The Turkish Version of the Survey of Activities and Fear of Falling in the Elderly

The Reliability and Validity of the Turkish Version of the Survey of Activities and Fear of Falling in the Elderly

The Survey of Activities and Fear of Falling in the Elderly (SAFE) was originally developed in English to determine the level of fear of falling and its interactions with activities of daily living. The purpose of this study was to translate and cross-culturally adapt the SAFE instrument into Turkish and investigate its psychometric properties.

Study Overview

• Status: Completed
• Conditions: Fall; Fear; Old Age; Debility; Activity, Motor; Participation, Patient

Detailed Description

The Survey of Activities and Fear of Falling in the Elderly (SAFE) was originally developed in English to determine the level of fear of falling and its interactions with activities of daily living. The purpose of this study was to translate and cross-culturally adapt the SAFE instrument into Turkish and investigate its psychometric properties. One hundred eleven older adults (72 females) with a mean age of 69 years (SD=7.22; range=60-87) were included. For cross-cultural adaptation, two bi-lingual translators used the back-translation procedure. Within a 5-to-7-day period after the first assessment, the participants completed the Turkish version of SAFE (SAFE-T) to evaluate test-retest reliability. Cronbach's alpha (α) was used to assess internal consistency. The correlation with the Turkish version of the Falls Efficiency Scale-International (FES-T) was determined to check the validity.

• Study Type: Observational
• Enrollment (Actual): 111

Contacts and Locations

Study Locations

• Turkey
  • Bakırkoy
    • Istanbul, Bakırkoy, Turkey, 34147
      • Istanbul University-Cerrahpasa

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

One-hundred eleven older adults who were admitted to the Department of Geriatrics at Istanbul Medeniyet University Goztepe Training and Research Hospital or who volunteered to participate in this study via an online form, were evaluated between January 2018 and July 2018.

Description

Inclusion Criteria:

1. age over 60 years old
2. ability to read and write in Turkish
3. score ≥24 on the Mini-Mental State Exam
4. >3 according to the Functional Ambulation Category (FAC)
5. no pathology in visual ability and hearing

Exclusion Criteria:

1. neurologist-diagnosed dementia or Alzheimer's disease
2. ambulatory only with a wheelchair
3. amputated lower extremity

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Only
• Time Perspectives: Cross-Sectional

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Survey of Activities and Fear of Falling in the Elderly	The Survey of Activities and Fear of Falling in the Elderly (SAFE), is a reliable (α = 0.95) and valid (r = 0.91) questionnaire for evaluating activity level, fear of falling, and activity restriction. SAFE assesses 11 community-based and home-based activities. SAFE is scored as the following: Activity level is scored as the number of activities being done. Maximum score is 11 and higher scores indicate a higher activity level. The fear of falling score is computed as the average worry scores across the 11 activities (or across as many of the activities that are done, i.e., if yes to A). Each activity is scored in the range 0 to 3 by recoding the answer. The recoding is described as 0=4 (Not at all worried), 1=3 (A little worried), 2=1 (Somewhat worried) and 3=1 (Very worried). In totally, higher scores indicate a greater fear of falling. Activity restriction is scored by counting the number of activities which is responded "less than you used to".	Baseline (First assessment)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Survey of Activities and Fear of Falling in the Elderly	The Survey of Activities and Fear of Falling in the Elderly (SAFE), is a reliable (α = 0.95) and valid (r = 0.91) questionnaire for evaluating activity level, fear of falling, and activity restriction. SAFE assesses 11 community-based and home-based activities. SAFE is scored as the following: Activity level is scored as the number of activities being done. Maximum score is 11 and higher scores indicate a higher activity level. The fear of falling score is computed as the average worry scores across the 11 activities (or across as many of the activities that are done, i.e., if yes to A). Each activity is scored in the range 0 to 3 by recoding the answer. The recoding is described as 0=4 (Not at all worried), 1=3 (A little worried), 2=1 (Somewhat worried) and 3=1 (Very worried). In totally, higher scores indicate a greater fear of falling. Activity restriction is scored by counting the number of activities which is responded "less than you used to".	Within a 5-to-7-day period after the first assessment (Second assessment)
Falls Efficiency Scale-International	Falls Efficiency Scale-International (FES-I) is a 16-item self-administered questionnaire that was designed to assess fear of falling in community-dwelling older people. It provides information on the level of concern about falls during daily living activities. Each item is rated on a four-point scale, where 1=not at all concerned, 2=somewhat concerned, 3=fairly concerned, and 4=very concerned. The total score ranges from 16 (no concern about falling) to 64 (extreme concern about falling). The Turkish version of FES-I (FES-T), which was previously reported as a reliable (α = 0.94) and valid (r = - 0.83) instrument, was used in the present study.	Baseline (First assessment)
History of Fall	Frequency of falls in the last six months was questioned.	Baseline (First assessment)
Leg Pain	Presence of leg pain at rest and during activity was questioned.	Baseline (First assessment)

Collaborators and Investigators

• Sponsor: Istanbul University-Cerrahpasa
• Investigators: Study Director: Burcu Ersoz Huseyinsinoglu, PhD, Istanbul University-Cerrahpasa

Publications and helpful links

General Publications

• Lachman ME, Howland J, Tennstedt S, Jette A, Assmann S, Peterson EW. Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE). J Gerontol B Psychol Sci Soc Sci. 1998 Jan;53(1):P43-50. doi: 10.1093/geronb/53b.1.p43.
• Allison LK, Painter JA, Emory A, Whitehurst P, Raby A. Participation restriction, not fear of falling, predicts actual balance and mobility abilities in rural community-dwelling older adults. J Geriatr Phys Ther. 2013 Jan-Mar;36(1):13-23. doi: 10.1519/JPT.0b013e3182493d20.
• Yardley L, Smith H. A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist. 2002 Feb;42(1):17-23. doi: 10.1093/geront/42.1.17.
• Gazibara T, Kurtagic I, Kisic-Tepavcevic D, Nurkovic S, Kovacevic N, Gazibara T, Pekmezovic T. Falls, risk factors and fear of falling among persons older than 65 years of age. Psychogeriatrics. 2017 Jul;17(4):215-223. doi: 10.1111/psyg.12217. Epub 2017 Jan 27.
• Ersoz Huseyinsinoglu B, Tufekcioglu Z, Birinci T, Demirdag F. The Reliability and Validity of the Turkish Version of the Survey of Activities and Fear of Falling in the Elderly. J Geriatr Phys Ther. 2021 Apr-Jun 01;44(2):E132-E137. doi: 10.1519/JPT.0000000000000260.

Study record dates

Study Major Dates

• Study Start (Actual): January 22, 2018
• Primary Completion (Actual): April 22, 2018
• Study Completion (Actual): July 22, 2018

Study Registration Dates

• First Submitted: October 22, 2019
• First Submitted That Met QC Criteria: October 23, 2019
• First Posted (Actual): October 25, 2019

Study Record Updates

• Last Update Posted (Actual): October 25, 2019
• Last Update Submitted That Met QC Criteria: October 23, 2019
• Last Verified: October 1, 2019

More Information

Terms related to this study

• Keywords: psychometrics; accidental falls; activity restriction; fear of falling; participation restriction
• Additional Relevant MeSH Terms: Pathologic Processes; Frailty
• Other Study ID Numbers: 287826

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No