Interpreting fear of falling in the elderly: What do we need to consider?

Purpose: Fear of falling (FF) is a serious problem in elderly. Available scales quantify FF by generating an aggregate total FF score disregarding the environment in which fear is expressed. This study examined the differences in psychosocial and physical characteristics and global functional capabilities between the elderly who experienced FF exclusively for activities usually performed in community environments and those who reported FF only for home-based activities. Methods: Older participants (age ≥ 65, n=1155) enrolled in the InCHIANTI study completed the evaluation of FF, personal mastery, depression, cognition, social support, lower limb strength, grip strength, balance, timed repeated sit-to-stand performance, visual acuity, and contrast sensitivity. Functional capacity measures included walking speed, ADL and IADL disability, self-reported difficulty climbing steps without support and difficulty walking at least 400m. Only those who reported FF exclusively for activities usually performed in the community environment (n=232) or in home environment (n=110) were included in the analysis. Results: Multivariate analysis of variance revealed that those who reported FF exclusively for home-based activities were significantly worse in psychosocial and physical characteristics measured (F(1,339)= 4.27; p < 0.01) and were also less able in all global functional capacity measures (p= 0.04 to < 0.01). Conclusions: There are significant characteristic and functional differences between the older persons who have FF performing community environment activities and those who express FF in home environment activities. The results strongly indicate the need to classify FF according to the environment or alternatively, to derive an aggregate score by appropriately weighting according to the environment, for valid interpretation of FF.