Showing papers by "Kim Delbaere published in 2009"

Socio-demographic, health-related and psychosocial correlates of fear of falling and avoidance of activity in community-living older persons who avoid activity due to fear of falling

Abstract: Background Fear of falling and avoidance of activity are common in old age and are suggested to be (public) health problems of equal importance to falls. Earlier studies of correlates of fear of falling and avoidance of activity did hardly differentiate between severe and mild levels of fear of falling and avoidance of activity which may be relevant from clinical point of view. Furthermore, most studies focused only on socio-demographics and/or health-related variables and hardly incorporated an extensive range of potential correlates of fear of falling including psychosocial variables. This study analyzes the univariate and multivariate associations between five socio-demographic, seven health-related and six psychosocial variables and levels of fear of falling and avoidance of activity in older persons who avoid activity due to fear of falling.

Concern About Falls Elicits Changes in Gait Parameters in Conditions of Postural Threat in Older People

Abstract: POOR walking performance has previously been associated with older age, increased risk of falling, and greater concern about falling. Changes in spatial and temporal gait parameters in older people due to concern about falling have been demonstrated via reduced speed (1–6), shorter stride length (1–4), prolonged double-support time (1,4), and increased gait variability (4,7). Similar changes have been associated with older age (8) and increased physiological falls risk (9). The question arises whether a combination of the aforementioned factors might further induce changes in walking performance, such that excessive concern could lead to extreme carefulness and adoption of overly cautious behaviors to reduce a perceived high risk of falling. By manipulating the environment in a way that exacerbates the potential consequences of a fall, it is possible to investigate whether concern about falls induces gait adaptations. Several studies have suggested that environmental manipulations can induce concern regarding the possibility of a fall (10–22). Some studies have demonstrated decreased sway while standing on an elevated platform, which was mediated by a stiffening strategy at the ankle joint (10–18). Brown and colleagues also described significant changes in gait parameters on an elevated walkway as evidenced by (a) a slowed speed, a shorter stride length, and longer time spent in double support; (b) reduced joint angles and reduced variability of joint kinematics; and (c) an increased level of muscle activation in the lower leg musculature (19–22). Although work to date has provided valuable insights regarding the potential influence of concern about falling on gait, it has been limited in two ways. First, the method of inducing fall-related concern during walking by environmental manipulation (i.e., narrow beam walking), in effect, changed the nature of the task (restricted stride width), making it difficult to identify the cause of the subsequent gait alterations (19–22). Second, previous work has been restricted to healthy older adults without a concern about falling (10–17,19–22). In this study, we aimed to address these issues. We provided an environmental manipulation without constraining the participant or the support surface. This comprised an elevated walkway, dimmed lighting, and no provision of protective devices such as a harness. We also studied older people with a range of physiological falls risk and levels of concern about falling to investigate the effect of both physiological and psychological factors on walking performance.

Sleep Quality and Falls in Older People Living in Self- and Assisted-Care Villages

Abstract: Background: Older people often experience unusual sleeping patterns and a poor quality of night-time sleep. Insufficient sleep has potential effects on cognition and physical functi

Falls and catastrophic thoughts about falls predict mobility restriction in community-dwelling older people: A structural equation modelling approach

Abstract: Objectives: How and when concerns about falls emerge is not yet completely known, because these concerns are present in both people with and without a falls history. The aim of this study was to investigate the role of catastrophic beliefs about falls and previous falls in the development of concerns about falls and resulting mobility restrictions (MR). Method: Within a cross-sectional design, 896 older people (mean age 76.2 +/- 4.7) living independently in the community completed a battery of questionnaires. Self-report data was gathered on previous falls, catastrophic beliefs about consequences of a fall (Catastrophizing About Falls Scale), concerns about falls (modified Falls Efficacy Scale) and mobility restrictions during daily life (Sickness Impact Profile 68). Results: Using structural equation modelling, we found that the number of falls in the previous year was not directly related to mobility restrictions in daily life, but via an increase of concerns about falls. Also catastrophic beliefs about the consequences of falls were related to concerns about falls and to mobility restrictions. Goodness-of-fit indices revealed that the presented model had an acceptable fit. Alternative models resulted in lesser-fit indices. Conclusion: Both previous falls and catastrophic beliefs about falls are unique and independent predictors of concerns about falls and, subsequently, of mobility restrictions. A cognitive-behavioural perspective upon mobility restrictions may provide important additional components for treatment and prevention of excessive concerns about falls in older people.