People who are afraid of falling down have a higher risk of experiencing subsequent falls, compared to individuals who do not have that fear, says a new report published in the BMJ (British Medical Journal). The authors say that both actual and perceived fall risk should be included in fall risk assessment in order to help protect elderly people from falls.
A significant number of elderly individuals are afraid of falling down. Fear of falling is also linked to anxiety, depressions, poor balance, and having had previous falls. The investigators, from Belgium and Australia wanted to understand fear of falling better, as well as determining its impact on the risk of falls.
The study involved 500 individuals, aged between 70 and 90 years. They all lived in Sydney, Australia. The participants underwent an extensive medical and neuropsychological assessment. Recognized scoring scales were used to estimate actual and perceived fall risks. All study participants were followed up each month for a twelve-month period.
The study revealed that actual fall risk and perceived fall risk both contribute to an individual’s risk, independently.
The researchers went further by splitting the sample into four groups, based on the contrast between actual and perceived risk. The groups were called:
- The vigorous group – those with low actual and low perceived fall risk. They were deemed to be at low risk of future significant falls.
- The aware group – those with high actual and high perceived fall risk. They were considered at high risk of future significant falls.
- The anxious group
- The stoic group
– those with a high actual and low perceived fall risk, which was protective for falling. They tended to have a positive outlook on life, were socially and community active, as well as physically active.
They found that the majority of individuals had an accurate perception of their fall risk. Approximately 30% of elderly individuals either overestimated or underestimated their fall risk, the authors wrote.
The researchers found that high levels of perceived fall risk tended to result in a higher risk of future falls, irrespective of the actual risk. They also found that the disparity between actual and perceived risk contributed towards the risk, mainly through psychological pathways.
The authors say that their findings indicate that attempts to reduce fear of falling among the elderly does not usually lead to increased risk of falls because the patients became overly confident and bold.
The concluded that perceived fall risk, as well as actual fall risk measures should be included in fall risk assessments.
Determinants of disparities between perceived and actual fall risk in community living older people.
Kim Delbaere, Jacqueline C T Close, Henry Brodaty, Perminder Sachdev, Stephen R Lord
Published 19 August 2010, doi:10.1136/bmj.c4165
BMJ 2010;341:c4165
Written by Christian Nordqvist