THE EFFECT OF FEAR OF FALLING AND
SLEEPING HABITS ON FUNCTIONAL LEVEL
IN OLD AGE
Selda Başar*, Nevin A. Guzel*, Ilke Keser*, Nihan K. Kafa*, Ozge C.
Medeni*, Zekeriya Ulger**
*Gazi University Faculty of Health Sciences, Department of
Physiotherapy and Rehabilitation-Ankara-Turkey
**Gazi University Faculty of Medicine, Deparment of Geriatrics
• In old age, there are various factors that may decrease
functional level
• Decrease in functional level has a limiting role in maintaining
individuality of the persons by increasing the dependence
• One of the causes that reduce function is deterioration in
mobility
Tinetti ME, Powell L. Fear of falling and low self-effi cacy: a case of dependence in elderly persons. J Gerontol.
1993;48(spec no.):35-38.
Lach HW. Incidence and risk factors for developing fear of falling in older adults. Public Health Nurs. 2005 JanFeb;22(1):45-52.
We studied two factors which can lead to lack of mobility in
elderly
 Sleeping habits
 Fear of falling
• Sleep is an important component of a healthy lifestyle.
• The optimal nighttime sleep duration for survival was 7 h
• Studies reported that short duration of sleep was 6 h and
less, long duration of sleep was more than 9 h
( Grandner et al 2010, Kripke et al. 2002)
• Numerous researches demonstrated that sleep duration
changes with age
(Stone 2009, Gangwisch et al 2008, Jung et al 2013)
• It was found that both short and long duration of sleep have
been associated with increased mortality
Cohen-Mansfield J Perach R. SLEEP 2012
• It is observed that increase in falling and injuring is
associated with sleep duration
Stone et al J Am Geriatr Soc 2006.
For this reason we consider that sleep duration can affect
the mobility and funtional level due to its relation with
injury
• Falls are the leading cause of injuries in older adults
http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html
• Even when falls do not result in injury, they can provoke a
fear of falling (FoF) that may set in motion a downward
spiral of progressive participation restriction
Allison et al. J Geriatr Phys Ther 2013;36:13-23
• The main risk factors for developing FOF are at least one fall
and being older
Fear of falling is defined as ‘a lasting concern about falling that
leads an individual to avoid’ activities that he/she remains
capable of performing
(Tinetti & Powell 1993)
Murphy and Isaac describe Fear of falling as the post-fall
syndrome
But fear of falling is commonly seen in elderly both participants
with a history of falls and participants with no history of falls
(SCHEFFER et al. 2008, Anon 2002a, Howland 1999)
In a study, it was detected that 30 to 50% of the elderly had fear
of falling
(Howland 1999)
• Impact of Fear of Falling on participation to an activity was
investigated
(Cumming et al. 2000)
• It was found that fear of falling in elderly limits the
participation to an activity or leads to immobility
(Howland 1999)
To our knowledge researches which investigate relation
between the fear of falling and functional level are limited
Except two researches (Tinetti et al 1994, Białoszewski et al.
2008), functional level are determined by the questionaire
In this study we used two objective tests to assess function
Tinetti ME, Mendes de Leon CF, Doucette JT, Baker DI. J Gerontol. 1994 May;49(3):M140-7. Fear of falling
and fall-related efficacy in relationship to functioning among community-living elders.
Arfken CL, Lach HW, Birge SJ, Miller JP. The prevalence and correlates of fear of falling in elderly persons
living in the community. Am J Public Health. 1994;84:565–570
Białoszewski D, Słupik A, Lewczuk E, Gotlib J, Mosiołek A, Mierzwińska A. 441-8.Incidence of falls and their
effect on mobility of individuals over 65 years of age relative to their place of residence. Ortop Traumatol
Rehabil. 2008 Sep-Oct;10(5)
Objective
Our aim for the study was to investigate the effects of
sleeping habits and the FoF on functional status in elderly
Methods
Participant’s demographics:
•
•
•
•
Total 41 individuals participated in the study
Median age: 74 (65-90) years
16 elderly have been living in nursing home
35 elderly have been living with his family
Exclusion criteria
•
•
•
•
•
Neurological or rheumatological disease
Previous lower extremity surgery
Mini mental state examination score ≤24
Being smaller than sixty five years old
Using sleeping pill
Methods
• To determine the sleeping habits daily sleeping time was
recorded as hour
• Total 24-hour sleep duration was estimated as the sum of
nighttime sleep hours and average daytime nap hours
Methods
• Fall risk was determined by Timed Get Up and Go test (TUG)
• FoF recorded as yes/no
• Participants were divided into two groups according to the
presence of FoF and sleep duration (6 /less than and more
than 6 hours)
• There is at least one fall history in elderly who are within a
group having FoF
• Other group does not have any fall history
Rikli RE, Jones CJ. 2001. Senior fitness test manual. Champaign, IL: Human Kinetics
Methods
Functional level was evaluated by
 Chair Stand test (CS)
 Timed Get Up and Go test
Statistical analysis
• Results of CS and TUG tests were compared by using Mann
Whitney U test for the groups which were formed according
to sleeping habits
• Relationship between sleeping habits, CS and TUG were
examined by Sperman correlation analysis
• Sleep duration, results of CS and TUG tests were compared
by using Mann Whitney U test for the groups which were
formed according to the FoF
Comparison of Age and BMI between groups sleeping 6
hours/or less and 6 hours
Group sleeping 6 hours or
less (n:18)
Group sleeping more than 6
hours (n: 23)
p
Median (Min – Max)
Median (Min – Max)
Age, year
71 (65-74)
76 (66-88)
0.23
BMI , kg/cm2
28 (21-36))
28 (20-42)
0.43
Mann- Whitney U test
The proportion of elderly whose sleep duration was 6 and less than 6 hours was 41 %
Age and BMI were similar (p> 0.05) between groups sleeping 6 hours or less and more
than 6 hours
Comparison of functional tests according to sleeping habits
Sleep duration, hour
CS, s
TUG, s
Group sleeping 6 hours or
less (n:18)
Group sleeping more than 6
hours (n: 23)
p
Median (Min – Max)
Median (Min – Max)
5 (3- 6)
8 (7-10)
0,00
11 (0-18)
10 (0-16)
0.46
8 (7-24)
11 (6-32)
0.66
Mann- Whitney U test
There was statistically significant different in sleep duration between two the groups
CS and TUG were not different between elderly whose sleep duration are 6 hours or less and
more than 6 hours respectively (p> 0.05)
Correlation among the CS ,TUG and sleeping habits in elderly
sleeping less than 6 hours or less
CS
Sleep duration
(hour)
TUG
r
p
r
p
0.38
0.21
-0.58
0.02
Spearman correlation analysis
It was found that there was a statistically significant negative relationship in a moderate
degree between sleep duration and TUG in elderly whose sleep duration is 6 or less (p<
0.05)
Correlation among the CS ,TUG and sleeping habits in elderly
sleeping more than 6 hours
CS
Sleep duration
(hour)
TUG
r
p
r
p
-0.23
0.50
0.29
0.36
Spearman correlation analysis
There was a weak correlation between sleep duration, CS and TUG in elderly whose sleep
duration is more than 6 hours. The relationship was not statistically significant (p> 0.05)
Comparison of Age and BMI between elderly with and
without the FoF
FoF
(Present) (n: 17)
FoF
(Absent) (n:24)
Median (Min – Max)
Median (Min – Max)
Age, year
71 (65-88)
75 (65-90)
0.07
BMI, k/cm2
29 (21-36)
30 (20-46)
0.06
Mann- Whitney U test
Age and BMI were similar (p> 0.05) between elderly with and without the FoF
p
Comparison of functional tests between elderly with
and without the FoF
FOF
(Present) (n: 17)
FOF
(Absent) (n:24)
Median (Min – Max)
Median (Min – Max)
CS
10 (0-16)
12 (0-18)
0.120
TUG
12 (8-32)
8 (6-31)
0.007
Mann- Whitney U test
CS was not different between elderly with and without the FoF (p> 0.05)
TUG was significant in favor of the group without FoF (p< 0.05)
p
Discussion
• In this research,
• It was found that functional level was not different in elderly
sleeping less than 6 hours or less and more than 6 hours
• However, while sleep duration was increasing, functional
level also increased in the elderly having 6 hours or less
sleep duration
The
optimal
nighttime
sleep
duration
for
survival was 7 h
Sleep duration is
associated
with
mortality and the
lowest risk is most
often found in
people who report
sleep durations of
7–8 h compared
with short or long
sleepers
• A series of subsequent investigations analyzed data from
adults
• These studies reported that short (6 h) and long (9 h) sleepers
had higher mortality rates than 7–8 h sleepers
• As early as 1964, data have shown that 7-h sleepers
experience the lowest risks for all-cause mortality, whereas
those at the shortest sleep durations have significantly higher
mortality risks. Numerous follow-up studies from around the
world (e.g., Japan, Israel, Sweden, Finland, the United
Kingdom) show similar relationships
• However, mortality was not investigated in this study
Michael A. Grandner , Lauren Hale , Melisa Moore , Nirav P. Patel Mortality associated with short sleep
duration: The evidence, the possible mechanisms, and the future. Sleep Medicine Reviews, Volume 14,
Issue 3, June 2010, Pages 191–203
Heslop P, Smith GD, Metcalfe C, Macleod J, Hart C. Sleep duration and mortality: The effect of short or
long sleep duration on cardiovascular and all-cause mortality in working men and women. Sleep Med.
2002 Jul;3(4):305-14.
Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and
insomnia. Arch Gen Psychiatry 2002;59(2):131–6.
Sleep duration
FoF
Reduced mobility
Falls
Injury and mortality
Stone et al J Am Geriatr Soc 2006
Cohen-Mansfield J Perach R. SLEEP 2012
Lach HW. Public Health Nurs. 2005
In this study,
• It was found that functional level decreased in elderly with
the FoF
• Kressig et al. determined that fear of falling and poor
functional performance are risk factors for falls in older
individuals
Kressig et al Am Geriatr Soc. 2001
• According to Alison et al. fear of falling has consistently been
correlated with self restriction of physical activity
Allison et al J Geriatr Phys Ther. 2013
• Peterson reported that FOF was associated with a decrease in
physical activity
Peterson 2001 Volume 8, Number 4 •
December 2001 Published by the American
Occupational Therapy Association, Inc.
• Białoszewski et al was found that the fear of falling was most
frequently indicated as the reason for the reduced mobility
Białoszewski D, Słupik A, Lewczuk E, Gotlib J,
Mosiołek A, Mierzwińska. Ortop Traumatol
Rehabil. 2008 Sep-Oct;10(5):441-8.
In this study,
since FoF limits the mobility (TUG), it was thought that
limited mobility reduced the elderly’s participation to
activities
Take Home Message
• Sleeping habits in elderly should be arranged in healty limits
• Reasons for fear of falling in elderly should be determined
• Functional level can be increased by decreasing fear of falling
Conclusion
Eliminating the reasons of FoF and interventions to enhance
sleep may improve the level of function in elderly
Thank you ….