Transient versus persistent fear of falling in community-dwelling older adults: incidence and risk factors

Mooyeon Oh-Park, Xiaonan Xue, Roee Holtzer, Joe Verghese, Mooyeon Oh-Park, Xiaonan Xue, Roee Holtzer, Joe Verghese

Abstract

Objectives: To investigate the incidence of fear of falling (FOF) and the risk factors associated with transient versus persistent FOF in community-dwelling older adults.

Design: Prospective cohort study.

Setting: Bronx County, New York.

Participants: Three hundred eighty participants without FOF at baseline in the Einstein Aging Study aged 70 and older.

Measurements: FOF was assessed at baseline and during follow-up interviews at 2- to 3-month intervals for a minimum 2 years. Incident FOF was classified as transient or persistent FOF. Transient FOF was defined as new-onset FOF reported at only one interview, and persistent FOF was FOF reported at two or more interviews over a 2-year period.

Results: Twenty-four-month cumulative incidence of incident FOF was 45.4%, with 60.0% of FOF being persistent. Predictors of incident FOF included female sex (adjusted hazard ratio (aHR)=1.55, 95% confidence interval (CI)=1.08-2.23), depressive symptoms (aHR=1.16, 95% CI=1.07-1.26), falls (aHR=1.50, 95% CI=1.01-2.21), and clinical gait abnormality (aHR=2.07, 95% CI=1.42-3.01). The proportion of participants with incident FOF increased linearly with increasing number of risk factors. Predictors for transient and persistent FOF were depressive symptoms and clinical gait abnormality. Female sex and previous falls were predictors of persistent but not transient FOF.

Conclusion: FOF status in older adults may change over time, with shared and distinct risk factors for persistent and transient FOF. Understanding the dynamic nature of FOF and these risk factors will help identify high-risk groups and design future intervention studies.

Conflict of interest statement

Conflict of Interest: Mooyeon Oh-Park is an Einstein Men’s Division Scholar partially supported through a National Institutes of Health (NIH) Clinical and Translational Science Award (Grant UL1 RR025750 and KL2RR025749) from the National Center for Research Resources, a component of the NIH, and NIH roadmap for Medical Research. Roee Holtzer is supported by a Paul B. Beeson Award from the National Institute on Aging (NIA-K23 AG030857). The Einstein Aging Study (PI: R.B. Lipton, MD) is funded by NIA Grant AG03949. Dr. Verghese is funded by NIA Grant RO1 AG025119.

© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

Figures

Figure 1
Figure 1
Cumulative percentage of participants developing incident fear of falling (FOF) in those with and without each of four risk factors. (A) Female versus male. (B) Geriatric Depression Scale (GDS) score

Figure 2

Occurrence of fear of falling…

Figure 2

Occurrence of fear of falling (FOF) according to FOF risk score (sum of…

Figure 2
Occurrence of fear of falling (FOF) according to FOF risk score (sum of the number of risk factors: female sex, Geriatric Depression Scale score ≥3, clinical gait abnormality, and falls during past 1 year) at baseline in participants with 2-year follow-up. Significant trend noted in the chi-square test for order in proportions for incident FOF (chi-square = 24.2; P<.001) and for persistent FOF (chi-square = 25.4; P<.001).
Figure 2
Figure 2
Occurrence of fear of falling (FOF) according to FOF risk score (sum of the number of risk factors: female sex, Geriatric Depression Scale score ≥3, clinical gait abnormality, and falls during past 1 year) at baseline in participants with 2-year follow-up. Significant trend noted in the chi-square test for order in proportions for incident FOF (chi-square = 24.2; P<.001) and for persistent FOF (chi-square = 25.4; P<.001).

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