Fear of falling in a geriatric

r ehabilitation unit and its corr elation

with the functional status
Santiago J.M., Quintana X., Sanchez-Ferrin, P.
Hospital Sociosanitari de lHospitalet. Consorci Sanitari Integral. LHospitalet de Llobregat, Barcelona, Spain

Introduction

Objective

Functional recovery requires a multidimensional approach. Patients often demonstrate Fear of

Falling (FoF), which deals to a restriction on their activity, worse quality of life, isolation and
depression. The literature shows prevalences in elderly patients in the community between 21%
and 85%, with few studies in hospitalized patients.

To observe the prevalence of FoF in patients admitted in our geriatric convalescence unit and to
determine if there is any correlation with the functional status.

Methods
Observational study of prevalence. Demographic data, co-morbidity, functional ability and gain and
cause of admission were collected. FoF is collected with a dichotomous question (yes / no) at admission
and the translation of the questionnaire Falls Efficacy Scale (FES) that evaluates self-confidence on
daily-living activities. (Table 1)
Inclusion criteria: Patients admitted from Feb. 1st on, and discharged before May 1st, able to walk/ stand.
Excluded dementia, confusion or inhability to understand the test.

SAMPLE DESCRIPTION
Sample

Mean Age
Sex

Table 1. Falls Efficacy Scale

On a scale from 1 to 10, with 1 being very confident and 10 being not confident at all, how confident are you
that you do the following activities without falling?

Mean Stay
Co-Morbidity (Charlson Index)
Cause of Admission

Score
1 very confident
10 not confident at all

Activity

Population attended 81
Meet criteria 57 (70.3%)
Missed 13 (28%),
Valid n=41 (72%) (50.5% of total)
78,20 (59-93)
Men 46,3% (n=19)
Women 53,7% (n=22)
35,37 days (Median 35)
Low (<2) 25 (61%); High (3 or >) 16 (39%)
Orthopedic surgery 20 (48,8%)
Neurological 4 (9,8%)
Medical condition 9 (22%)
Vascular 4 (9,8%)
Other surgical conditions 4 (9,8%)
Yes 22 (53,7%); No 18 (43,9%); 1 no data.
0= 36 (87,8%); 1= 4 (9,8%); 2= 1 (2,4%)
None: 18 (43,9%)
Yes: 23 (56,1%):
Cane: 1 (2,4%); Crutch: 8 (19,5%); 2 crutches: 3 (7,3%);
Walker: 4 (9,8%); Wheelchair: 7 (17,1%)

Depression at Adm
Registered Falls
Assistive devices at discharge

Take a bath or shower / Baarse o ducharse

Reach into cabinets or closets / Alcanzar una estantera o armario
Walk around the house /Caminar por la casa
Prepare meals not requiring carrying heavy or hot objects /Preparar comida
Get in and out of bed /Salir o entar de la cama
Answer the door or telephone /Abrir la puerta o contestar el telfono
Get in and out of a chair /Sentarse o levantarse de la silla
Getting dressed and undressed /Vestirse o desvestirse
Personal grooming (i.e. washing your face) /Aseo personal
Getting on and off of the toilet /Sentarse o levantarse de la taza del bao

Figure 1. Sex

Figure 2. Cause of admission

Total Score

A total score of greater than 70 indicates that the person has a fear of falling

Results
BARTHEL RESULTS
Functional ability:
Barthel Index Score
(BI) (Mean)
Functional impairment:
BI level

Barthel Index Gain

RESULTS OF FOF
Baseline 89,76/100
Admission 61,95
At Discharge 82,55
Total (BI < 20)
Severe (IB 20-35)
Moderate (IB 40-55)
Mild (IB 60-95)
Independent (IB 100)

FES (Falls Efficacy Scale)

Admission (%)
13,6
4,5
50
27,3
4,5

Discharge (%)
4,5
0
13,6
50
31,8

Mean: 20,6 points.

Mean efficiency: 0,6 (BI Disc-BI Adm/Stay) (>07)
< 20 BI points: 20 (48,8%)
>20 BI points: 21 (51,2%)

Figure 3. Functional Impairment: BI Level

FES Admission

Mean
(FES <70)
FoF (FES > 70)

62,17
27
14

65,92%
34,1%

FES Discharge

Mean
(FES <70)
FoF (FES > 70)

50,98
29
12

70,7%
29,3%

Fear of Falling: Dichotomic question at admission

Figure 4. FES (Falls Efficacy Scale

Yes 22 (53,7%);
No 18 (43,9%)
(1 Missed)

Figure 5. Fear of Falling (Dichotomic Question)

At discharge, patients with FES < 70 have a BI (p= 0,002) and a gain (BI > 20) (p= 0,029), statistically higher than patients with FES >70. No differences were observed between FES and BI at admission.
With dichotomic question at admission, there is no relation with BI gain at discharge (p=0,459).
No correlation is observed between FoF by FES and dichotomic question (y/n) at admission and discharge (p=0,002) (p.e 94,4% of patients who respond NOT to Fof have FES < 70).

Conclusions
n

Patients without FoF at discharge have higher Barthel Index value and BI gain. It has not
been observed this behavior in BI levels at admission, although the trend would suggest the
opposite, possibly due to insufficient sample.

A relation exists between FoF defined by FES and dichotomous question. The complexity of
answering the FES has reduced the sample, so the dichotomous question may be a good
screening tool.

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n