Relationships among balance confidence, physical function, living situation and fall status in older adults Public Deposited


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  • Falls are extremely common among the older adult population, account for substantial morbidity and mortality, and are often potentially preventable. It is estimated that 9 out of 10 of hip fractures in older adults occur as the result of a fall. The economic consequences of hip fractures are estimated at $10 to $15 billion annually in the United States alone. Adults aged 65 years and older are the fastest growing segment of the U.S. population; therefore falls in this population represent an increasing public health burden. Physical activity has been identified as a lifestyle factor that helps to maintain physical functioning, balance, and mobility as we age, thereby reducing the incidence of falls. Activity levels are known to decline with advancing age so much that for many adults 65 and older, the normal activities of daily living constitute the majority of their daily physical activity. Many older adults today are choosing to live in retirement communities that provide independent housing, housecleaning, laundry services, yard care, and meal preparation. This living situation may further reduce the activity level of its residents by performing many of the normal tasks of daily living for them. Fear of falling has been used in the literature to describe a loss of confidence and voluntary restriction of activity occurring after a fall that may be out of proportion to any injuries sustained by the fall. This is prevalent among older adults and has been reported in as many as 50-60% of previous fallers and also in 20-46% of individuals who have never fallen. Fear of falling that occurs as a result of aging and/or restricted activity level, along with associated declines in mobility, function, and balance, undermines selfconfidence and increases the fall risk in this population. The aims of this study were to determine whether physical function and balance self-efficacy scores differed between older adults living in the community and those in retirement communities, to examine the relationships that exist between balance confidence, physical function, living situation, and fall status in this older adult population, and to develop an equation that could be used to predict older adults most likely to experience multiple falls. The data used in this study were part of a longitudinal research study conducted at the Bone Research Laboratory at Oregon State University in Corvallis, OR. Participants consisted of 317 adults between 65 and 95 years of age (80.7 ± 5.7). This included 105 persons living in the local community, and 212 persons from retirement communities within a 70-mile radius. Community subjects were tested at the university laboratory one year and retirement subjects were tested on-site at their residence the following year. Participants were tested on hip abduction strength, Tandem Gait, Timed Up and Go, postural sway, lateral stepping velocity and reaction time, and also completed a Balance Self-Efficacy questionnaire. Falls incidence was tracked for 1 year following testing. An ANOVA revealed differences between community residents and retirement residents, with community dwelling residents scoring better overall, and significantly better on the following physical function tests; Timed Up & Go, Tandem Gait, Quick Step reaction time and stepping velocity, tandem body sway, and Balance Self-Efficacy. Differences in scores between the two groups ranged from 6.7% to 33%. A correlation analysis between balance selfefficacy scores and physical function scores revealed a positive, moderate relationship between physical function and balance self-efficacy, with correlations that ranged from R 0.113 to R = 0.559 (p < .005). Fall numbers were negatively correlated to balance self-efficacy scores, but correlations were weak, from R = 0.102 to R= 0.126 (p < .005). Regression analysis resulted in an equation using one variable, medial-lateral body sway while standing comfortably with eyes open. The resulting logistic equation is: Log (μ/ (1-μ)) = -.728 + (2.85 1 * lateral sway, eyes open). Using a ROC curve analysis, the model correctly classified 5 8.9% of individuals into the correct fall category (one-time vs. multiple fallers), with specificity of 73% and sensitivity of 43%. In conclusion, significant differences in physical function and balance confidence occurred between subjects in the different residential settings, regardless of fall incidence. Correlations between BSE scores and physical function variables were statistically significant, reinforcing the differences in test scores noted between community and retirement subjects. BSE scores were negatively correlated to fall number although R-values were weak, indicating that in our population, self-efficacy scores were not strongly related to the number of falls one experienced. A regression equation correctly classified 58.9% of subjects as one-time or multiple fallers using the single variable of medial-lateral body sway. Our study shows that community subjects had better physical function and balance self-efficacy than retirement subjects. The literature has reported a strong relationship between physical activity level and functional ability, with reductions in physical activity leading to declines in function over time. Retirement communities may be set up with a safer external environment that may be helping to decrease fall incidence, however administrators must still plan appropriate physical activity programs in order to assist residents in maintaining a high level of function, thereby decreasing fall risk even more.
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