Fear of Falling in Older Adults Undergoing Comprehensive Geriatric Care: Results of a Prospective Observational Study

TL;DR

This study finds that fear of falling is common among older adults in geriatric care and is linked to depression and heart failure, with little improvement after treatment.

Contribution

The study identifies clinical factors associated with persistent fear of falling in older adults undergoing comprehensive geriatric care.

Findings

Fear of falling was reported by 74.8% of patients upon hospital admission and remained largely unchanged at discharge.

Persistent high fear of falling after treatment was associated with depressive symptoms and heart failure diagnoses.

Improvements in functional tests did not significantly correlate with changes in fear of falling scores.

Abstract

Objectives: This prospective observational study aimed to investigate the prevalence, progression, and clinical factors associated with fear of falling (FOF) in older adults hospitalized for comprehensive geriatric care (CGC). Methods: FOF was assessed using two measures: a single-item question (SIQ) asking, “Are you currently afraid of falling?” with responses scored as (0) not at all; (1) a little; (2) quite a bit; (3) very much, and the Falls Efficacy Scale International (FES-I). FES-I scores were categorized into low (FES-I 16–19), moderate (FES-I 20–27), and high (FES-I 28–64) concerns about falling. FOF scores were analyzed in relation to patients’ characteristics and functional performance. Results: A total of 103 patients were included in the final analysis (mean age: 81.9 years, 64.1% female). Upon hospital admission, 74.8% of patients reported FOF (SIQ ≥ 1), with no significant change at discharge (73.8%, p > 0.999). Patients’ FES-I scores indicated high concerns about falling, with only slight improvements following CGC. The median FES-I score upon admission decreased from 31 (IQR: 23.5–40) to 30 (IQR: 23.5–38) at discharge (p < 0.001). Logistic regression analysis revealed that persistently high concerns about falling (FES-I 28–64) after undergoing CGC were associated with depressive symptoms (Geriatric Depression Scale score ≥ 6; OR: 3.61, 95% CI: 1.30–10.04) and a diagnosis of heart failure (OR: 3.63, 95% CI: 1.30–10.11). Patients’ scores in the Barthel Index, Timed Up and Go Test, and Tinetti Test improved after treatment, but these changes (Δ) did not show a significant correlation with those in the FES-I or SIQ. Conclusions: Our findings demonstrate that FOF is highly prevalent among older adults hospitalized for CGC and persists with only minimal improvement following treatment. Persistently high concerns about falling even after completing CGC were associated with depressive symptoms and a diagnosis of heart failure. These results highlight the potential for more targeted interventions within CGC to more effectively address FOF in this vulnerable population.

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