Abstract

Background Fear of falling (FoF) is associated with activity restriction (AR) and reduced quality of life (QoL), leading to loss of independence. Physical and cognitive functions are associated with FoF. Inconsistencies in the mediating role of physical and cognitive function and complex interrelationships require further investigation; These relationships may differ between fallers and non-fallers. Our aim was to investigate the direct and indirect pathways between FoF, activity restriction/avoidance, QoL, and the mediating role of latent (unobserved) variables of physical and cognitive function in both fallers and non-fallers in a cohort of community-dwelling older adults.

Methods Data from Wave 1 of The Longitudinal Irish Study of Ageing (TILDA) was used (with permission from ISSDA). The study was approved by the University of Sunderland ethics committee (011063). Outcome measures from TILDA include QoL, FoF, AR, physical function (Timed-Up and Go (TUG) and Grip strength), and cognitive function (Mini-mental State Examination (MMSE)). Data were cleaned (e.g., remove missing or NA) and processed in R Studio (version: 1.4.1106). Welch’s T-test was used to model differences in outcome measures between fallers and non-fallers, fallers with/without FoF, and, non-fallers with/without FoF. Mean difference (MD), 95% confidence (compatibility) intervals (CI) are reported for key comparisons. Structural equation modelling (SEM) will be used to model interrelationships between observed and latent variables, adjusting for medical, health and lifestyle covariates. Multiple models will be run, including imputing missing data.

Results Our preliminary findings indicate 4761 participants (≥50 years of age) with full datasets; Of which 6.3% reported activity avoidance, 20.7% had FoF, and 20.2% had previously fallen. Compared to non-fallers, fallers had lower QoL scores (MD =-1.66 ; 95% CI =-2.19,-1.14 AU), MMSE (MD =-0.11; 95% CI= -0.24, 0.02) and grip strength (MD = -1.49; 95% CI = -2.18 to 0.80 kg) and higher TUG (MD = 0.45; 95% CI = 0.24,0.67). Fallers with FoF had lower QoL, and grip strength and higher TUG (p <0.001), non-fallers with FoF had lower QoL and grip strength and higher TUG.

Conclusion Physical function and cognitive differences are reported between faller and non-faller groups. SEM will allow for modelling these complex interrelationships between FoF, AR and QoL, mediated via our latent variables (physical and cognitive function). The data will inform health- and activity- promoting strategies to improve QoL in older adults with FoF.