Relationship between Physical Fitness, History of Falls and Depression with Fear of Falls among Institutionalised Elderly Population: A Cross-sectional Study

Introduction: Institutionalised elderly are more prone to falls and depression due to their functional dependence and social isolation. Physical fitness plays an important role in falls prevention. Fear of Falls (FoF) can be described as an anxiety or a patient’s concern about falling that can lead an individual to avoid activities that they are capable of performing, thus reducing their physical activity and overall fitness. The consequences of FoF include an increased risk of falling, reduced physical activity, decreased social interaction and lower quality of life. FoF is one of the potentially modifiable risk factors where intervention could be effective in preventing falls. Knowledge of and relationships between risk factors and FoF will be useful in developing strategies to reduce FoF and improve the quality of life in the elderly population. Aim: To explore the relationship between physical fitness, history of falls and depression with FoF in the institutionalised elderly population. Materials and Methods: This cross-sectional study was carried out at institutional old-age homes in the Kalyan-Dombivli area, Mumbai, Maharashtra, India. The total duration of the study was four months, from August 2024 to November 2024. After obtaining permission from the old-age homes, participants were approached and screened according to inclusion criteria. The inclusion criteria were institutionalised elderly aged 60- 85 years, ambulatory with or without an assistive device, both male and female. Those participants who voluntarily agreed to participate were recruited by convenience sampling. After screening 130 participants according to the inclusion criteria, 124 participants agreed to be part of the study. Demographic data such as age, gender, education, number of years residing in the old-age home, number of co-morbidities, medical and surgical history and medication history were collected. History of falls in the last 12 months was also documented. The outcome measures assessed were the Senior Fitness Test for physical fitness, history of falls, Falls Efficacy Scale-International (FoF) and Geriatric Depression Scale. Spearman correlation was used to assess the relationships between physical fitness, depression and FoF. The Chi-square test (p-value ≤0.05) was used to determine whether there was a significant difference between the history of falls and FoF. Results: The mean age of the participants was 71.4±5.8 years. Of the 124 participants, 64 had a history of falls. Concerns about falls were higher among fallers than among non fallers. The Chisquare test showed no significant difference between these two groups (p-value=0.843). Among physical fitness parameters, there was a negative correlation between the arm curl test (upper limb strength) and FoF in the fallers group. There was a significant positive correlation between the back-scratch test (left side) and FoF score (p-value=0.0156). There was no correlation between lower-limb strength, agility, or aerobic capacity and FoF. There was no significant correlation between depression and FoF among study participants (p-value=0.5879). Conclusion: There was no correlation between physical fitness parameters and history of falls except for upper-limb flexibility and strength. All participants, irrespective of fall history, showed high concerns about falls. Depression in the participants also showed no significant relationship with FoF.