EXPERT ANALYSIS FROM AAGP 2016

WASHINGTON (FRONTLINE MEDICAL NEWS) – Fear of falling at 12 weeks was associated with poorer functional recovery up to 1 year after hip fracture, particularly if the person had a high level of function before the fracture, a study has shown.

Inherent in this fear is a tendency of the patient to limit his activities, which in turn affects his sense of balance, visual attention, and gait. This leads to an increased risk of further falls, according to Emily Bower, a doctoral candidate who presented the findings at the annual meeting of the American Association for Geriatric Psychiatry.

The study included 241 hip fracture patients, three-quarters of whom were female, with an average age of 77 years. All of the patients lived in the community, nearly all were able to participate in basic activities of daily living, and three-quarters could walk without assistance.

Patients were assessed for their level of functionality at week 4, week 12, week 26, and week 52, as well as their fear of falling using the Falls Efficacy Scale International ( FES-I ).

The investigators found that by week 52, 48% of all patients had reached full recovery of functional status. At week 12, 53% of all patients had FES-I scores indicating a lower fear of falling.

“That means that almost half of our participants were reporting high fear of falling 3 months after hip fracture, which is a substantial number when you consider that in the general population, fear of falling is reported by about one in five older adults,” Ms. Bower, who is enrolled at the San Diego State University/University of California, San Diego, joint doctoral program in clinical psychology, said in an interview.

At 1-year after fracture, for each 1 point increase in FES-I scores, the odds of reaching full recovery were lowered by 12% (P = .003). Meanwhile, in patients with low baseline levels of functioning, there was “no effect of fear of falling,” according to Ms. Bower.

The upshot is that for patients with high levels of functional independence prior to injury, more intervention may be required to bring them back to their levels of activity before the fracture, according to Ms. Bower, who suggested multicomponent activities that combine psychological, physical, and environmental factors, such as tai chi.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

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