Characteristics and fall experiences of older adults with and without fear of falling outdoors

Tracy Chippendale and Chang Dae Lee

Department of Occupational Therapy, New York University, Steinhardt School of Culture, Education, and Human Development, New York, NY, USA

ARTICLE HISTORY Received 15 November 2016 Accepted 17 March 2017

ABSTRACT Objective: Using a theoretical model that combines an ecological perspective and Bandura’s theory of self-efficacy as a guide, we sought to compare experiences and characteristics of community dwelling older adults with and without concern about falling outdoors. Method: A survey of randomly selected community dwelling older adults across NYC (N = 120) was conducted using the outdoor falls questionnaire. Descriptive quantitative analyses of participant characteristics were conducted for all participants and for those with and without concern about falling outside. Conventional content analysis using two coders was employed to examine outdoor fall experiences for each group. A mixed methods matrix was used to integrate qualitative and quantitative findings. Results: Some participant characteristics were more common among those with a concern about falling outside such as decreased functional status, female gender, and number of prior outdoor falls. As per descriptions of outdoor fall experiences, participants with concern were more likely to report a fall while climbing stairs or stepping up a curb, describe an intrinsic factor as a cause of their fall, use an injury prevention strategy during the fall, sustain a moderate to severe injury, seek medical attention, have had an ambulance called, require help to get up, and describe implementation of a behavioral change after the fall. Conclusions: Differences exist in participant characteristics and outdoor fall experiences of those with and without concern about falling outside. The proposed model can be used to understand fear of falling outdoors and can help to inform the target population and content of intervention programs.

KEYWORDS Fear of falling; outdoor falls; mixed methods

Introduction

Falls are a significant public health concern due to their high prevalence rates and serious consequences for the health and well-being of older adults (Center for Disease Control, 2016). Although risk of falls increases with age, there is evidence to suggest adults in late mid-life are also at risk (Verma, Willetts, Marucci-Wellman, Lombardi, & Courtney, 2016). Outdoor falls are just as common as indoor falls and are just as likely to result in serious injuries. However, they are associated with different risk factors. Examples of risk factors for indoor falls include slow gait speed, impaired balance and strength, impaired cognition, multiple medication, and limitation in activities of daily living to name a few. Conversely, male gen- der, younger age, having a fast gait speed, and participating in more leisure time physical activity are associated with risk for outdoor falls (Kelsey, Proctor-Gray, Hannan, & Li, 2012; Li et al., 2006). Thus, characteristics and profiles of people at risk for outdoor falls differ significantly from those at risk for indoor falls. Fear of falling (FOF), one of the fall-related psy- chological concerns (Hull, Kneebone, & Farquharson, 2013), can also increase risk for falls (Friedman, Munoz, West, Rubin, & Fried, 2002). Noteworthy is that older adults may experience a FOF regardless of whether or not they have experienced a fall (Denkinger, Lukas, Nikolaus, & Hauer, 2015). Prevalence rates for FOF among community dwelling older adults are var- ied, but have been found to be between 33% and 46% among older adults who have not sustained a fall and

between 21% and 85% among older adults who have fallen (Kumar, Carpenter, Morris, Iliffe, & Kendrick, 2014).

In addition to an increased risk for falls, fear or concern about falling can result in a number of other negative conse- quences that have both immediate and long term effects. Immediate effects may include activity restriction (Deshpande et al., 2008), and gait changes (Chamberlin, Fulwider, Sanders, & Medeiros, 2005; Reelick, Iersel, Kessels, Marcel, & Rikkert, 2009) whereas long term effects include a decline in function and social isolation (Deshpande et al., 2008; Liu, 2014). Given the serious physical, psychological, and social consequences, studies that explore factors that contribute to FOF are war- ranted to help inform interventions and clinical practice. Some factors associated with FOF in general (indoors and out- doors) have been found consistently across studies such as female gender, impaired physical function, and use of a walk- ing aid (Denkinger et al., 2015). Less common or consistent factors include visual impairments/self-perception of vision (Donoghue et al., 2014; Liu, 2014), declining muscle mass and strength (Oh, Hong, Lee, & Han, 2015; Trombetti et al., 2016), use of multiple medications, (Kumar et al., 2014), the neigh- borhood environment (Chippendale & Boltz, 2014), hearing impairment (Malini, Lourenco, & Lopes 2015), education level (Kumar et al., 2014), and mental health (e.g. depression and anxiety) (Hull et al., 2013; Liu, 2014; Malini et al., 2016). In sum- mary, impaired physical function can be both the cause and consequence of FOF.

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