Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy

Abstract

Background: Patients with diabetic peripheral neuropathy (DPN) demonstrate gait alterations compared with their nonneuropathic counterparts, which may place them at increased risk for falling. However, it is uncertain whether patients with DPN also have a greater fear of falling.

Methods: A voluntary group of older adults with diabetes was asked to complete a validated fear of falling questionnaire (Falls Efficacy Scale International [FES-I]) and instructed to walk 20 m in their habitual shoes at their habitual speed. Spatiotemporal parameters of gait (eg, stride velocity and gait speed variability) were collected using a validated body-worn sensor technology. Balance during walking was also assessed using sacral motion in the mediolateral and anteroposterior directions. The level of DPN was quantified using vibration perception threshold from the great toe.

Results: Thirty-four diabetic patients (mean ± SD: age, 67.6 ± 9.2 years; body mass index, 30.9 ± 5.7; hemoglobin A1c, 7.9% ± 2.3%) with varying levels of neuropathy (mean ± SD vibration perception threshold, 34.6 ± 22.9 V) were recruited. Most participants (28 of 34, 82%) demonstrated moderate to high concern about falling based on their FES-I score. Age (r = 0.6), hemoglobin A1c level (r = 0.39), number of steps required to reach steady-state walking (ie, gait initiation) (r = 0.4), and duration of double support (r = 0.44) were each positively correlated with neuropathy severity (P < .05). Participants with a greater fear of falling also walked with slower stride velocities and shorter stride lengths (r = -0.3 for both, P < .05). However, no correlation was observed between level of DPN and the participant's actual concern about falling.

Conclusions: Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy.

Conflict of interest statement

Conflict of Interest: Guest editor, Bijan Najafi, PhD, was not involved in the review and acceptance of this paper.

Figures

Figure 1

LEGSys portable wearable gait analyzer system with sensors attached via straps.

Figure 2

Associations between neuropathy severity quantified by the vibration perception threshold and age (A), hemoglobin A1c (HbA1c) level (B), number of steps required to achieve steady-state walking (C), and double support (D).

Figure 3

Scatterplot demonstrating the lack of association between fear of falling (Falls Efficacy Scale International [FES-I] scores) and vibration perception threshold values (level of neuropathy). The shaded area identifies participants in the diabetic peripheral neuropathy (DPN) group.

Figure 4

Associations between fear of falling (Falls Efficacy Scale International [FES-I] scores) and stride velocity (A) and stride length (B).