Relationship between fall-related efficacy and activity engagement in community-dwelling older adults: a meta-analytic review

Stacey Schepens, Ananda Sen, Jane A Painter, Susan L Murphy, Stacey Schepens, Ananda Sen, Jane A Painter, Susan L Murphy

Abstract

Objective: Fear of falling can lead to restricted activity, but little is known about how this fear affects different aspects of people's lives. This study examined the relationship between fall-related efficacy (i.e., confidence or belief in one's ability to perform activities without losing balance or falling) and activity and participation.

Method: We conducted a meta-analysis of studies comparing community-dwelling older adults' fall-related efficacy to measures of activity or participation.

Results: An examination of 20 cross-sectional and prospective studies found a strong positive relationship between fall-related efficacy and activity (r = .53; 95% CI [.47, .58]). An insufficient number of studies examining fall-related efficacy and participation were available for analysis.

Conclusion: Low fall-related efficacy may be an important barrier to occupational engagement for many older adults and warrants careful consideration by occupational therapists. Future research should explore interventions that target fall-related efficacy and examine their effects on activity performance and engagement.

Copyright © 2012 by the American Occupational Therapy Association, Inc.

Figures

Figure 1. Selection process of studies considered…
Figure 1. Selection process of studies considered for and included in the meta-analysis
Note. ABC = Activities-specific Balance Confidence scale; FES = Falls Efficacy Scale.
Figure 2. Forest plot depicting the average…
Figure 2. Forest plot depicting the average r value and associated 95% confidence interval from 20 distinct studies, as well as the pooled r value

References

    1. American Occupational Therapy Association. Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy. (2) 2008;62:625–683. .
    1. Anaby D, Miller WC, Eng JJ, Jarus T, Noreau L PACC Research Group. Can personal and environmental factors explain participation of older adults? Disability and Rehabilitation. 2009;31:1275–1282. .
    1. Ashe MC, Eng JJ, Miller WC, Soon JA. Disparity between physical capacity and participation in seniors with chronic disease. Medicine and Science in Sports and Exercise. 2007;39:1139–1146. .
    1. Bandura A. Self-efficacy mechanism in human agency. American Psychologist. 1982;37:122–147. .
    1. Bandura A. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall; 1986.
    1. Bandura A. Self-efficacy: The exercise of control. New York: W. H. Freeman; 1997.
    1. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–1101. .
    1. Bergland A, Wyller TB. Risk factors for serious fall related injury in elderly women living at home. Injury Prevention. 2004;10:308–313. .
    1. Berkman LF, Seeman TE, Albert M, Blazer D, Kahn R, Mohs R, et al. High, usual, and impaired functioning in community-dwelling older men and women: Findings from the MacArthur Foundation Research Network on Successful Aging. Journal of Clinical Epidemiology. 1993;46:1129–1140. .
    1. Binda SM, Culham EG, Brouwer B. Balance, muscle strength, and fear of falling in older adults. Experimental Aging Research. 2003;29:205–219. .
    1. Boyd R, Stevens JA. Falls and fear of falling: Burden, beliefs and behaviours. Age and Ageing. 2009;38:423–428. .
    1. Brouwer B, Musselman K, Culham E. Physical function and health status among seniors with and without a fear of falling. Gerontology. 2004;50:135–141. .
    1. Cho BL, Scarpace D, Alexander NB. Tests of stepping as indicators of mobility, balance, and fall risk in balance-impaired older adults. Journal of the American Geriatrics Society. 2004;52:1168–1173. .
    1. Chou KL, Yeung FK, Wong EC. Fear of falling and depressive symptoms in Chinese elderly living in nursing homes: Fall efficacy and activity level as mediator or moderator. Aging and Mental Health. 2005;9:255–261. .
    1. Cochran WG. The combination of estimates from different experiments. Biometrics. 1954;10:101–129.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2. New York: Erlbaum; 1988.
    1. Cumming RG, Salkeld G, Thomas M, Szonyi G. Prospective study of the impact of fear of falling on activities of daily living, SF–36 scores, and nursing home admission. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences. 2000;55A:299–305. .
    1. Curcio CL, Gomez F, Reyes-Ortiz CA. Activity restriction related to fear of falling among older people in the Colombian Andes mountains: Are functional or psychosocial risk factors more important? Journal of Aging and Health. 2009;21:460–479. .
    1. Delbaere K, Close JC, Brodaty H, Sachdev P, Lord SR. Determinants of disparities between perceived and physiological risk of falling among elderly people: Cohort study. British Medical Journal. 2010;341:c4165.
    1. Deshpande N, Metter EJ, Bandinelli S, Lauretani F, Windham BG, Ferrucci L. Psychological, physical, and sensory correlates of fear of falling and consequent activity restriction in the elderly: The InCHIANTI study. American Journal of Physical Medicine and Rehabilitation. 2008;87:354–362. .
    1. Deshpande N, Metter EJ, Lauretani F, Bandinelli S, Guralnik J, Ferrucci L. Activity restriction induced by fear of falling and objective and subjective measures of physical function: A prospective cohort study. Journal of the American Geriatrics Society. 2008;56:615–620. .
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634.
    1. Fisher BJ. Successful aging, life satisfaction, and generativity in later life. International Journal of Aging and Human Development. 1995;41:239–250. .
    1. Fisher RA. Frequency distribution of the values of the correlation coefficient in samples of an indefinitely large population. Biometrika. 1915;10:507–521.
    1. Fletcher PC, Guthrie DM, Berg K, Hirdes JP. Risk factors for restriction in activity associated with fear of falling among seniors within the community. Journal of Patient Safety. 2010;6:187–191.
    1. Fletcher PC, Hirdes JP. Restriction in activity associated with fear of falling among community-based seniors using home care services. Age and Ageing. 2004;33:273–279. .
    1. Friedman SM, Munoz B, West SK, Rubin GS, Fried LP. Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. Journal of the American Geriatrics Society. 2002;50:1329–1335. .
    1. Gagnon N, Flint AJ, Naglie G, Devins GM. Affective correlates of fear of falling in elderly persons. American Journal of Geriatric Psychiatry. 2005;13:7–14.
    1. Giladi N, Herman T, Reider-Groswasser II, Gurevich T, Hausdorff JM. Clinical characteristics of elderly patients with a cautious gait of unknown origin. Journal of Neurology. 2005;252:300–306. .
    1. Grembowski D, Patrick D, Diehr P, Durham M, Beresford S, Kay E, et al. Self-efficacy and health behavior among older adults. Journal of Health and Social Behavior. 1993;34:89–104. .
    1. Hatch J, Gill-Body KM, Portney LG. Determinants of balance confidence in community-dwelling elderly people. Physical Therapy. 2003;83:1072–1079.
    1. Hedges LV, Olkin I. Statistical methods for metaanalysis. Orlando, FL: Academic Press; 1985.
    1. Herman T, Inbar-Borovsky N, Brozgol M, Giladi N, Hausdorff JM. The Dynamic Gait Index in healthy older adults: The role of stair climbing, fear of falling and gender. Gait and Posture. 2009;29:237–241. .
    1. Hotchkiss A, Fisher A, Robertson R, Ruttencutter A, Schuffert J, Barker DB. Convergent and predictive validity of three scales related to falls in the elderly. American Journal of Occupational Therapy. 2004;58:100–103. .
    1. Howland J, Lachman ME, Peterson EW, Cote J, Kasten L, Jette A. Covariates of fear of falling and associated activity curtailment. Gerontologist. 1998;38:549–555. .
    1. Inderjeeth CA, Glennon D, Petta A, Soderstrom J, Boyatzis I, Tapper J. Vitamin D and muscle strength in patients with previous fractures. New Zealand Medical Journal. 2007;120:U2730.
    1. Jørstad EC, Hauer K, Becker C, Lamb SE ProFaNE Group. Measuring the psychological outcomes of falling: A systematic review. Journal of the American Geriatrics Society. 2005;53:501–510. .
    1. Kato C, Ida K, Kawamura M, Nagaya M, Tokuda H, Tamakoshi A, et al. Relation of Falls Efficacy Scale (FES) to quality of life among nursing home female residents with comparatively intact cognitive function in Japan. Nagoya Journal of Medical Science. 2008;70:19–27.
    1. Kempen GI, van Haastregt JC, McKee KJ, Delbaere K, Zijlstra GA. Socio-demographic, health-related and psychosocial correlates of fear of falling and avoidance of activity in community-living older persons who avoid activity due to fear of falling. BMC Public Health. 2009;9:170. .
    1. Kielhofner G. A model of human occupation: Theory and application. 4. Philadelphia: Lippincott Williams & Wilkins; 2008.
    1. 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) Journals of Gerontology, Series B: Psychological Sciences. 1998;53B:43–50. .
    1. Lent RW, Brown SD, Larkin KC. Relation of self-efficacy expectations to academic achievement and persistence. Journal of Counseling Psychology. 1984;31:356–362. .
    1. Li F, Harmer P, McAuley E, Fisher KJ, Duncan TE, Duncan SC. Tai chi, self-efficacy, and physical function in the elderly. Prevention Science. 2001;2:229–239. .
    1. Li F, McAuley E, Fisher KJ, Harmer P, Chaumeton N, Wilson NL. Self-efficacy as a mediator between fear of falling and functional ability in the elderly. Journal of Aging and Health. 2002;14:452–466. .
    1. Liu-Ambrose T, Katarynych LA, Ashe MC, Nagamatsu LS, Hsu CL. Dual-task gait performance among community-dwelling senior women: The role of balance confidence and executive functions. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences. 2009;64A:975–982. .
    1. Lorig KR, Holman H. Self-management education: History, definition, outcomes, and mechanisms. Annals of Behavioral Medicine. 2003;26:1–7. .
    1. Maki BE, Holliday PJ, Topper AK. Fear of falling and postural performance in the elderly. Journal of Gerontology, Series B: Biological Sciences and Medical Sciences. 1991;46B:123–131.
    1. Masud T, Morris RO. Epidemiology of falls. Age and Ageing. 2001;30(Suppl 4):3–7. .
    1. McAuley E, Konopack JF, Morris KS, Motl RW, Hu L, Doerksen SE, et al. Physical activity and functional limitations in older women: Influence of self-efficacy. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences. 2006;61B:270–277.
    1. McAuley E, Mihalko S, Rosengren K. Self-efficacy and balance correlates of fear of falling in the elderly. Journal of Aging and Physical Activity. 1997;5:329–340.
    1. McKee KJ, Orbell S, Austin CA, Bettridge R, Liddle BJ, Morgan K, et al. Fear of falling, falls efficacy, and health outcomes in older people following hip fracture. Disability and Rehabilitation. 2002;24:327–333. .
    1. Medell JL, Alexander NB. A clinical measure of maximal and rapid stepping in older women. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences. 2000;55A:429–433. .
    1. Moore DS, Ellis R. Measurement of fall-related psychological constructs among independent-living older adults: A review of the research literature. Aging and Mental Health. 2008;12:684–699. .
    1. Murphy SL, Williams CS, Gill TM. Characteristics associated with fear of falling and activity restriction in community-living older persons. Journal of the American Geriatrics Society. 2002;50:516–520. .
    1. Myers AM, Powell LE, Maki BE, Holliday PJ, Brawley LR, Sherk W. Psychological indicators of balance confidence: Relationship to actual and perceived abilities. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences. 1996;51A:37–43. .
    1. Peterson E, Howland J, Kielhofner G, Lachman ME, Assmann S, Cote J, et al. Falls self-efficacy and occupational adaptation among elders. Physical and Occupational Therapy in Geriatrics. 1999;16:1–16.
    1. Peterson E, Kielhofner G, Tham K, von Koch L. Falls self-efficacy among adults with MS: A phenomenological study. OTJR: Occupation, Participation and Health. 2010;30:148–157. .
    1. Powell LE, Myers AM. The Activities-specific Balance Confidence (ABC) scale. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences. 1995;50A:28–34. .
    1. Rosengren KS, McAuley E, Mihalko SL. Gait adjustments in older adults: Activity and efficacy influences. Psychology and Aging. 1998;13:375–386. .
    1. Rubenstein LZ. Falls in older people: Epidemiology, risk factors and strategies for prevention. Age and Ageing. 2006;35(Suppl 2):ii37–ii41. .
    1. Schepens S, Goldberg A, Wallace M. The short version of the Activities-specific Balance Confidence (ABC) scale: Its validity, reliability, and relationship to balance impairment and falls in older adults. Archives of Gerontology and Geriatrics. 2010;51:9–12. .
    1. Sharpe D. Of apples and oranges, file drawers and garbage: Why validity issues in meta-analysis will not go away. Clinical Psychology Review. 1997;17:881–901. .
    1. Sihvonen S, Kulmala J, Kallinen M, Alén M, Kiviranta I, Sipila S. Postural balance and self-reported balance confidence in older adults with a hip fracture history. Gerontology. 2009;55:630–636. .
    1. Skelton DA, Becker C, Lamb SE, Close J, Zijlstra W, Yardley L, et al. Prevention of Falls Network Europe: A thematic network aimed at introducing good practice in effective falls prevention across Europe. European Journal of Ageing. 2004;1:89–94. .
    1. Stajkovic AD, Luthans F. Self-efficacy and work-related performance: A meta-analysis. Psychological Bulletin. 1998;124:240–261. .
    1. Steultjens MP, Dekker J, Bijlsma JW. Coping, pain, and disability in osteoarthritis: A longitudinal study. Journal of Rheumatology. 2001;28:1068–1072.
    1. Talley KM, Wyman JF, Gross CR. Psychometric properties of the Activities-specific Balance Confidence scale and the Survey of Activities and Fear of Falling in Older Women. Journal of the American Geriatrics Society. 2008;56:328–333. .
    1. Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A. A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. Journal of Gerontology, Series B: Psychological Sciences and Social Sciences. 1998;53B:384–392.
    1. Tinetti ME, Mendes de Leon CF, Doucette JT, Baker DI. Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. Journal of Gerontology. 1994;49:M140–M147.
    1. Tinetti ME, Powell L. Fear of falling and low self-efficacy: A case of dependence in elderly persons. Journal of Gerontology. 1993;48:35–38.
    1. Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. Journal of Gerontology. 1990;45:239–243.
    1. Whiteneck G, Dijkers MP. Difficult to measure constructs: Conceptual and methodological issues concerning participation and environmental factors. Archives of Physical Medicine and Rehabilitation. 2009;90(Suppl):S22–S35. .
    1. Wilson MM, Miller DK, Andresen EM, Malmstrom TK, Miller JP, Wolinsky FD. Fear of falling and related activity restriction among middle-aged African Americans. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences. 2005;60A:355–360. .
    1. World Health Organization. Towards a common language for functioning, disability, and health. 2002 Retrieved October 18, 2010, from .
    1. Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the Falls Efficacy Scale–International (FES–I) Age and Ageing. 2005;34:614–619. .
    1. Zijlstra GA, van Haastregt JC, van Eijk JT, van Rossum E, Stalenhoef PA, Kempen GI. Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age and Ageing. 2007;36:304–309. .

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera