Helen W. Lach

The prevalence and correlates of fear of falling in elderly persons living in the community

OBJECTIVES Fear of falling has been recognized as a potentially debilitating consequence of falling in elderly persons. However, the prevalence and the correlates of this fear are unknown. METHODS Prevalence of fear of falling was calculated from the 1-year follow-up of an age- and gender-stratified random sample of community-dwelling elderly persons. Cross-sectional associations of fear of falling with quality of life, frailty, and falling were assessed. RESULTS The prevalence of fear increased with age and was greater in women. After adjustment for age and gender, being moderately fearful of falling was associated with decreased satisfaction with life, increased frailty and depressed mood, and recent experience with falls. Being very fearful of falling was associated with all of the above plus decreased mobility and social activities. CONCLUSIONS Fear of falling is common in elderly persons and is associated with decreased quality of life, increased frailty, and recent experience with falls.

Falls in the Elderly: Reliability of a Classification System

To determine risk factors for falls, previous studies have classified falls according to the contribution of factors both intrinsic and extrinsic to the host. Due partly to the lack of operational definitions and the absence of information on reliability, no consensus on classification has been reached. Consequently, in a 3‐year prospective study of falls occurring in a probability sample of community‐dwelling elderly (n = 1,358), a fall classification system was developed and tested for interrater reliability. The 366 falls in the first year of the study were independently classified by two reviewers on the basis of a narrative description and structured interview. The falls in the four major categories of the classification system included: falls related to extrinsic factors (55%), falls related to intrinsic factors (39%), falls from a non‐bipedal stance (8%) and unclassified falls (7%). The interrater reliability for the four major categories was 89.9% with a kappa of 0.828. The system provides operational definitions for types of falls and a reliable and flexible method for classifying falls in the elderly.

Can older adults with dementia accurately report depression using brief forms? Reliability and validity of the Geriatric Depression Scale.

The Geriatric Depression Scale (GDS) is a commonly used screening tool, but its use in older adults with cognitive impairment has been controversial. This study compared the short forms of the GDS with clinician diagnosis of depression using standard criteria (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision) in people with and without dementia. Sensitivity and specificity were acceptable for all forms of the GDS. These results build evidence for using the short GDS 5- and 15-item versions in populations that include people with mild to moderate dementia, increasing the ease of depression screening so it can be performed more frequently in clinical settings.

Application of the Transtheoretical Model to Health Education for Older Adults

The application of theory to practice can be challenging. This article describes the experiences of one organization in applying the Transtheoretical Model (TTM) to a health promotion program for older adults, Health Stages. The concepts of the model, especially stage of change, were successfully used for program planning, curriculum development, and program evaluation. A Programming Grid was developed to guide curriculum development and evaluate if programs were reaching out to people at all stages of readiness to make healthy changes. Other TTM constructs, including self-efficacy, decisional balance, and processes of change were incorporated into the Health Stages curriculum. Evaluation showed that the pilot sites increased their offering of action- and maintenance-oriented programs, filling in the gaps in current programming. Older adults were receptive and interested in the model. The TTM enhanced the program by providing a framework for design and a method for reaching a wider audience of older adults with important health information.

Alzheimer's disease: Assessing safety problems in the home

providing a safe environment is a challenge for families and health professionals caring for patients with Alzheimers disease. 1 The progressive loss of memory, judgment, and motor functions may lead to hazardous behavior, resulting in accidents or injuries. Caregivers often ask for advice about how to provide safe care for those with Alzheimers disease. Despite some general knowledge of safety concerns, little is known about the prevalence, incidence, or home management of safety problems or accidents in Alzheimers disease and other dementias. Home safety problems, such as falls, wandering, unsafe driving, and physical violence, have long been reported in the study of behavioral problems in dementia. 16 And several publications provide suggestions for caregivers about safety problems and their management, as well as home modifications to assist people with memory problems in functioning and safety. 7-14 But we cannot predict who is at risk for safety problems or whether the severity of dementia increases the risk of safety problems. The purpose of this pilot study was to determine which safety problems were most common in our patient population, to explore the relationship between dementia severity

Visual Acuity, Visual Disabilities and Falling in the Elderly

Poor vision has been suggested as a risk factor for falling in the elderly. We analyzed the findings from a cohort of community-dwelling elderly (N = 875) to determine the relative risks for impaired visual acuity and various visual disabilities with falling, recurrent falling, and serious injurious falls. The prevalences of impaired visual acuity and four visual disabilities were low. None of the vision variables examined predicted time to first serious injurious fall after controlling for balance, cognition, age, and gender. However, bumping into objects predicted falling and recurrent falling. The lack of associations between visual disabilities and falling suggests that poor vision, as measured here, plays a limited role in predicting falling in relatively well community-dwelling elderly.

The Dementia Friendly Hospital Initiative education program for acute care nurses and staff.

Individuals with Alzheimers disease and other dementias have 3.2 million hospital stays annually, which is significantly more than older individuals without dementia. Hospitalized patients with dementia are at greater risk of delirium, falls, overwhelming functional decline that may extend the hospital stay, and prolonged or complicated rehabilitation. These risks highlight the need for staff education on the special care needs of this vulnerable population. This article describes a one-day education program, the Dementia Friendly Hospital Initiative, designed to teach staff how to provide the specialized care required by patients with dementia. Participants (N = 355) from five different hospitals, including 221 nurses, completed a pretest-posttest evaluation for the program. Changes in participants attitudes and practices, confidence, and knowledge were evaluated. Scores indicated significant improvement on the posttest. The evaluation provides further evidence for recommending dissemination of the Dementia Friendly Hospital Initiative.

The Nursing Home Falls Self-Efficacy Scale Development and Testing

We examined a brief measure of falls self-efficacy in nursing home residents participating in a pilot randomized controlled trial to study the effects of hip protectors on the prevention of fractures (N = 116, mean age 82 ± 8, 72% female). Internal consistency reliability was acceptable with Cronbach’s alpha of .79. Factor analysis supported two factors representing self-efficacy expectations and outcome expectancy. Contrasted groups comparisons and construct validity were examined. We found lower falls self-efficacy in participants who needed help with mobility, in people with lower executive function, and in participants who reported fear of falling. Scores were not associated with prospective falls or adherence with hip protector use. The findings of this study provide preliminary support for the reliability and validity of the scale for future research.

Nutritional Issues of Korean Americans

This cross-sectional, descriptive study examined factors influencing healthy eating of Korean Americans in a convenience sample of 517 Korean adults in a Midwestern city. Participants completed a self-administered survey written in either English or Korean as their preferences, which measured health, acculturation, healthy eating benefits, barriers, and self-efficacy as well as healthy eating practice. Descriptive statistics, cluster analysis, and structural equation modeling were used for analysis. Participants reported retaining elements of the traditional Korean diet regardless of acculturation. The worst eating habits were seen in participants who were younger (t = 4.57), currently not married (t = 3.10), less educated (F = 5.03), and acculturated to American society (F = 5.93) at the p < .05. Clinicians should provide culturally sensitive interventions targeting Korean Americans with poor dietary habits by providing population-specific, tailored interventions about the benefits of healthy eating and modeling healthier recipes for traditional Korean dishes.

The Collateral Source version of the Geriatric Depression Scale: evaluation of psychometric properties and discrepancy between collateral sources and patients with dementia in reporting depression

BACKGROUND Depression is under-diagnosed and under-treated in older adults. The purposes of this study were to (a) evaluate the psychometric properties of the Collateral Source Geriatric Depression Scale (CS-GDS), (b) compare collateral source scores on the CS-GDS with patient scores on the GDS, and (c) examine factors associated with any discrepancies between the CS-GDS and the GDS. METHODS This secondary analysis used data from 132 older adults and their collateral sources attending a geriatric assessment program over a 15-month period. Scores on the 30-, 15-, and 5-item CS-GDS were compared to clinician diagnoses of depression using DSM-IV-TR criteria and patient GDS scores. RESULTS The three forms of the CS-GDS had acceptable internal consistency, sensitivity and specificity with recommended cut-off scores of 18, 9 and 3, respectively. Collateral sources reported more depressive symptoms than patients did themselves. Simple regression analysis showed that caregiver burden significantly influenced the discrepancy between CS-GDS scores and GDS scores (β = 0.147; p = 0.004). Functional limitations and collateral relations to the patient were not associated with these discrepancies. CONCLUSION All three collateral versions had acceptable psychometric properties, which supports the use of the CS-GDS to assess depression in older adults. The CS-GDS provides an important alternative for depression screening with older adults who cannot complete screening tools themselves; however, alternative cut-off scores must be used for high sensitivity and specificity.