Despite extensive research about improving the effectiveness of falls prevention interventions, at-risk individuals are not always willing recipients. Reasons for rejecting treatments are still poorly understood. Applying the health belief model (HBM), if perceived severity and susceptibility can be understood in the context of falling, this might better inform intervention designs.
Method
Sixty-two participants were recruited from inpatient wards at a local acute hospital. Participants completed two self-report questionnaires, the Staying Independent Checklist (SIC) and the Falls Efficacy Scale – International (FES-I), measuring perceived susceptibility and severity respectively.
Results
One-way ANOVA analysis revealed a significant association between FES-I total scores and SIC score categories [F (1,60) = 6.277, p = .015].Stepwise regression with backward elimination also found that falls history (β = .292, p = .033), sex (β = .269, p = .042), and FIM lower body dressing (β = − .286, p = .035) had significant associations with FES-I scores.
Conclusion
Level of perceived susceptibility and severity of falling should be considered when determining if falls prevention interventions are relevant, regardless of functional ability and physical health status. Future research to determine the underlying mechanisms which drives health behaviours related to falls prevention should be conducted.
BowerESWetherellJLPetkusAJ, et al. (2016) Fear of falling after hip fracture: prevalence, course, and relationship with one-year functional recovery. The American Journal of Geriatric Psychiatry24(12): 1228–1236.
2.
BraunBL (1998) Knowledge and perception of fall-related risk factors and fall-reduction techniques among community-dwelling elderly individuals. Physical Therapy78(12): 1262–1276.
3.
ChampionVLSkinnerCS (2008) The health belief model. Health Behavior and Health Education: Theory, Research, and Practice4: 45–65.
4.
ChealBClemsonL (2001) Older people enhancing self-efficacy in fall-risk situations. Australian Occupational Therapy Journal48(2): 80–91.
5.
DelbaereKCloseJCTMikolaizakAS, et al. (2010) The falls efficacy scale international (FES-I). A comprehensive longitudinal validation study. Age and Ageing39(2): 210–216. DOI: 10.1093/ageing/afp225.
6.
Epidemiology & Disease Control Division, Ministry of Health, Singapore; Institute for Health Metrics and Evaluation. The Burden of Disease in Singapore 1990–2017: An overview of the Global Burden of Disease Study 2017 results. Seattle, WA: IHME. 2019.
7.
GanzDABaoYShekellePG, et al. (2007) Will my patient fall?Journal of the Society of Laparoendoscopic Surgeons297: 77–86. DOI: 10.1001/jama.297.1.77.
8.
GitlinLNHauckWWWinterL, et al. (2006) Effect of an in-home occupational and physical therapy intervention on reducing mortality in functionally vulnerable older people: reliminary findings. Journal of the American Geriatrics Society54(6): 950–955.
9.
HauerKYardleyLBeyerN, et al. (2010) Validation of the falls efficacy scale and falls efficacy scale international in geriatric patients with and without cognitive impairment: results of self-report and interview-based questionnaires. [research support, non-U.S. gov’t validation studies]. Gerontology56(2): 190–199. DOI: 10.1159/000236027.
10.
HauerKAKempenGISchwenkM, et al. (2011) Validity and sensitivity to change of the falls efficacy scales international to assess fear of falling in older adults with and without cognitive impairment. Gerontology57(5): 462–472.
11.
HoangOTJullamatePPiphatvanitchaN, et al. (2017) Factors related to fear of falling among community-dwelling older adults. Journal of Clinical Nursing26(1–2): 68–76.
12.
HortonK (2007) Gender and the risk of falling: a sociological approach. Journal of Advanced Nursing57(1): 69–76. DOI: 10.1111/j.1365-2648.2006.04061.x.
13.
HughesKvan BeurdenEEakinEG, et al. (2008) Older persons’ perception of risk of falling: implications for fall-prevention campaigns. American Journal of Public Health98(2): 351–357. DOI: 10.2105/ajph.2007.115055.
14.
JungD (2008) Fear of falling in older adults: comprehensive review. Asian Nursing Research2(4): 214–222.
15.
KeithRAGrangerCVHamiltonBB, et al. (1987) The functional independence measure: a new tool for rehabilitation. Advances in Clinical Rehabilitation1: 6–18.
16.
KempenGIvan HaastregtJCMcKeeKJ, et al. (2009) Socio-demographic, health-related and psychosocial correlates of fear of falling and avoidance of activity in community-living older persons who avoid activity due to fear of falling. BMC Public Health9(1). DOI: 10.1186/1471-2458-9-170.
17.
LeeD-CAMcDermottFHoffmannT, et al. (2013) ‘They will tell me if there is a problem’: limited discussion between health professionals, older adults and their caregivers on falls prevention during and after hospitalization. Health Education Research28(6): 1051–1066.
18.
MackenzieLBylesJMishraG (2004) An occupational focus on falls with serious injury among older women in Australia. Australian Occupational Therapy Journal51(3): 144–154.
19.
MoreiraMNBiltonTLDiasRC, et al. (2016) What are the main physical functioning factors associated with falls among older people with different perceived fall risk?Physiotherapy Research International: the Journal for Researchers and Clinicians in Physical Therapy22(3): e1664. DOI: 10.1002/pri.1664.
20.
OttenbacherKJHsuYGrangerCV, et al. (1996) The reliability of the functional independence measure: a quantitative review. Archives of Physical Medicine and Rehabilitation77(12): 1226–1232.
21.
RimalRNRealK (2003) Perceived risk and efficacy beliefs as motivators of change: use of the risk perception attitude (RPA) framework to understand health behaviors. Human Communication Research29(3): 370–399.
22.
RobsonKCoyleJPopeR (2018) Exploration of older people’s perceptions of behavioural factors associated with falls. Age and Ageing47(5): 734–740. DOI: 10.1093/ageing/afy051.
23.
RosenstockIM (1974) The health belief model and preventive health behavior. Health Education Monographs2(4): 354–386.
24.
RubensteinLZVivretteRHarkerJO, et al. (2011) Validating an evidence-based, self-rated fall risk questionnaire (FRQ) for older adults. Journal of Safety Research42(6): 493–499.
25.
SahadevanSLimPPTanNJ, et al. (2000) Diagnostic performance of two mental status tests in the older Chinese: influence of education and age on cut-off values. International Journal of Geriatric Psychiatry15(3): 234–241.
26.
SchmidAARittmanM (2009) Consequences of poststroke falls: activity limitation, increased dependence, and the development of fear of falling. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association63(3): 310–316. DOI: 10.5014/ajot.63.3.310.
27.
SlovicPPetersE (2006) Risk perception and affect. Current Directions in Psychological Science15(6): 322–325.
28.
StevensJANoonanRKRubensteinLZ (2010) Older adult fall prevention: perceptions, beliefs, and behaviors. American Journal of Law & Medicine4(1): 16–20.
29.
SuzukiTSonodaSMisawaK, et al. (2005) Incidence and consequence of falls in inpatient rehabilitation of stroke patients. Experimental Aging Research31(4): 457–469. DOI: 10.1080/03610730500206881.
30.
VisschedijkJvan BalenRHertoghC, et al. (2013) Fear of falling in patients with hip fractures: prevalence and related psychological factors. Journal of the American Medical Directors Association14(3): 218–220.
31.
VivretteRLRubensteinLZMartinJL, et al. (2011) Development of a fall-risk self-assessment for community-dwelling seniors. Journal of Aging and Physical Activity19(1): 16–29.
32.
WielandtTStrongJ (2000) Compliance with prescribed adaptive equipment: a literature review. British Journal of Occupational Therapy63(2): 65–75.
33.
XuTO’loughlinKClemsonL, et al. (2019) Therapists’ perspectives on adapting the stepping on falls prevention programme for community-dwelling stroke survivors in Singapore. Disability and Rehabilitation41(21): 2528–2537. DOI: 10.1080/09638288.2018.1471168.
34.
YardleyLDonovan-HallMFrancisK, et al. (2006) Older people’s views of advice about falls prevention: a qualitative study. Health Education Research21(4): 508–517.
35.
ZijlstraGARVan HaastregtJCMVan RossumE, et al. (2007) Interventions to reduce fear of falling in community-living older people: a systematic review. Journal of the American Geriatrics Society55(4): 603–615.
