Top

BMC Geriatrics

Published in:

Open Access 01-12-2022 | Anxiety | Research

Are multimorbidity patterns associated with fear of falling in community-dwelling older adults?

Authors: Jaquelini Betta Canever, Bruno de Souza Moreira, Ana Lúcia Danielewicz, Núbia Carelli Pereira de Avelar

Published in: BMC Geriatrics | Issue 1/2022

Abstract

Background

Multimorbidity is defined as the co-occurrence of multiple chronic or acute diseases and medical conditions in the same individual and can be grouped into different patterns based on the type of disease. These patterns are associated with poorer quality of life and premature death. It is believed that these patterns entail functional limitations, which may contribute to the fear of falling; however, this association remains unknown. Identifying this possible association is fundamental for developing individual and collective care approaches aimed at preventing the different patterns of chronic diseases in older adults in order to decrease the fear of falling. The objective of this study was to investigate the association between multimorbidity patterns and fear of falling in older adults.

Methods

This was a cross-sectional study including 308 older adults. The exposure variables were the presence of three multimorbidity patterns (cardiopulmonary, musculoskeletal, and vascular-metabolic) and pattern association assessed by self-report of two or more similar coexisting chronic diseases. The outcome was fear of falling assessed by the Brazilian version of Falls Efficacy Scale-International (cut-off point ≥ 23 points). Multivariable logistic regression was used to analyze the association between variables.

Results

Older adults with cardiopulmonary, musculoskeletal, vascular-metabolic patterns and pattern association had 3.49 (95%CI 1.13; 10.78), 2.03 (95%CI 1.13; 3.64), 2.14 (95%CI 1.20; 3.82), and 4.84 (95%CI 2.19; 10.68), respectively, greater chances of presenting fear of falling when compared to older adults without the patterns.

Conclusions

The presence of multimorbidity patterns is associated with higher chances of reporting fear of falling. It is emphasized that the introduction of public health programs aimed at preventing multimorbidity patterns is essential to reduce possible adverse health outcomes, including fear of falling and its negative consequences for older adult health.

Kruschke C, Butcher HK. Evidence-based practice guideline: Fall prevention for older adults. J Gerontol Nurs. 2017;43:15–21.PubMed

Peel NM. Epidemiology of falls in older age. Can J Aging. 2011;30:7–19.PubMed

Smith A de A, Silva AO, Rodrigues RAP, Moreira MASP, Nogueira J de A, Tura LFR. Avaliação do risco de quedas em idosos residentes em domicílio. Revista Latino-Americana de Enfermagem. 2017;25.

Akyol Y, Ulus Y, Tander B, Tomak L, Zahiroğlu Y, Bilgici A, et al. Falls, fear of falling, and associated factors in ambulatory patients with rheumatoid arthritis: A comparative study with healthy controls. Turk J Phys Med Rehabil. 2018;64:213–21.PubMedPubMedCentral

Lopes KT, Costa DF, Santos LF, Castro DP, Bastone AC. Prevalência do medo de cair em uma população de idosos da comunidade e sua correlação com mobilidade, equilíbrio dinâmico, risco e histórico de quedas. Rev Bras Fisioter. 2009;13:223–9.

Ang GC, Low SL, How CH. Approach to falls among the elderly in the community. Singapore Med J. 2020;61:116–21.PubMedPubMedCentral

Jung D. Fear of falling in older adults: comprehensive review. Asian Nurs Res. 2008;2:214–22.

Lavedán A, Viladrosa M, Jürschik P, Botigué T, Nuín C, Masot O, et al. Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both? PLoS ONE. 2018;13:1–14.

Oh E, Hong GRS, Lee S, Han S. Fear of falling and its predictors among community-living older adults in Korea. Aging Ment Health. 2017;21:369–78.PubMed

10.

Canever JB, Danielewicz AL, Leopoldino AAO, de Avelar NCP. Is the self-perception of the built neighborhood associated with fear of falling in community-dwelling older adults ? Arch Gerontol Geriatr. 2021;95:104395. https://doi.org/10.1016/j.archger.2021.104395.CrossRefPubMed

11.

Hajek A, König H-H. What are the psychosocial consequences when fear of falling starts or ends? Evidence from an asymmetric fixed effects analysis based on longitudinal data from the general population. Int J Geriatr Psychiatry. 2020;35:1028–35.PubMed

12.

Auais M, French S, Alvarado B, Pirkle C, Belanger E, Guralnik J. Fear of Falling Predicts Incidence of Functional Disability 2 Years Later: A Perspective From an International Cohort Study. J Gerontol A Biol Sci Med Sci. 2018;73:1212–5. https://doi.org/10.1093/gerona/glx237.CrossRefPubMed

13.

Young WR, Mark WA. How fear of falling can increase fall-risk in older adults: Applying psychological theory to practical observations. Gait Posture. 2015;41:7–12. https://doi.org/10.1016/j.gaitpost.2014.09.006.CrossRefPubMed

14.

Vitorino LM, Marques-Vieira C, Low G, Sousa L, Cruz JP. Fear of falling among Brazilian and Portuguese older adults. Int J Older People Nurs. 2019;14:1–8.

15.

Moreira B de S, Andrade AC de S, Xavier CC, Proietti FA, Braga L de S, Friche AA de L, et al. Perceived neighborhood and fall history among community-dwelling older adults living in a large Brazilian urban area: a multilevel approach. International Journal of Environmental Health Research. 2020;:1–13. https://doi.org/10.1080/09603123.2020.1782354.

16.

Vitorino LM, Teixeira CAB, Boas ELV, Pereira RL, dos Santos NO, Rozendo CA. Fear of falling in older adults living at home: Associated factors. Revista da Escola de Enfermagem. 2017;51:1–6.

17.

Ferreira FR, César CC, de Andrade FB, de Souza Junior PRB, Lima-Costa MF, Proietti FA. Aspects of social participation and neighborhood perception: ELSI-Brazil. Rev Saude Publica. 2018;52:1–11.

18.

Starfield B, Lemke KW, Bernhardt T, Foldes SS, Forrest CB, Weiner JP. Comorbidity: implications for the importance of primary care in “case” management. Ann Fam Med. 2003;1:8–14.PubMedPubMedCentral

19.

Prados-Torres A, Calderón-Larrañaga A, Hancco-Saavedra J, Poblador-Plou B, van den Akker M. Multimorbidity patterns: a systematic review. J Clin Epidemiol. 2014;67:254–66.PubMed

20.

Vetrano DL, Rizzuto D, Calderón-Larrañaga A, Onder G, Welmer AK, Qiu C, et al. Walking Speed Drives the Prognosis of Older Adults with Cardiovascular and Neuropsychiatric Multimorbidity. Am J Med. 2019;132(10):1207-1215.e6.PubMed

21.

Schmidt TP, Wagner K, Schneider I, Danielewicz A. Multimorbidity patterns and functional disability in elderly Brazilians: a cross-sectional study with data from the Brazilian National Health Survey. Cad Saude Publica. 2020;36(11):e00241619.PubMed

22.

Grande G, Marengoni A, Vetrano D, Roso-Llorach A, Rizzuto D, Zucchelli A, et al. Multimorbidity burden and dementia risk in older adults: The role of inflammation and genetics. Alzheimers Dement. 2021;17(5):768–76.PubMedPubMedCentral

23.

Marengoni A, Akugizibwe R, Vetrano DL, Roso-Llorach A, Onder G, Welmer A-K, et al. Patterns of multimorbidity and risk of disability in community-dwelling older persons. Aging Clin Exp Res. 2021;33:457–62.PubMedPubMedCentral

24.

Vetrano DL, Roso-Llorach A, Fernández S, G-C M, V C, O G, et al. Twelve-year clinical trajectories of multimorbidity in a population of older adults. Nat Commun. 2020;11:3223.PubMedPubMedCentral

25.

Aburub AS, Phillips SP, Aldughmi M, Curcio C-L, Guerra RO, Auais M. Fear of Falling Among Community-Dwelling Older Adults with Heart Disease: Findings from an International Mobility in Aging Study (IMIAS). Physiotherapy theory and practice. 2021;:1–14.

26.

Kelly C, Fleischer A, Yalla S, Grewal GS, Albright R, Berns D, et al. Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy. J Am Podiatr Med Assoc. 2013;103:480–8.PubMedPubMedCentral

27.

Rosic G, Milston AM, Richards J, Dey P. Fear of falling in obese women under 50 years of age: a cross-sectional study with exploration of the relationship with physical activity. BMC obesity. 2019;6:7. https://doi.org/10.1186/s40608-019-0230-z.CrossRefPubMedPubMedCentral

28.

Chang HT, Chen HC, Chou P. Factors associated with fear of falling among community-dwelling older adults in the Shih-Pai Study in Taiwan. PLoS ONE. 2016;11:1–12.

29.

Canever JB, Danielewicz AL, Avelar NCP. Associação entre aspectos físicos-funcionais, comportamentais e de saúde com o medo de cair em idosos comunitários. Acta Fisiátrica. 2020;27:160–6.

30.

Lapier TK, Cleary K, Kidd J. Exercise self-efficacy, habitual physical activity, and fear of falling in patients with coronary heart disease. Cardiopulm Phys Ther J. 2009;20:5–11 (https://pubmed.ncbi.nlm.nih.gov/20467523).PubMedPubMedCentral

31.

Painter JA, Allison L, Dhingra P, Daughtery J, Cogdill K, Trujillo LG. Fear of falling and its relationship with anxiety, depression, and activity engagement among community-dwelling older adults. Am J Occup Ther. 2012;66:169–76.PubMed

32.

Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C. Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing. 2005;34:614–9.PubMed

33.

Camargos FFO, Dias RC, Dias JMD, Freire MTF. Cross-cultural adaptation and evaluation of the psychometric properties of the Falls Efficacy Scale-International Among Elderly Brazilians (FES-I-BRAZIL). Rev Bras Fisioter. 2010;14:237–43.PubMed

34.

Hauer KA, Kempen GIJM, Schwenk M, Yardley L, Beyer N, Todd C, et al. Validity and Sensitivity to Change of the Falls Efficacy Scales International to Assess Fear of Falling in Older Adults with and without Cognitive Impairment. Gerontology. 2011;57:462–72. https://doi.org/10.1159/000320054.CrossRefPubMed

35.

Schmidt TP, Wagner KJP, Schneider IJC, Danielewicz AL. Multimorbidity patterns and functional disability in elderly Brazilians: A cross-sectional study with data from the Brazilian National Health Survey. Cad Saude Publica. 2020;36:1–12.

36.

Baré M, Herranz S, Roso-Llorach A, Jordana R, Violán C, Lleal M, et al. Multimorbidity patterns of chronic conditions and geriatric syndromes in older patients from the MoPIM multicentre cohort study. BMJ open. 2021;11:e049334.PubMedPubMedCentral

37.

Yao S-S, Cao G-Y, Li M, Ai P, Huang Z, Xu B. The prevalence and patterns of multimorbidity among community-dwelling older adults in China: a cross-sectional study. The Lancet. 2018;392:S84.

38.

Wang Z, Peng W, Li M, Li X, Yang T, Li C, et al. Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai. China BMC Public Health. 2021;21:418. https://doi.org/10.1186/s12889-021-10463-y.CrossRefPubMed

39.

Yao S-S, Cao G-Y, Han L, Chen Z-S, Huang Z-T, Gong P, et al. Prevalence and Patterns of Multimorbidity in a Nationally Representative Sample of Older Chinese: Results From the China Health and Retirement Longitudinal Study. J Gerontol A Biol Sci Med Sci. 2020;75:1974–80.PubMed

40.

Rivera-Almaraz A, Manrique-Espinoza B, Ávila-Funes JA, Chatterji S, Naidoo N, Kowal P, et al. Disability, quality of life and all-cause mortality in older Mexican adults: association with multimorbidity and frailty. BMC Geriatr. 2018;18:236.PubMedPubMedCentral

41.

Garin N, Koyanagi A, Chatterji S, Tyrovolas S, Olaya B, Leonardi M, et al. Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study. J Gerontol A Biol Sci Med Sci. 2016;71:205–14.PubMed

42.

Violan C, Foguet-Boreu Q, Flores-Mateo G, Salisbury C, Blom J, Freitag M, et al. Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies. PloS One. 2014;9:e102149.PubMedPubMedCentral

43.

Schäfer I, Hansen H, Schön G, Höfels S, Altiner A, Dahlhaus A, et al. The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. first results from the multicare cohort study. BMC Health Serv Res. 2012;12:89. https://doi.org/10.1186/1472-6963-12-89.CrossRefPubMedPubMedCentral

44.

Bertolucci PHF, Brucki S, Campacci SR, Juliano Y. O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr. 1994;52:1–7.PubMed

45.

Brucki S, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr. 2003;61:777–81.PubMed

46.

Canever JB, Danielewicz AL, Leopoldino AAO, Giehl MWC, de Avelar NCP. How Much Time in Sedentary Behavior Should Be Reduced to Decrease Fear of Falling and Falls in Community-Dwelling Older Adults? J Aging Phys Act. 2021;1:17.

47.

Matsudo S, Araújo T, Matsudo V, Andrade D, Andrade E, Oliveira LC, et al. Questionário Internacional De Atividade Física (Ipaq): Estupo De Validade E Reprodutibilidade No Brasil. Questionário Internacional De Atividade Física (Ipaq): Estupo De Validade E Reprodutibilidade No Brasil 2001;6:5–18.

48.

Oliveira CC, McGinley J, Lee AL, Irving LB, Denehy L. Fear of falling in people with chronic obstructive pulmonary disease. Respir Med. 2015;109:483–9.PubMed

49.

Manini TM, Pahor M. Physical activity and maintaining physical function in older adults. Br J Sports Med. 2009;43:28–31.PubMed

50.

Salazar A, Dueñas M, Ojeda B, Failde I. Association of painful musculoskeletal conditions and migraine headache with mental and sleep disorders among adults with disabilities, Spain, 2007–2008. Prev Chronic Dis. 2014;11:E30.PubMedPubMedCentral

51.

Mat S, Kamaruzzaman SB, Chin A-V, Tan MP. Impact of Knee Pain on Fear of Falling, Changes in Instrumental Activities of Daily Living, and Falls Among Malaysians Age 55 Years and Above. Front Public Health. 2020;8:571196.PubMedPubMedCentral

52.

Meyer F, König HH, Hajek A. Osteoporosis, fear of falling, and restrictions in daily living. Evidence from a nationally representative sample of community-dwelling older adults. Frontiers in Endocrinology. 2019;10 SEP:1–6.

53.

Scott KM, Von Korff M, Alonso J, Angermeyer MC, Bromet E, Fayyad J, et al. Mental-physical co-morbidity and its relationship with disability: results from the World Mental Health Surveys. Psychol Med. 2009;39:33–43.PubMed

54.

Lee S, Oh E, Hong GRS. Comparison of factors associated with fear of falling between older adults with and without a fall history. Int J Environ Res Public Health. 2018;15:982.PubMedCentral

55.

Neri SGR, Gadelha AB, de David AC, Ferreira AP, Safons MP, Tiedemann A, et al. The Association Between Body Adiposity Measures, Postural Balance, Fear of Falling, and Fall Risk in Older Community-Dwelling Women. Journal of geriatric physical therapy. 2001;2019(42):E94-100.

56.

Neri SGR, Gadelha AB, Correia ALM, Pereira JC, Safons MP, Lima RM. Association between obesity, risk of falls and fear of falling in older women. Revista Brasileira de Cineantropometria e Desempenho Humano. 2017;19:450–8.

57.

Yang F, Kim J, Yang F. Effects of obesity on dynamic stability control during recovery from a treadmill-induced slip among young adults. J Biomech. 2017;53:148–53.PubMed

58.

Son SM. Influence of Obesity on Postural Stability in Young Adults. Osong Public Health Res Perspect. 2016;7:378–81. https://doi.org/10.1016/j.phrp.2016.10.001.CrossRefPubMedPubMedCentral

59.

Resnick HE, Vinik AI, Schwartz AV, Leveille SG, Brancati FL, Balfour J, et al. Independent effects of peripheral nerve dysfunction on lower-extremity physical function in old age: the Women’s Health and Aging Study. Diabetes Care. 2000;23:1642–7.PubMed

60.

Bretan O, Pinheiro RM, Corrente JE. Avaliação funcional do equilíbrio e da sensibilidade cutânea plantar de idosos moradores na comunidade. Braz J Otorhinolaryngol. 2010;76:219–24.PubMed

61.

Jackson AS, Sui X, Hébert JR, Church TS, Blair SN. Role of lifestyle and aging on the longitudinal change in cardiorespiratory fitness. Arch Intern Med. 2009;169:1781–7. https://doi.org/10.1001/archinternmed.2009.312.CrossRefPubMedPubMedCentral

62.

He Z, Bian J, Carretta HJ, Lee J, Hogan WR, Shenkman E, et al. Prevalence of Multiple Chronic Conditions Among Older Adults in Florida and the United States: Comparative Analysis of the OneFlorida Data Trust and National Inpatient Sample. J Med Internet Res. 2018;20:e137.PubMedPubMedCentral

63.

Zimmerman B, Sutton BP, Low KA, Fletcher MA, Tan CH, Schneider-Garces N, et al. Cardiorespiratory fitness mediates the effects of aging on cerebral blood flow. Frontiers in aging neuroscience. 2014;6:59.PubMedPubMedCentral

64.

McCarthy K, Ward M, Romero Ortuño R, Kenny RA. Syncope, fear of falling and quality of life among older adults: findings from the irish longitudinal study on aging (TILDA). Frontiers in cardiovascular medicine. 2020;7:7.PubMedPubMedCentral

65.

Stubbs B, West E, Patchay S, Schofield P. Is there a relationship between pain and psychological concerns related to falling in community dwelling older adults? A systematic review Disability and rehabilitation. 2014;36:1931–42.PubMed

66.

Monteiro AM, Forte P, Carvalho J, Barbosa TM, Morais JE. Relationship between fear of falling and balance factors in healthy elderly women: A confirmatory analysis. J Women Aging. 2021;33:57–69.PubMed

67.

Immonen M, Haapea M, Similä H, Enwald H, Keränen N, Kangas M, et al. Association between chronic diseases and falls among a sample of older people in Finland. BMC Geriatr. 2020;20:225. https://doi.org/10.1186/s12877-020-01621-9.CrossRefPubMedPubMedCentral

68.

Paliwal Y, Slattum PW, Ratliff SM. Chronic Health Conditions as a Risk Factor for Falls among the Community-Dwelling US Older Adults: A Zero-Inflated Regression Modeling Approach. Biomed Res Int. 2017;2017:5146378.PubMedPubMedCentral

69.

de Amorim JSC, Torres KCL, Teixeira-Carvalho A, Martins-Filho OA, Lima-Costa MF. Peixoto SV. Inflammatory markers and occurrence of falls: Bambuí Cohort Study of Aging. Revista de saude publica; 2019. p. 53.

70.

Lee Y, Kim H, Jeong H, Noh Y. Patterns of Multimorbidity in Adults: An Association Rules Analysis Using the Korea Health Panel. Int J Environ Res Public Health. 2020;17:2618. https://doi.org/10.3390/ijerph17082618.CrossRefPubMedCentral

71.

Villacampa-Fernández P, Navarro-Pardo E, Tarín JJ, Cano A. Frailty and multimorbidity: Two related yet different concepts. Maturitas. 2017;95:31–5.PubMed

72.

Martínez-Arnau FM, Prieto-Contreras L, Pérez-Ros P. Factors associated with fear of falling among frail older adults. Geriatric nursing (New York, NY). 2021;42:1035–41.

Title: Are multimorbidity patterns associated with fear of falling in community-dwelling older adults?
Authors: Jaquelini Betta Canever
Bruno de Souza Moreira
Ana Lúcia Danielewicz
Núbia Carelli Pereira de Avelar
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Anxiety
Published in: BMC Geriatrics / Issue 1/2022
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-022-02889-9

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

The role of socio-demographic factors and physical functioning in the intra- and interpersonal variability of older adults’ sedentary time: an observational two-country study

Anticipatory care planning for community-dwelling older adults at risk of functional decline: a feasibility cluster randomized controlled trial

Applying the PDSA cycle to a group activity promoting lifestyle change for the active ageing of older Thai adults – a focused ethnography

Is multimorbidity associated with higher risk of falls among older adults in India?

Circulating miR-181a as a novel potential plasma biomarker for multimorbidity burden in the older population

Standards and quality of care for older persons in long term care facilities: a scoping review

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials