Older Adults’ Psychosocial Responses to a Fear of Falling: A Scoping Review to Inform Occupational Therapy Practice

Abstract

Falls in older adults are a major health concern, yet the “fear of falling”, a common psychosocial response that can occur post-fall, has seldom been investigated. A scoping review was conducted to identify and map interventions that occupational therapists can use to manage the fear of falling psychosocial response (FoFPR) among older adults. Thirteen electronic databases were searched and 22 studies were retrieved. Cognitive behavioral therapy, guided imagery, and Tai Chi were interventions found to help older adults deal with their FoFPRs. Occupational therapists assisting older adults in this area can play a significant role.     

Personality and performance: A comparative analysis of workers in transition economies

We use data collected from employees in five transition economies to study whether locus of control and preference for challenge versus affiliation are positively related to worker performance. We find that earnings are positively related to the internal locus of control and preference for challenge among participants of the Armenian and Serbian surveys. In the Russian sample, earnings tend to be higher among workers with a more internal locus of control. Earnings are not systematically related to personality in Kazakhstan and Kyrgyzstan. For most countries, self-reported performance tends to be significantly higher among workers with preference for challenge. Generally, the size of the personality effect on performance is at least as great as the effect of experience or education. Although more research needs to be done before final conclusions about the causes of cross-country differences can be made, we argue that variation in personality effects across countries may be influenced by level of economic development, degree of market-orientation, and cultural diversity.     

The protective role of higher intellectual functioning on violence in the household population of Great Britain

Despite compelling evidence of the effect of intelligence on delinquency and violent crime, there is limited data on its impact on population violence. We aimed to determine the association of categories of intelligence with violent behaviors in the general population and the extent of the impact of social class on these associations. A randomly selected sample of 14,738 individuals was derived from 2 British national surveys of adults aged 16 years and older. We measured self-reported violent behavior in the past 5 years, including: repetition, injury, violence while intoxicated, familial and extra-familial victim types and intimate partner violence. We examined the moderating role of social class on all outcomes. The increased risk of violence among persons of below average IQ was explained by social class at population level. High IQ had an overall protective effect on all outcomes except violence towards family members, irrespective of socio-economic circumstances. Social class moderated the association of IQ with violence by decreasing its protective effect among those in the lowest socio-economic positions. Our findings suggest that the association of IQ and violence is not linear but protective on population level. Social class has both an explaining and a moderating role in this association.     

The Effect of External and Internal Focus of Attention on Gait Variability in Older Adults

Internal focus of attention on a movement or focusing on an external target are both strategies that can affect motor performance. The authors explored whether manipulating subjects' focus of attention while walking would alter gait variability, a measure reflecting consistency of gait and associated with the risk of falling in older adults. Twenty community-living older adults participated in the study and were tested while focusing their attention on (a) gait consistency (internal focus) or (b) metronome beats (external focus). In both conditions gait variability increased (i.e., worsened p < .05) or did not change. No benefit was found in instructing subjects to focus on gait consistency or metronome beats. Such instructions may actually have distracted and interfered with the execution of gait.     

Performance of Faller and Nonfaller Older Adults on a Motor–Motor Interference Task

Typically, falls in older adults occur when 2 tasks are performed simultaneously, due to the increased motor demand required to maintain stability and attention to perform the other task. The authors' purpose was to investigate walking while grasping, transporting, and placing a dowel on a predetermined target while manipulating difficulty levels of the manual task. Faller and nonfaller older adults performed a walking block (manual tasks combined with gait) and a stationary block (upright stance combined with manual tasks). The manual task involved grasping, transporting, and placing the dowel over a target. The results showed that fallers underperformed when compared with nonfallers in the task of placing the dowel over the target. The main difference observed between the groups was found in the condition that required allocation of attention between tasks and greater accuracy in the final placement of the object. Fallers showed gait stability similar to the nonfallers, but fallers were less accurate than nonfallers in the object placement task, especially for the highest level of difficulty. Thus, fallers seem to use a stability-first strategy. Fallers had problems in executing the manual tasks, which suggests a more global change in motor behavior rather than specific changes to balance control.     

An international comparative study of self-reported driver behavior

Using a large data base of 20,725 questionnaires from 19 European countries, this article uses a combination of factor analysis and tree based regression to determine driver groups with homogeneous self-reported behavior and determine whether regional differences in driving behaviors exist. Self-reported behavior, including speeding, reckless driving, seat belt use, and drinking and driving are examined. The results suggest that speeding and general reckless (dangerous) behavior are related, perhaps capturing a driver's “risk taking” or “pre-trip violations” behavior. Similarly, seat belt use and driving under the influence of alcohol are also related and may represent a driver's “law abiding” tendency or “during-trip violations” behavior. Further, important regional differences and similarities between European drivers are uncovered. Northern European drivers report a significantly higher compliance with drinking and driving laws and seat belt use regulations than do Southern and Eastern European drivers.     

The effect of a non-steroidal anti-inflammatory drug on two important predictors for accidental falls: Postural balance and manual reaction time. A randomized, controlled pilot study

Accidental falls in older individuals are a major health and research topic. Increased reaction time and impaired postural balance have been determined as reliable predictors for those at risk of falling and are important functions of the central nervous system (CNS). An essential risk factor for falls is medication exposure. Amongst the medications related to accidental falls are the non-steroidal anti-inflammatory drugs (NSAIDs). About 1-10% of all users experience CNS side effects. These side effects, such as dizziness, headaches, drowsiness, mood alteration, and confusion, seem to be more common during treatment with indomethacin. Hence, it is possible that maintenance of (static) postural balance and swift reactions to stimuli are affected by exposure to NSAIDs, indomethacin in particular, consequently putting older individuals at a greater risk for accidental falls. The present study investigated the effect of a high indomethacin dose in healthy middle-aged individuals on two important predictors of falls: postural balance and reaction time. Twenty-two healthy middle-aged individuals (59.5 ± 4.7 years) participated in this double-blind, placebo-controlled, randomized crossover trial. Three measurements were conducted with a week interval each. A measurement consisted of postural balance as a single task and while concurrently performing a secondary cognitive task and reaction time tasks. For the first measurement indomethacin 75 mg (slow-release) or a visually identical placebo was randomly assigned. In total, five capsules were taken orally in the 2.5 days preceding assessment. The second measurement was without intervention, for the final one the first placebo group got indomethacin and vice versa. Repeated measures GLM revealed no significant differences between indomethacin, placebo, and baseline in any of the balance tasks. No differences in postural balance were found between the single and dual task conditions, or on the performance of the dual task itself. Similarly, no differences were found on the manual reaction time tasks. The present study showed that a high indomethacin dose does not negatively affect postural balance and manual reaction time in this healthy middle-aged population. Although the relatively small and young sample limits the direct ability to generalize the results to a population at risk of falling, the results indicate that indomethacin alone is not likely to increase fall risk, as far as this risk is related to abovementioned important functions of the CNS, and not affected by comorbidities.     

Intraindividual Variability of Neuromotor Function Predicts Falls Risk in Older Adults and those with Type 2 Diabetes

This study was designed to examine the effect of increasing age and type 2 diabetes on the average responses and inter- and intraindividual variability of falls risk, reaction time, strength, and walking speed for healthy older adults and older persons with type 2 diabetes (T2DM). Seventy-five older individuals (controls) and 75 persons with T2DM aged between 50 and 79 years participated in the study. Assessments of falls risk, reaction time (RT), knee extension strength, and walking speed were conducted. The results revealed that advancing age for both control and T2DM groups was reflected by a progressive increase in falls risk, decreased leg strength and a decline (i.e., slowing) of reactions and gait speed. Conversely, the level of intraindividual variability for the RT, strength and gait measures increased with increasing age for both groups, with T2DM persons tending to be more variable compared to the healthy controls of similar age. In contrast to the intraindividual changes, measures of interindividual variability revealed few differences between the healthy elderly and T2DM individuals. Taken together, the findings support the proposition that intraindividual variability of neuromotor measures may be useful as a biomarker for the early detection of decline in physiological function due to age or disease.     

Predicting interest in liposuction among women with eating problems: a population-based study

The purpose of this paper was to examine predictors of an interest in liposuction among women with eating problems. A questionnaire was sent to 3500 women aged 18-35 years, whereof 378 of 1861 responders screened positively on eating problems. Assessments included sociodemographic status, social network, physical exercise, attitudes towards cosmetic surgery, teasing history, body dysmorphic disorder-like symptoms, body image, self-esteem, personality, interpersonal attachment and emotional distress. Fifty-two percent reported an interest in liposuction, which was independently predicted by appearance orientation, appearance evaluation, being critical/quarrelsome, teasing history, wish for a better relationship with father, low education and being unmarried. Predictors differed somewhat from those previously found in the general population. Considering that our sample consisted of women with self-reported eating problems, the association between liposuction and eating behaviors should be further examined in a sample of patients with a formal eating disorder diagnosis.