Objectives: Falls can have detrimental effects on older adults' psychological well-being, physical health, and survival rates. However, certain psychosocial mediators may lessen the negative impact of suffering a fall on health and well-being. Perceived control is a psychosocial factor that was examined as a mediator of the falls – health and well-being relationship in the current study. Method: Participants were 232 community-dwelling older adults, age 68 or older who took part in a longitudinal study in 2008 and 2010 and completed measures of perceived control, self-rated health, health-care utilization, number of falls, depressive symptomology, and perceived stress. Survival was also tracked for seven years from 2008 through 2015. Results: Older adults who suffered a fall had poorer health and well-being two years later compared to those who did not suffer a fall. Perceived control mediated the negative impact of falls on subsequent health and well-being outcomes two years later. Among older adults who experienced a fall, higher levels of perceived control predicted better subsequent health and well-being. Suffering one or more falls also predicted less likelihood of survival seven years later,
(Edited publisher abstract)
Objectives: Falls can have detrimental effects on older adults' psychological well-being, physical health, and survival rates. However, certain psychosocial mediators may lessen the negative impact of suffering a fall on health and well-being. Perceived control is a psychosocial factor that was examined as a mediator of the falls – health and well-being relationship in the current study. Method: Participants were 232 community-dwelling older adults, age 68 or older who took part in a longitudinal study in 2008 and 2010 and completed measures of perceived control, self-rated health, health-care utilization, number of falls, depressive symptomology, and perceived stress. Survival was also tracked for seven years from 2008 through 2015. Results: Older adults who suffered a fall had poorer health and well-being two years later compared to those who did not suffer a fall. Perceived control mediated the negative impact of falls on subsequent health and well-being outcomes two years later. Among older adults who experienced a fall, higher levels of perceived control predicted better subsequent health and well-being. Suffering one or more falls also predicted less likelihood of survival seven years later, beyond the effects of age, gender, marital status, and education. Conclusion: Findings highlight the importance of assessing risk of falling and levels of perceived control in later life.
(Edited publisher abstract)
Health and Social Care in the Community, 23(6), 2015, p.594–604.
Publisher:
Wiley
The vast majority of elderly people in Sweden live in private homes in their communities for as long as possible. Poor health and a high risk of falls are very common among this group. This cross-sectional study investigates the association between falls and general health, appetite, dental health, and the use of multiple medications among home-dwelling men and women aged ≥75 years. Data were collected between October 2008 and March 2009 using a postal questionnaire. A total of 1243 people participated in the questionnaire survey (74% response rate), of which 1193 were included in the analysis. The majority of participants were women (n = 738, 62%). Falls in the previous 12-month period were reported by 434 (36%) participants. Most fallers (n = 276, 64%) were women. The majority of the fallers lived in a flat (n = 250, 58%). Poor health (aOR: 1.61; CI: 1.34–1.95), poor dental health (aOR: 1.22; CI: 1.07–1.39) and the use of four or more types of medication daily (aOR: 1.13; CI: 1.03–1.25) were significantly associated with falls in all participants. Poor dental health was found irrespectively of living in a flat (aOR: 1.23; CI: 1.04–1.46) or living in a house (aOR: 1.28; CI: 1.02–1.61), and both were significantly associated with falls. The use of more than four different types of medication daily (aOR: 1.25; CI: 1.11–1.41) was associated with falls for those living in a flat. The results highlight that falls are associated with poor general health, poor dental health and the use of four or more types of medication daily. Health professionals should provide health promotion education and investigate dental health and risk factors for oral disease. Likewise, medical and clinical practices of physicians and community care nurses should include assessing the risk of falling, and treatment that predisposes falls.
(Publisher abstract)
The vast majority of elderly people in Sweden live in private homes in their communities for as long as possible. Poor health and a high risk of falls are very common among this group. This cross-sectional study investigates the association between falls and general health, appetite, dental health, and the use of multiple medications among home-dwelling men and women aged ≥75 years. Data were collected between October 2008 and March 2009 using a postal questionnaire. A total of 1243 people participated in the questionnaire survey (74% response rate), of which 1193 were included in the analysis. The majority of participants were women (n = 738, 62%). Falls in the previous 12-month period were reported by 434 (36%) participants. Most fallers (n = 276, 64%) were women. The majority of the fallers lived in a flat (n = 250, 58%). Poor health (aOR: 1.61; CI: 1.34–1.95), poor dental health (aOR: 1.22; CI: 1.07–1.39) and the use of four or more types of medication daily (aOR: 1.13; CI: 1.03–1.25) were significantly associated with falls in all participants. Poor dental health was found irrespectively of living in a flat (aOR: 1.23; CI: 1.04–1.46) or living in a house (aOR: 1.28; CI: 1.02–1.61), and both were significantly associated with falls. The use of more than four different types of medication daily (aOR: 1.25; CI: 1.11–1.41) was associated with falls for those living in a flat. The results highlight that falls are associated with poor general health, poor dental health and the use of four or more types of medication daily. Health professionals should provide health promotion education and investigate dental health and risk factors for oral disease. Likewise, medical and clinical practices of physicians and community care nurses should include assessing the risk of falling, and treatment that predisposes falls.
(Publisher abstract)
Subject terms:
falls, older people, health, nutrition, medication, risk, home care;
Fear of falling leads to many adverse consequences and may compromise the quality of life of older adults. Psychological factors are potential mediators between the fear of falling and quality of life, but have yet to be explored in detail. This study presents results from examining the mediating effect of the self-concept of health and physical independence. Data from Western and Eastern countries were compared. Concerns about falling, the level of participation in physical activities, the self-concept of health and physical independence, and health-related quality of life were measured using samples from Taiwan (n = 193) and Germany (n = 182). Multiple regression models were used to test the mediating effects. The relationship between fear of falling and quality of life was partially mediated through participation in physical activities and the self-concept of health and physical independence in both the Taiwanese and German samples. In particular, the self-concept of health and physical independence of the Taiwanese sample resulted in the strongest mediating effect. Potential mediating mechanisms through both participation in physical activities and the self-concept of health and physical independence provide useful information for understanding related theories and for explicating interventions. Cultural factors should also be accounted for when conducting research and programs related to the fear of falling.
(Publisher abstract)
Fear of falling leads to many adverse consequences and may compromise the quality of life of older adults. Psychological factors are potential mediators between the fear of falling and quality of life, but have yet to be explored in detail. This study presents results from examining the mediating effect of the self-concept of health and physical independence. Data from Western and Eastern countries were compared. Concerns about falling, the level of participation in physical activities, the self-concept of health and physical independence, and health-related quality of life were measured using samples from Taiwan (n = 193) and Germany (n = 182). Multiple regression models were used to test the mediating effects. The relationship between fear of falling and quality of life was partially mediated through participation in physical activities and the self-concept of health and physical independence in both the Taiwanese and German samples. In particular, the self-concept of health and physical independence of the Taiwanese sample resulted in the strongest mediating effect. Potential mediating mechanisms through both participation in physical activities and the self-concept of health and physical independence provide useful information for understanding related theories and for explicating interventions. Cultural factors should also be accounted for when conducting research and programs related to the fear of falling.
(Publisher abstract)
Subject terms:
health, falls, quality of life, anxiety, independence, self-concept, older people;
British Journal of General Practice, 57(537), April 2007, pp.271-276.
Publisher:
Royal College of General Practitioners
... lived with someone else. Those living alone were more likely to reports fair to poor health, poor vision, difficulties in instrumental and basic activities of daily living, worse memory and mood, lower physical activity, poorer diet, risk of social isolation, hazardous alcohol use, having no emergency carer, and multiple falls in the previous 12 months. After adjustment for age, sex, income, and educational attainment, living alone remained associated with multiple falls, functional impairment, poor diet, smoking status, risk of social isolation, and three self-reported chronic conditions: arthritis and/or rheumatism, glaucoma, and cataracts. It is concluded that targeted population screening using lone status may be useful in identifying older individuals at high risk of falling.
In the UK, population screening for unmet need has failed to improve the health or older people. Attention is turning to interventions targeted at 'at-risk' groups. Living alone in later life is seen as a potential health risk. This study aimed to investigate the associations between lone status and health behaviours, health status, and service use in non-disabled older people. The study used secondary analysis of baseline data from a randomised controlled trial of health risk appraisal in older people. Sixty percent of 2,641 community-dwelling non-disabled people aged 65 years and over registered in four group practice in London agreed to participate in the study; 84% of these returned completed questionnaires. A third of this group (n=860, 33.1%) lived along and two-thirds (n=1,741, 66.9%) lived with someone else. Those living alone were more likely to reports fair to poor health, poor vision, difficulties in instrumental and basic activities of daily living, worse memory and mood, lower physical activity, poorer diet, risk of social isolation, hazardous alcohol use, having no emergency carer, and multiple falls in the previous 12 months. After adjustment for age, sex, income, and educational attainment, living alone remained associated with multiple falls, functional impairment, poor diet, smoking status, risk of social isolation, and three self-reported chronic conditions: arthritis and/or rheumatism, glaucoma, and cataracts. It is concluded that targeted population screening using lone status may be useful in identifying older individuals at high risk of falling.
Subject terms:
older people, risk, surveys, activities of daily living, falls, health, health needs;
Health and Social Care in the Community, 27(6), 2019, pp.1375-1387.
Publisher:
Wiley
Poor recovery among older adults with hip fractures can occur despite successful surgical repair and rehabilitation, suggesting other factors might play a role in recovery, such as social factors. The aim of this scoping review was to provide an overview of the literature on the role of social factors in older adult's recovery after hip fracture. This review followed the York Framework and its modifications and recent reporting guidelines. Two independent researchers searched main medical databases (CINAHL, EMBASE, Medline, PsycINFO and the Cochrane libraries) from inception to June 2017, for studies investigating social factors and recovery post hip fracture. Studies were excluded if they were qualitative, perspective papers or if participants were < 65 years or they were not living in the community. This study screened 2,503 unique abstracts in total and 19 studies fulfilled the inclusion criteria. Social factors investigated in the included studies were social support, socioeconomic factors and living arrangement. This study classified outcomes in the studies into three subgroups: physical functional recovery, mortality and other outcomes (pain, hospital length of stay and quality of life). This study found evidence that social support and socioeconomic factors (e.g. socioeconomic status) were significantly associated with an increase in functional recovery, a decrease in mortality and other outcomes, but conflicting evidence was found for the effect of one's living arrangement. Only two included studies were randomised controlled trials. To conclude, social factors, such as social support and socioeconomic status, affect physical functional recovery and mortality in older adults with hip fractures. However, this is an under researched area that lacks rigorously designed studies and would benefit from more studies with rigorous designs.
(Edited publisher abstract)
Poor recovery among older adults with hip fractures can occur despite successful surgical repair and rehabilitation, suggesting other factors might play a role in recovery, such as social factors. The aim of this scoping review was to provide an overview of the literature on the role of social factors in older adult's recovery after hip fracture. This review followed the York Framework and its modifications and recent reporting guidelines. Two independent researchers searched main medical databases (CINAHL, EMBASE, Medline, PsycINFO and the Cochrane libraries) from inception to June 2017, for studies investigating social factors and recovery post hip fracture. Studies were excluded if they were qualitative, perspective papers or if participants were < 65 years or they were not living in the community. This study screened 2,503 unique abstracts in total and 19 studies fulfilled the inclusion criteria. Social factors investigated in the included studies were social support, socioeconomic factors and living arrangement. This study classified outcomes in the studies into three subgroups: physical functional recovery, mortality and other outcomes (pain, hospital length of stay and quality of life). This study found evidence that social support and socioeconomic factors (e.g. socioeconomic status) were significantly associated with an increase in functional recovery, a decrease in mortality and other outcomes, but conflicting evidence was found for the effect of one's living arrangement. Only two included studies were randomised controlled trials. To conclude, social factors, such as social support and socioeconomic status, affect physical functional recovery and mortality in older adults with hip fractures. However, this is an under researched area that lacks rigorously designed studies and would benefit from more studies with rigorous designs.
(Edited publisher abstract)
Subject terms:
literature reviews, health, injuries, falls, recovery, older people, social care, socioeconomic groups, housing, standard of living;
Outlines the results of Aesop's falls prevention dance programme for older people, Dance to Health. This arts based intervention address older people's falls and problems with some current falls prevention exercise programmes, by incorporating evidence-based exercise programmes into creative, social and engaging dance activity. The programme was developed using the Aesop 7-item checklist, which lists the features an arts programme should have for it to be taken up by the health system and made available to every patient who could benefit. The report outlines the rationale for creating the programme, the outcomes achieved - in addition to reduced falls, cost effectiveness, and the wider impact of the programme. It reports that the pilot successfully brought people from the worlds of dance and older people's exercise together, was able to train dance artists in the evidence-based falls programme, and also developed six evidence-based falls prevention programmes with 196 participants. A total of 73 per cent of participants achieved the target of 50 hours’ attendance over the six months, compared with a national average for completing standard falls prevention exercise programmes of 31 per
(Edited publisher abstract)
Outlines the results of Aesop's falls prevention dance programme for older people, Dance to Health. This arts based intervention address older people's falls and problems with some current falls prevention exercise programmes, by incorporating evidence-based exercise programmes into creative, social and engaging dance activity. The programme was developed using the Aesop 7-item checklist, which lists the features an arts programme should have for it to be taken up by the health system and made available to every patient who could benefit. The report outlines the rationale for creating the programme, the outcomes achieved - in addition to reduced falls, cost effectiveness, and the wider impact of the programme. It reports that the pilot successfully brought people from the worlds of dance and older people's exercise together, was able to train dance artists in the evidence-based falls programme, and also developed six evidence-based falls prevention programmes with 196 participants. A total of 73 per cent of participants achieved the target of 50 hours’ attendance over the six months, compared with a national average for completing standard falls prevention exercise programmes of 31 per cent for primary prevention and 46 per cent for secondary prevention. Additional outcomes identified included increases in group identification, relationships and reduced loneliness, functional health and wellbeing, and mental health and wellbeing.
(Edited publisher abstract)
Objectives: This study used latent growth curve modeling (LGCM) to estimate the independent and joint associations between frailty and depression trajectories and likelihood of nursing home admission and falls resulting in injury.
Methods: Data come from five waves (2004–2012) of the Health and Retirement Study. Community-dwelling individuals aged 51 and older (N = 13,495) were analyzed using LGCM. Frailty was measured using a frailty index consisting of 30 deficits. Depressive symptoms were measured using the eight-item Centers for Epidemiologic Studies – Depression scale. Adverse health outcomes included nursing home admissions and falls resulting in injury.
Results: Prevalence of frailty increased over the study period (24.1%–32.1%), while the prevalence of depression was relatively constant over time (approximately 13%). Parallel process LGCM showed that more rapid increases of frailty and depressive symptoms were associated with higher odds of both nursing home admission and serious falls over time (Frailty: ORNursing home = 1.33, 95% CI: 1.09–1.66; ORFall = 1.52, 95% CI: 1.12–2.08; Depression: ORNursing home = 3.63, 95% CI: 1.29–9.97; ORFall = 1.16, 95% CI: 1.01–1.34). Associations between frailty and adverse outcomes were attenuated, and in some cases were no longer statistically significant, after accounting for concurrent depression.
Conclusion: Frailty trajectories may be important indicators of risk for nursing home admissions and falls, independent of baseline frailty status; however, concurrent depression trajectories are associated with adverse outcomes
(Publisher abstract)
Objectives: This study used latent growth curve modeling (LGCM) to estimate the independent and joint associations between frailty and depression trajectories and likelihood of nursing home admission and falls resulting in injury.
Methods: Data come from five waves (2004–2012) of the Health and Retirement Study. Community-dwelling individuals aged 51 and older (N = 13,495) were analyzed using LGCM. Frailty was measured using a frailty index consisting of 30 deficits. Depressive symptoms were measured using the eight-item Centers for Epidemiologic Studies – Depression scale. Adverse health outcomes included nursing home admissions and falls resulting in injury.
Results: Prevalence of frailty increased over the study period (24.1%–32.1%), while the prevalence of depression was relatively constant over time (approximately 13%). Parallel process LGCM showed that more rapid increases of frailty and depressive symptoms were associated with higher odds of both nursing home admission and serious falls over time (Frailty: ORNursing home = 1.33, 95% CI: 1.09–1.66; ORFall = 1.52, 95% CI: 1.12–2.08; Depression: ORNursing home = 3.63, 95% CI: 1.29–9.97; ORFall = 1.16, 95% CI: 1.01–1.34). Associations between frailty and adverse outcomes were attenuated, and in some cases were no longer statistically significant, after accounting for concurrent depression.
Conclusion: Frailty trajectories may be important indicators of risk for nursing home admissions and falls, independent of baseline frailty status; however, concurrent depression trajectories are associated with adverse outcomes to a similar degree as frailty. Focus should be given to distilling elements of the frailty index which confer most risk for poor health outcomes.
(Publisher abstract)
Subject terms:
depression, mental health, mental health problems, older people, risk, outcomes, falls, admission to care, nursing homes, health;
Optimal mobility is fundamental for healthy ageing and quality of life. This study is part of a cross-sectional population-based study of 85-year-old people residing in Linköping municipality, Sweden. The purpose was to describe 85-year-old peoples' health-related quality of life (HRQoL) in relation to mobility and fall risk while adjusting for gender and body mass index. Data collection included a postal questionnaire, a home visit and a reception visit. HRQoL was assessed with EQ-5D-3L, mobility with the Timed Up and Go test (TUG) and fall risk with the Downton Fall Risk Index (DFRI). All those who completed the DFRI, TUG and EQ-5D-3L were included in the present study (N = 327). Lower HRQoL was associated with longer time taken to complete TUG and higher fall risk in both genders but not with body mass index. Women had higher risk of falling, took a longer time to complete TUG and reported less physical activity compared with men. Health-care professionals should address mobility capacity and fall risk in order to maintain quality of life in elderly people. This is of utmost importance, especially for elderly women because impaired mobility, high risk of falling and occurrence of pain are common among women, and related to lower HRQoL.
(Publisher abstract)
Optimal mobility is fundamental for healthy ageing and quality of life. This study is part of a cross-sectional population-based study of 85-year-old people residing in Linköping municipality, Sweden. The purpose was to describe 85-year-old peoples' health-related quality of life (HRQoL) in relation to mobility and fall risk while adjusting for gender and body mass index. Data collection included a postal questionnaire, a home visit and a reception visit. HRQoL was assessed with EQ-5D-3L, mobility with the Timed Up and Go test (TUG) and fall risk with the Downton Fall Risk Index (DFRI). All those who completed the DFRI, TUG and EQ-5D-3L were included in the present study (N = 327). Lower HRQoL was associated with longer time taken to complete TUG and higher fall risk in both genders but not with body mass index. Women had higher risk of falling, took a longer time to complete TUG and reported less physical activity compared with men. Health-care professionals should address mobility capacity and fall risk in order to maintain quality of life in elderly people. This is of utmost importance, especially for elderly women because impaired mobility, high risk of falling and occurrence of pain are common among women, and related to lower HRQoL.
(Publisher abstract)
Subject terms:
health, quality of life, older people, risk, mobility, falls, ageing, gender;
Great Britain. Department for Communities and Local Government
Publication year:
2012
Pagination:
36p.
Place of publication:
London
Lifetime Homes Standards (LHS) are a series of 16 design features that make a dwelling adaptable. The aim of this study was to provide an assessment of the health benefits associated with new homes built to current building regulations, and in particular built to the LHS. Data were drawn from the English House Condition Survey and the Housing Health and Safety Rating Scheme. The analysis considers direct health benefits associated with the reduction of injury caused by hazards in dwellings, and indirect health benefits that promote psychological wellbeing and activity. The findings estimate that the total cost of building-related hazards is approximately £2.48 billion per annum in direct health costs and £40 billion per annum as a potential cost to society. Homes built to current building regulations offer significant health advantages over the average stock, and may provide direct NHS health cost savings per dwelling in excess of £4,000 during a 60-year expected lifespan. Building to the LHS could provide an extra £194 of savings over 60 years, or £700 if the potential adaptations to bathrooms and access to a bedroom/bathroom were made. When considering the potential cost to society, the savings are likely to be much higher. A home built to current building regulations could save £83,000 during a 60-year lifespan, compared to the average for the current stock. Building to the LHS could provide a further £1,600 in savings, or £8,600 if potential adaptations were made.
Lifetime Homes Standards (LHS) are a series of 16 design features that make a dwelling adaptable. The aim of this study was to provide an assessment of the health benefits associated with new homes built to current building regulations, and in particular built to the LHS. Data were drawn from the English House Condition Survey and the Housing Health and Safety Rating Scheme. The analysis considers direct health benefits associated with the reduction of injury caused by hazards in dwellings, and indirect health benefits that promote psychological wellbeing and activity. The findings estimate that the total cost of building-related hazards is approximately £2.48 billion per annum in direct health costs and £40 billion per annum as a potential cost to society. Homes built to current building regulations offer significant health advantages over the average stock, and may provide direct NHS health cost savings per dwelling in excess of £4,000 during a 60-year expected lifespan. Building to the LHS could provide an extra £194 of savings over 60 years, or £700 if the potential adaptations to bathrooms and access to a bedroom/bathroom were made. When considering the potential cost to society, the savings are likely to be much higher. A home built to current building regulations could save £83,000 during a 60-year lifespan, compared to the average for the current stock. Building to the LHS could provide a further £1,600 in savings, or £8,600 if potential adaptations were made.
Subject terms:
housing, housing conditions, older people, quality of life, building design, cost effectiveness, falls, health;
This report demonstrates the continuing health and societal impacts of poor housing in Wales. The research was commissioned by Shelter Cymru and BRE Trust in order to apply a methodology developed to calculate the cost of poor housing in England to the Welsh housing stock. Proportionately, there is considerably more poor housing in Wales than in England, with dangerous stairs and steps, and cold and damp homes being key problems. It is estimated that works targeted at reducing the worst hazards would have a benefit to the National Health Service of around £67 million per year. This figure doubles if the definition of poor housing is widened to include all homes with a SAP (energy efficiency rating) of 40 or less and basic heating and insulation improvements are provided for these homes. The author notes that in addition to the direct costs, poor housing also results in broader economic consequences for society in Wales which can be calculated at a further £100 million per annum.
This report demonstrates the continuing health and societal impacts of poor housing in Wales. The research was commissioned by Shelter Cymru and BRE Trust in order to apply a methodology developed to calculate the cost of poor housing in England to the Welsh housing stock. Proportionately, there is considerably more poor housing in Wales than in England, with dangerous stairs and steps, and cold and damp homes being key problems. It is estimated that works targeted at reducing the worst hazards would have a benefit to the National Health Service of around £67 million per year. This figure doubles if the definition of poor housing is widened to include all homes with a SAP (energy efficiency rating) of 40 or less and basic heating and insulation improvements are provided for these homes. The author notes that in addition to the direct costs, poor housing also results in broader economic consequences for society in Wales which can be calculated at a further £100 million per annum.
Subject terms:
housing, housing conditions, local authority housing, poverty, quality of life, standards, costs, falls, health;