Original article
What is the Relationship Between Fear of Falling and Gait in Well-Functioning Older Persons Aged 65 to 70 Years?

Presented in part to the Gerontological Society of America, November 21–25, 2008, National Harbor, MD.
https://doi.org/10.1016/j.apmr.2010.03.005Get rights and content

Abstract

Rochat S, Büla CJ, Martin E, Seematter-Bagnoud L, Karmaniola A, Aminian K, Piot-Ziegler C, Santos-Eggimann B. What is the relationship between fear of falling and gait in well-functioning older persons aged 65 to 70 years?

Objective

To investigate the association between fear of falling and gait performance in well-functioning older persons.

Design

Survey.

Setting

Community.

Participants

Subjects (N=860, aged 65–70y) were a subsample of participants enrolled in a cohort study who underwent gait measurements.

Interventions

Not applicable.

Main Outcome Measures

Fear of falling and its severity were assessed by 2 questions about fear and related activity restriction. Gait performance, including gait variability, was measured using body-fixed sensors.

Results

Overall, 29.6% (210/860) of the participants reported fear of falling, with 5.2% (45/860) reporting activity restriction. Fear of falling was associated with reduced gait performance, including increased gait variability. A gradient in gait performance was observed from participants without fear to those reporting fear without activity restriction and those reporting both fear and activity restriction. For instance, stride velocity decreased from 1.15±.15 to 1.11±.17 to 1.00±.19 m/s (P<.001) in participants without fear, with fear but no activity restriction and with fear and activity restriction, respectively. In multivariate analysis, fear of falling with activity restriction remained associated with reduced gait performance, independent of sex, comorbidity, functional status, falls history, and depressive symptoms.

Conclusions

In these well-functioning older people, those reporting fear of falling with activity restriction had reduced gait performance and increased gait variability, independent of health and functional status. These relationships suggest that early interventions targeting fear of falling might potentially help to prevent its adverse consequences on mobility and function in similar populations.

Section snippets

Study Design and Population

Participants were a subsample of subjects enrolled in the Lc65+. The recruitment of the cohort has been described in detail elsewhere.20 Briefly, a random sample of 3056 community-dwelling persons born between 1934 and 1938 was contacted. From the 1310 subjects who completed baseline data collection during an in-person visit, 861 had gait parameters recorded. Main reasons for missing gait parameters were unavailability of the recording device (24.9%, n=326), inability to walk because of health

Results

Overall, 70.3% (605/860) of the participants reported no fear of falling, 24.4% (210/860) reported fear of falling without activity restriction, and 5.2% (45/860) reported fear of falling with activity restriction. Table 1 provides the baseline characteristics of the population and compares these characteristics across the 3 groups. Significant gradients were observed from participants without fear of falling to those with fear but no activity restriction and to those reporting both fear and

Discussion

This study shows that fear of falling was independently associated with reduced gait performance in a population of community-dwelling, well-functioning elderly persons aged 65 to 70 years. Results provide original and detailed information on gait performance across levels of fear of falling in this population and show evidence of a gradual and significant deterioration in most gait parameters across levels of fear of falling and activity restriction, despite the overall favorable health and

Conclusions

This study provides new evidence of an independent association between fear of falling and gait performance, including increased gait variability. Even in well-functioning older people, fear of falling appears as an important prognostic marker, to be confirmed in longitudinal data. As such, it could be a specific target for interventions aimed at preventing or delaying functional decline and disability.

Acknowledgments

We thank the research assistants, and we thank John C Beck, MD, for comments on the manuscript.

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    Supported by the Swiss National Scientific Foundation (grant nos. 325200-109401 and 32473B-120795), the Leenaards Foundation, the Loterie Romande.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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    Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.