Abstract
This study investigated whether fear of falling (FOF) measured by two different instruments, the Falls Efficacy Scale-International (FES-I) and the single question on FOF and activity restriction (SQ-FAR), is associated with mortality at 6-year follow-up. Participants (n = 1359, 58.6% women) were community-dwelling persons enrolled in the Lausanne cohort 65 + , aged 66 to 71 years at baseline. Covariables assessed at baseline included demographic, cognitive, affective, functional and health status, while date of death was obtained from the office in charge for population registration. Unadjusted Kaplan Meyer curves were performed to show the survival probability for all-cause mortality according to the degree of FOF reported with FES-I and SQ-FAR, respectively. Bivariable and multivariable Cox regression analyses were performed to assess hazard ratios, using time-in-study as the time scale variable and adjusting for variables significantly associated in bivariable analyses. During the 6-year follow-up, 102 (7.5%) participants died. Reporting the highest level of fear at FES-I (crude HR 3.86, 95% CI 2.37–6.29, P < .001) or “FOF with activity restriction” with SQ-FAR (crude HR 2.42, 95% CI 1.44-4.09, P = .001) were both associated with increased hazard of death but these associations did not remain significant once adjusting for gender, cognitive, affective and functional status. As a conclusion, although high FOF and related activity restriction, assessed with FES-I and SQ-FAR, identifies young-old community-dwelling people at increased risk of 6-year mortality, this association disappears when adjusting for potential confounders. As a marker of negative health outcomes, FOF should be screened for in order to provide personalized care and reduce subsequent risks.
Highlights
Fear of falling (FOF) is common in community-dwelling older people, and has been shown to be associated with adverse outcomes such as frailty incidence, care dependence, depression, or falls (Scheffer et al 2008; SeematterBagnoud et al 2010)
There was no collinearity between FOF as measured by Falls Efficacy Scale-International (FES-I), respectively single question on FOF and activity restriction (SQ-FAR), and covariates, with variance inflation factor (VIF) values smaller than 2
When adjusting for this set of variables, neither FES-I nor SQ-FAR did remain significantly associated with mortality at 6-year in multivariable analyses, whereas being a woman, reporting instrumental activities of daily living (IADL) impairment and being frail were associated with a higher mortality risk in both FOF models (Table 2)
Summary
Fear of falling (FOF) is common in community-dwelling older people, and has been shown to be associated with adverse outcomes such as frailty incidence, care dependence, depression, or falls (Scheffer et al 2008; SeematterBagnoud et al 2010). European Journal of Ageing single question, and mortality among community-dwelling people during a follow up ranging from 7 to 10 years (Chang et al 2017; Kim & Bae 2020; Lee et al 2020) This association was observed when adjusting for socio-demographic variables, lifestyle habits as well as chronic diseases. Two studies were able to examine the association of low, respectively moderate FOF with mortality, showing a dose-response gradient, none of them measured FOF-related activity restriction This precluded to further evaluate whether FOF with activity restriction would be more strongly associated with mortality than FOF alone, through a pathway of physical inactivity, increased sarcopenia, and frailty over time (Choi et al 2017; Deshpande et al 2008). Further insight on such an association would help better targeting of older persons needing intervention on fear of falling, as well as better designing of such interventions
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