Jane Painter

Fear of Falling and Its Relationship With Anxiety, Depression, and Activity Engagement Among Community-Dwelling Older Adults

OBJECTIVE This study examined (1) the relationship of fear of falling to depression, anxiety, activity level, and activity restriction and (2) whether depression or anxiety predicted fear of falling, activity level, activity restriction, or changes in activity level. METHOD We administered the Survey of Activities and Fear of Falling in the Elderly; the Geriatric Depression Scale-30; and the Hamilton Anxiety Scale, IVR Version, during a one-time visit to 99 community-dwelling adults ≥55 yr old. RESULTS We found significant relationships between (1) fear of falling and depression, anxiety, and activity level; (2) depression and anxiety; and (3) activity restriction and depression. Activity level was negatively correlated with activity restriction, fear of falling, depression, and anxiety. Anxiety predicted both fear of falling and activity level. Both anxiety and depression predicted activity restriction because of fear of falling and for other reasons. CONCLUSION Occupational therapy practitioners should consider screening their older adult clientele for fear of falling, anxiety, and depression because these states may lead to fall risk and activity restriction.

Participation restriction, not fear of falling, predicts actual balance and mobility abilities in rural community-dwelling older adults.

Background and Purpose:Fear of falling (FOF) has been correlated with an increased risk for falls, self-restriction of physical activity, and subsequent decrease in quality of life in older adults. The relationship between perceived FOF, participation restriction, and balance and mobility abilities is unclear, as results from prior studies are inconsistent. Few studies have used the Survey of Activities and Fear of Falling in the Elderly (SAFE) as a standard measure of FOF, although this survey provides both a measure of FOF and participation restriction. Only one study has explored the relationship of individual items from the SAFE with balance and mobility tests that predict fall risk. The primary purpose of this study was to investigate the relationships between FOF and participation restriction as measured by the SAFE and actual balance and mobility abilities in a diverse group of older adults. Participants:Eighty-two community-dwelling older adults (17 men) with a mean age of 74 (SD = 8.8; range = 55–91) participated in this study. The sample comprised 45% African Americans and 54% whites. Methods:Fear of falling and participation restriction were assessed using the SAFE, a self-assessment survey. The SAFE assesses information about participation in 11 functional activities as well as the extent to which fear is a source of participation restriction. Balance and functional mobility were measured using the Berg Balance Scale (BBS) and Timed Get Up & Go Test (TUG), respectively. Participants were categorized as low (N = 36), mixed (N = 19), or high (N = 24) risk for future falls based on their past fall history and results on the BBS and the TUG. Data analysis included &khgr;2 and Spearman correlation and 2 regression analyses. Results:Both SAFE FOF and participation restriction scores were significantly correlated with BBS and TUG scores. However, SAFE participation restriction scores, but not SAFE FOF scores, predicted BBS and TUG scores. SAFE FOF scores could discriminate older adults at high risk for falls from those at mixed and low risk but could not discriminate between the mixed- and low-risk groups. Discussion/Conclusion:The relationship between self-reported participation restriction and objectively measured balance and mobility abilities is stronger than the relationship between self-reported FOF and objectively measured balance and mobility abilities. These findings lend support to the argument that participation restriction may be the critical mediating factor between FOF, balance and mobility limitations, and fall risk. Evaluation of and intervention for FOF and fall risk without direct and specific attention to participation restriction may not yield optimal results. Older adults whose goals include both reduction in fall risk and increase in participation level may need combined treatment approaches.

Home Environment Considerations for People with Alzheimer's Disease

The purpose of this pilot study was to develop a home assessment specifically designed for people with Dementia of Alzheimers type (DAT), and determine its effectiveness in designing appropriate environmental strategies. Since the home environment plays an integral role in monitoring ADL performance and behaviors of the AD population, an understanding of how environmental cues influence function and conduct is crucial when assessing and developing environmental intervention strategies. The new assessment, using a person-environment fit theoretical model, assisted the occupational therapist in evaluating the environments legibility and stability to ensure a safe environment through specific physical, psychological, and social cues.

Unprecedented opportunities in fall prevention for occupational therapy practitioners

Lindy Clemson, PhD, MAppSC(OT), DipOT, is Associate Professor in Ageing, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia Falls are a serious threat to the lives and occupational well-being of older adults. More than one-third of community-living adults ages 65 yr or older fall each year (Centers for Disease Control and Prevention [CDC], 2008; Rubenstein & Josephson, 2002), and 20%–30% of falls result in moderate to severe injuries, such as traumatic brain injuries and fractures (Sterling, O’Connor, & Bonadies, 2001). Over the past 20 years, an explosion of research across disciplines has deepened our understanding of fall risk factors and effective interventions. This special issue of AJOT on fall prevention provides examples of how occupational therapy practitioners are contributing to this body of knowledge. Cumulative fall research knowledge to date has informed three major evidencebased initiatives that are currently underway to support practice in fall prevention: (1) publication of the Clinical Practice Guideline: Prevention of Falls in Older Persons (American Geriatrics Society [AGS] & British Geriatrics Society [BGS], 2010), (2) the CDC’s efforts to disseminate four specific fall prevention programs with documented effectiveness, and (3) the emergence of state fall prevention coalitions. It is critically important for occupational therapy practitioners to be aware of these initiatives. Each offers occupational therapy practitioners unprecedented opportunities to extend and strengthen their active role in fall prevention efforts at the national, state, and local levels. This editorial highlights these three initiatives and discusses how occupational therapy clinicians and researchers can contribute to each of them and build on their success to further develop fall prevention research and practice.

The predictive value of selected job rewards on occupational therapists' job satisfaction in ambulatory care settings.

Using a perceived reward model of overall job satisfaction, this study utilized a correlational research design with multiple regression analysis to determine the predictive power of extrinsic rewards and intrinsic rewards, collectively and individually, as determinants of overall job satisfaction among registered occupational therapists (OTR) working full-time in ambulatory care settings. The intrinsic rewards (task involvement and task autonomy), collectively and individually, were perceived to be significant overall job satisfaction determinants. General working conditions was the only significant extrinsic reward. Given the demand for OTRs in ambulatory care settings, a better understanding of factors that influence overall job satisfaction among OTRs could prove beneficial in developing appropriate recruitment and retention job design strategies.

Influence of Gender on Falls

ABSTRACT This study examined whether gender influenced fall-related risk factors among community-dwelling adults of 50 years of age and older who lived in a rural county in eastern North Carolina. Over a 4-year period, a semistructured fall questionnaire was administered. Significant findings at the 0.05 level included (a) women fell more frequently than men in the 71–80-year-old group; (b) women notified other people about their falls more often than men; (c) women who lived alone fell more often than men living alone; and (d) women were more fearful of falling than men. New findings from this study included the percentage of participants who felt like they were going to fall again; comparison of gender to the location of fall; activities engaged in when the fall occurred; fall-related injuries; bathroom safety equipment; and activity restriction due to a fear of falling.

Developing and Implementing a Senior Community Based Fall Prevention and Home Safety Program

Occupational therapists are primary candidates in taking a proactive role in meeting the community dwelling senior citizens safety, environmental, and cognitive needs through the development of community based programs in conjunction with aging organizations. The purpose of this paper is to provide recommendations to occupational therapists in developing, implementing, and marketing a senior community based fall prevention and home safety program in conjunction with a Council on Aging and occupational therapy outpatient private practice.

The Culture of Falls and Fear of Falling: A Phenomenological Study

Purpose: This phenomenological study explored and described the lived experiences of community-dwelling older adults regarding what falls and fear of falling meant to them, and how each entity influenced self-efficacy, functional performance, and degree of engagement in occupations. Methods: Thirty-one older adults, 58 to 94 years old, were interviewed one time at a senior center or continual care retirement community. All interviews were analyzed using QSR NUD*IST 6 software. Results: Three main themes emerged: 1) highly fearful, and having their lives affected by the fear of falling; 2) having fallen, but rationalized their fears and modified their lives accordingly; and, 3) felt they had not fallen by their definition and remained active in place. Conclusion: Findings suggest the importance for practitioners to listen and understand their clients’ stories and perceptions of how they are selectively engaging in life’s activities while maintaining a personal perception of living an active life style.

Family intervention with the traumatically brain injured patient.

The occupational therapist plays an integral role in the evaluation and treatment of the traumatically brain injured (TBI) patient. Although the TBI patients needs are relatively well-defined by the nature of the injury, less well recognized and frequently over- 1ooked is the emotional and psychological trauma experienced by the family of the TBI patient. Depending on the information provided, the family can be an asset or hindrance in the patients rehabilitation. By working with the TBI patients family, the occupational therapist can guide the family into a more cohesive force that will assist the patient throughout the rehabilitative process. This article provides suggestions to evaluate and manage concerns and fears raised by the families of TBI patients. It rovides an organizational guideline for educating the family about BI and incorporating them in the rehabilitation of the TBI patient.

Quick Reference Dictionary for Occupational Therapy 4th edition, 589 pp., by Karen Jacobs and Laela Jacobs, Softcover, ISBN 1-55642-656-9, 2004, SLACK Incorporated, Thorefare, NJ, www.slackbooks.com Order #36569,

Though there are more comprehensive and expensive medical dictionaries on the market, occupational therapists, occupational therapy assistants, and students will find this reference book as an essential text for his or her library since, it is designed specifically for the occupational therapy practitioner and occupational therapy student. The small size of this reference book is user friendly and easy to carry throughout the day compared to larger and heavier medical dictionaries, and it is reasonably priced. Occupational therapy students find this book particularly beneficial when completing their fieldworks. There are over 3600 definitions and 60 appendices, which offer the reader a quick summary of common terms used by occupational therapists and essential AOTA references. Examples of pertinent AOTA information include: the Code of Ethics, Core Values, and Attitudes of Occupational Therapy Practice, and AOTA’s Vision and Mission Statements. However, it is unclear why the authors included an appendix on AOTA’s past presidents. Unfortunately, the AOTA’s Occupational Therapy Practice Framework: Domain and Practice (2002) is not included in the text or appendices. The terms and associated definitions are in alphabetical order and are easy to understand, though there are no illustrations or diagrams to accompany the definitions. Occupational therapy practitioners and students will need to use the table of contents to find specific information in the appendices since there is no index provided. The appendices will assist the reader in refreshing his or her memory on various scales (i.e., Rancho Los