Fear of falling in new long-term care enrollees

Objectives: To measure the prevalence of fear of falling in older adults at the time of long-term care (LTC) enrollment and identify potentially treatable risk factors for low fall related self-efficacy. Design: Prospective cohort study. Setting: Three LTC programs in Upstate New York. Participants: 112 new enrollees in LTC, aged 55 or older, who passed a cognitive screen. Measurements: Self-reported falls, the falls efficacy scale (FES), medical conditions, the short geriatric depression scale, and physical performance measures (Berg balance scale, hip flexor, knee extensor and grip strength, gait speed and a six-minute walk). Results: Of the 54 subjects (48.2%) who reported fear of falling, 41 (75.9%) reported activity modification secondary to fear. Fearful subjects were more likely to be female (P =.003), report low back pain (P =.030) and lower extremity arthritis (P =.037). Fearful subjects were weaker at the hip (P <.001) and knee (P =.001), and had shorter six-minute walk distances. Subjects with better FES scores had better Berg scores (P <.001), had greater hip and knee strength, had faster gait speeds and walked further in six minutes (P <.001, P =.006, P =.001 and P =.001 respectively). Subjects with low FES scores and fearful subjects were more likely to have depressive symptoms (P =.003, P=.044, respectively). Conclusion: Falls and fear of falling are more common in new LTC enrollees than in previously described community dwelling and SNF cohorts. Attention to associated characteristics like depression, arthritis, low back pain and lower extremity weakness may identify opportunities to reduce fear and improve patient safety during this transitional period.