Falls, perceived fall risk and activity curtailment among older people receiving home-help service

Sammanfattning: Falls and fall-related concern and fear of falling are not well understood when it comes to old people receiving home-help services, a transitional population in-between those living independently in the community and those living in residential care facilities. The psychological distress attributable to the perceived risk of falling among this population needs further exploration, which is also the case regarding possible ways to increase their feeling of security. The aims of this thesis were to investigate the incidence of falls, fall-related concern, fear of falling and fall-related activity curtailment amongst older people receiving homehelp services, as well as exploring the validity and user expectations of an automatic fall detector and alarm prototype. In a one-year prospective cohort study of 614 home-help recipients in one municipality in northern Sweden, the fall incidence was estimated to be 626 (95% CI: 479 – 773) per 1,000 person-years. The fall risk was significantly associated with receiving help for personal ADL needs: IRR 2.8 (95 % CI: 2.1 - 3.8). An unexpected finding was that the fall incidence was significantly correlated to the amount of daylight (r: -0.78, r2: 0.61; p: 0.003). A cross-sectional study of 51 home-help recipients in three municipalities in northern Sweden revealed that 65% (95% CI: 52% – 78%) had a high degree of concern about falling according to the Falls Efficacy Scale International (FES-I). This concern was significantly associated with concern about the consequences of falling, mobility and morale, but its correlation to fear of falling was moderate. The proportion reporting that they needed assistance to perform a specific activity or avoided one owing to a fear of falling was 57% and 26%, respectively. Such fear-dependent need for assistance was associated with morale and mobility, and fear-dependent activity avoidance with morale and fallrelated concern. While wearing a fall sensor attached to their hips, twenty middle-aged people performed six different intentional falls. For reference, these people, and 21 older people from a residential care unit, walked through a sequential ADL track. The results showed that the sensor could discriminate various types of falls from daily life activities with a sensitivity of 97.5% and a specificity of 100%. When the principle of the automatic fall sensor and alarm system were described for them, 74% of the 51 elderly home-help recipients stated that it would increase their security, 66% that it would decrease their fear of falling and 57% that it would increase their freedom to move about, while 28% feared it could influence their privacy. In conclusion, falls and fall-related concern seem to be common amongst the elderly recipients of home-help services, and this should be taken into account when planning the provision of services. Mobility, concern about the consequences of falling and morale seem to be connected both with a concern about falling and fall-related activity curtailment. Furthermore, a fall detector system has promising potential for use among homehelp recipients. The correlation between the incidence of falling and the amount of daylight should be further explored.