, Gorely T, Biddle S: Validity of the ActiGraph GT3X + inclinometer and different counts per minute cut-points for the assessment of sedentary behaviour. J Sci Med Sport 2013, 15:S68.
• [30]StataCorp: Statistical Software: Release 13. College Station, TX: StataCorp LP; 2013.
• [31]Lachman ME, Howland J, Tennstedt S, Jette A, Assmann S, Peterson EW: Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE). J Gerontol B Psychol Sci Soc Sci 1998, 53:43-50.
• [32]Friedman SM, Munoz B, West SK, Rubin GS, Fried LP: 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.
• [33]Delbaere K, Close JCT, Brodaty H, Sachdev P, Lord SR: Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study. Br Med J 2010, 341:c4165.
• [34]Jefferis BJ, Sartini C, Lee IM, Choi M, Amuzu A, Gutierrez C, Casas JP, Ash S, Lennnon LT, Wannamethee SG, Whincup PH: Adherence to physical activity guidelines in older adults, using objectively measured physical activity in a population-based study. BMC Public Health 2014, 14:382. BioMed Central Full Text
• [35]Gorman E, Hanson HM, Yang PH, Khan KM, Liu-Ambrose T, Ashe MC: Accelerometry analysis of physical activity and sedentary behavior in older adults: a systematic review and data analysis. Eur Rev Aging Phys Act 2014, 11:35-49.