1. ABSTRACTDISCUSSION REFERENCES METHODS & INSTRUMENTATION Fear of Falling and Activity Restriction among Community-Dwelling Older Adults PO 6025 Jane A. Painter, EdD, OTR/L, FAOTA & Leonard G. Trujillo, PhD., OTR/L, FAOTA Department of Occupational Therapy East Carolina University College of Allied Health Sciences Greenville, North Carolina 27858 252.744.6199 painterj@ecu.edu trujillol@ecu.edu INTRODUCTION 1 Painter, J. A., Allison, L., Dhingra, P., Daughtery, J., Cogdill, K., & Trujillo, L. G. (2012). Fear of falling and its relationship with anxiety, depression, and activity engagement among community- dwelling older adults. AJOT, 66, 169–176. 2 World Health Organization. (2010). Falls: Fact sheet No. 344. Retrieved November 15, 2010 from www.who.int/media centre/factsheets/fs344/en/index.html 3 Boyd, R., & Stevens, J. A. (2009). Falls and fear of falling: Burden, beliefs and behaviours. Age and Ageing, 38, 423–428. 4 Lachman, E., Howland, J., Tennstedt, S., Jette, A., Assmann, S., & Peterson, E. (1998). Fear of falling and activity restriction: The Survey of Activities and Fear of Falling in the Elderly (SAFE). J of Gerona, Series B: 53B, 43–50. 5 Yesavage, J. A., Brink, J. A., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 37–49. 6 Hamilton, A. (1969). Diagnosis and rating of anxiety. British Journal of Psychiatry Special Publication, 3, 76–79. Findings from the current research offer new insights regarding the interrelationship between FOF & activity level, FOF & depression, and FOF & anxiety. Current results suggest the importance of addressing anxiety and depression in relation to FOF and activity level. A strength of the current research relates to using the SAFE assessment since it does not require estimation activity performance a person does not do. Our findings, coupled with those of past research suggest that older adults who were more actively engaged in ADLs and IADLS had a lower FOF, less depression, and lower anxiety. Conversely, participants who were more fearful, depressed, and anxious restricted their activity level. In summary, OT practice implications include the following considerations: A person can develop a FOF whether or not a fall has occurred. Anxiety has been found to cause a fear of falling. Fear of falling can lead to increased fall risk, decreased motivation, and decreased perceptions of capabilities, all of which can then lead to self-imposed activity restriction. Occupational therapy practitioners should assess for FOF and anxiety for older adults who display anxiety and decreased motivation to perform functional activities. A fall is an unintentional, sudden change in body position resulting in contact with the ground in the absence of an external force or intrinsic event. 2 FOF, a concomitant psychological symptom, is an constant worry about falling; it is increasingly identified among community-dwelling older adults who have and have not fallen. 3 FOF can lead to increased fall risk, decreased quality of life, & activity restriction (20-60%). 3 Older adults who have FOF have the highest level of depression (37.5%). Little research has been done to explore relationship between FOF and anxiety. FOF creates a vicious downward spiral of physical and occupational performance and activity restriction. This study examined the relationship between FOF with anxiety, depression, and activity engagement among community-dwelling older adults. 1 The Survey of Activities and FOF in the Elderly 4 ; the Geriatric Depression Scale–30 5 ; & the Hamilton Anxiety Scale, IVR 6 during a one-time, two hour appointment with 99 community-dwelling adults ≥ 55 yr old from 7 community centers and 1 apartment complex in eastern rural North Carolina. Participant Demographics This study examined the relationship of fear of falling (FOF) to depression, anxiety, activity level, and activity restriction & whether depression or anxiety predicted FOF, activity level, activity restriction, or changes in activity level. Significant relationships were found between FOF & depression, anxiety, & activity level; depression & anxiety; and activity restriction & depression. Activity level was negatively correlated with activity restriction, FOF, depression, & anxiety. Anxiety predicted both FOF & activity level. Both anxiety & depression predicted activity restriction because of fear of falling and for other reasons. OT practitioners should consider screening older adult clientele for FOF, anxiety, & depression since they may lead to fall risk and activity restriction. 1 RESULTS Table Relationships Between Fear of Falling, Depression and Anxiety (N=99) Variable12345 1. SAFE A. Activity Level r--.210*-.529*-.299**-.280** p-.037.000.003.005 2. SAFE B. Fear of Falling r-.210*-.189.381**.401** p.037-.060.000 3. SAFE F. Activity Restriction r-.529**0189-.205*.185 p.000.060-.041.075 4.GDS Score r-.299.381**.205*-.679** p.003.000.041-.000 5. HAMA Score r-.280**.401**.180.679**- p.005.000.075.000- Note. GDS = Geriatric Depression Scale - 30: HAMA = Hamilton Anxiety Scale, IVR Version SAFE= Survey of Activities and Fear of Falling in the elderly *p ≤.05 (2 tailed). ** p ≤.01 level (2 tailed) Prediction of Individual SAFE Items by Anxiety and Depression ANOV A Standardized Coefficient βtp Predicted SAFE ItemdfFp A. Activity Level GDS24.697.011-0.051-0.400.690 HAMA24.697.011-.263-2.065.042 B. Fear of Falling GDS2 13.60 5<.0010.14710246.216 HAMA2 13.60 5<.0010.3623.069.003 C. Not done for reasons other than fear of falling GDS22.087.1300.0560.427.671 HAMA22.087.130-0.236-1.802.075 D. Not done for reasons in addition to fear of falling GDS2 16.91 1<.0010.2942.563.012 HAMA2 16.91 1<.0010.2692.339.021 F. Activity restriction GDS20.949.3910.0080.057.955 HAMA20.949.3910.1341.016.312 NOTE: Significance levels set at ≤.05; all significant findings are in BOLD. ANNOVA = analysis of variance; GDS = Geriatric Depression Scale-30; HAMA = Hamilton Anxiety Scal, IVR Version; SAFE = Survey of Activities and Fear of Falling in the elderly. Sample Characteristics (N=99) Measuren% Demographics Age73.7 Female82 Male17 Fall Experience Experienced a fall32 Experienced injury from a fall40 HAMA - Feelings of Anxiety Normal55 Mild76 Moderate14 Severe44 GDS- Feelings of Depression Normal84 Mild10 Severe11 SAFE - Activity Level 10-11 Activities34 9 Activities26 7-8 Activities20 5-6 Activities14 1-4 Activities55 SAFE- Fear of Falling No Fear of Falling61 Mild fear of Falling 28 Moderate Fear of Falling77 Severe Fear of Falling33 Significant Relationship Between FOF, Depression, & Anxiety