Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission

Background The aim of this study was to assess the impact of Fear of fallin g on the health of older people. Methods. A total of 528 subjects (mean age 77 years) were recruited from tw o hospitals in Sydney, Australia, and followed for approximately 12 months. Eighty-five subjects died during follow-up. and 31 were admitted to an age d care institution. Tinetti's Falls Efficacy Scale (FES) was successfully a dministered to 418 subjects as part of the baseline assessment. Among those with baseline FES scores, ability to perform 10 activities of daily living (ADLs) was assessed at baseline and Follow-up in 307 subjects, and SF-36 s cores were assessed at baseline and follow-up in 90 subjects recruited duri ng the latter part of the study. Falls during follow-up were identified usi ng a monthly falls calendar. Results. Compared with those with a high fall-related self-efficacy (FES sc ore = 100), those with a low fall-related self-efficacy (FES score less tha n or equal to 75) had an increased risk of falling (adjusted relative risk 2.09. 95% confidence interval [CI] 1.31-3.33). Those with poorer fall-relat ed self-efficacy had greater declines in ability to perform ADLs (p < .001) : the total ADL score decreased by 0.69 activities among persons with low F ES scores (less than or equal to 75) but decreased by only 0.04 activities among persons with FES scores of 100. Decline in ADLs was not explained; by the higher frequency of falls among persons with low FES scores. SF-36 sco res (particularly scores on the Physical Function and Bodily Pain subscales ) tended to decline more among persons with poor Fall-related self-efficacy . Nonfallers who said they were afraid of falling had an increased risk of admission to an aged care institution. Conclusions. Pear of falling has serious consequences for older people. Int erventions that successfully reduce fear of falling and improve fall-relate d self-efficacy are likely to have major health benefits.