FEAR, MORALE AND PHYSICAL PERFORMANCE, NOT PAST FALLS, MEDIATE FALLS EFFICACY IN COMMUNITY DWELLING OLDER PEOPLE

Pauelsen M.1, Nyberg L.1, Röijezon U.1, Vikman I.11Luleå University of Technology, Health Sciences, Luleå, SwedenBackground: Fall-related concerns have a large impact on well-being, balance performance and future falls. The primary focus in fall-related concern research has generally been related to physical factors and previous falls. This is mirrored by the use of the traditional fear avoidance model for falls in clinical settings, in which actual falls play a pivotal part in creating and perpetuating the cycle of fear - activity avoidance - falls - fear. Many researchers and clinicians, however, have started to acknowledge that more factors play a part in this complex issue.Purpose: We aimed at investigating falls-efficacy in relation to several psychological, demographic and physical factors in an effort to discover a more fitting model for explaining fall-related concern.Methods: We have visited a random population sample of 115 people, aged 70 or more and living in a municipality in Northern Sweden. The participants were assessed for falls efficacy by means of the Falls Efficacy Scale – International (FES-I). We also collected data on selected potential covariates such as fear of falling, fall consequence concerns, falls history, physical performance, activity, cognitive performance, morale, medication and selected demographics. We then used multiple regression analyses in order to model covariate associations to prevalence and degree of fall-related concern.Results: The analyses show the following: The sample presents a median FES-I score of 21, and 36 % (CI.95 limits: 27 %; 44 %) score 22 or higher, indicating poor fall-related efficacy. Further, 39% (CI.95 limits: 30 %; 48 %) express some degree of fear of falling while 54 % (CI.95 limits: 45 %; 63 %) are concerned about sustaining injuries from a fall (consequence concern). The correlation between fear of falling and falls efficacy seems weak (r = .55), indicating related but separate phenomena. Moreover, data indicate no significant associations between previous falls and falls efficacy, fear of falling, or consequence concern. On the other hand, FES-I scores seem to be explained to a degree of 48 % by the three variables physical performance, fear of falling, and morale (as measured by the Philadelphia Geriatric Centre Morale scale).Conclusion(s): These findings may contribute to a better understanding of fall-related concerns. Perhaps fear, morale, and physical ability are stronger mediators than actual falls experience in itself. If so, this would call for the development of a new model which more adequately describes how fall-related concerns are mediated while excluding falls as a cause.Implications: The clinical implications of this model would mean a shift to include more psychosocial aspects to reduce fall-related concern and risk of falling. An approach directed more towards morale, as well as increasing efficacy and improving physical performance.Funding acknowledgements: Funded by the Swedish Research Council.Partly funded by Swedish National Graduate School for Competitive Science on Ageing and Health.Topic: Older peopleEthics approval: Ethics approval was given by the Ethical vetting board of Umeå, Sweden (reg. 2015/182-31).All authors, affiliations and abstracts have been published as submitted.