April 2015, Volume 65, Issue 4

Short Communication

Fear of falling in elderly people living in a nursing home - perspective from Manisa

Nurgul Gungor Tavsanli  ( Celal Bayar University, School of Health, Sehitler Mah. Istasyon Mevkii PK. 45020 Centrum, Manisa, Turkey. )
Sevgi Nehir Turkmen  ( Celal Bayar University, School of Health, Sehitler Mah. Istasyon Mevkii PK. 45020 Centrum, Manisa, Turkey. )

Abstract

Our study aimed to determine the level of fear of falling in elderly nursing home residents. The research population consisted of all the elderly residents of Manisa Municipal Nursing Home between November 2011 and February 2012. The 76 elderly people who agreed to participate were included in the study. A demographics form and the Tinetti Falls Efficacy Scale were used in data collection. The statistical analysis of the data was performed using SPSS 15.0, using percentage calculations, the t-test and Cronbach\'s alpha. The mean score on the Tinetti Falls Efficacy Scale for elderly individuals was found to be 4.57 ± 3.80. 57.9% of the old people feared falling while taking a bath, 59.2% while going to bed or getting up, and 53.6% while sitting down or getting up from a chair. It was found that mean fear of falling scores were significantly higher in elderly individuals with chronic diseases, sleep problems and urinary incontinence.
Keywords: Elderly people, Nursing homes, Fear of falling, Evidence-Based Measures.


Introduction

In old age, morphological, physiological and pathological changes combine with the effects of various illnesses, resulting in a deterioration of physical and mental skills and abilities.1 According to a World Health Organization report, the population of over-65s was 390 million in 1998, and will reach 800 million or 10% of the world\'s population by 2025.2 In Turkey, people aged 65 and over formed 5.7% of the population in 2005, and this figure is expected to reach 17.6% by 2050.3
Falling means coming from the level where an individual was to a lower level and an immobile state as a result of carelessness without any compelling force, fainting or stroke.4,5
It has been pointed out that more than a quarter of falls result in physical injury such as contusions, cuts or breakages.5 The result of a fall can be a small injury or a serious one. Small injuries include bruises, damage to soft tissue, or injuries which do not require sutures, while serious injuries can be breakages of the hip, pelvis, or radius, injuries which require sutures, or haematoma, and can result in death.5
Fear of falling or of the injuries that can result from it can seriously affect the functioning of old people and can greatly lower their quality of life. A third of those who had not had a fall and half of those who had fallen were found to limit their daily activities because of a fear of falling.6
Most falls happen indoors, and most falls by old people occur during habitual activities such as walking. Indoor falls most often happen in the bathroom, on the stairs, in the bedroom or in the kitchen. Outdoor falls happen at street obstacles or on steps. Falls in communal living centers such as nursing homes most often happen when moving from bed to another location, when getting up, or in the bathroom.6-8
Determining old people\'s fear of falling by the use of a scoring system when they are accepted into a nursing home can enable the necessary care approaches to be taken and evidence-based protective measures to be taken in time and will at the same time protect old people from injury.9
The aim of the present study was to determine the level of fear of falling of old people residing in a nursing home.


Methods and Results

The study was planned as a cross-sectional descriptive study to determine the fear of falling in old people living in a nursing home. The population of the study was formed from all of the old people residing in Manisa Municipal Nursing Home between November 2011 and February 2012 (n= 85). As all of the individuals in the population were included in the sampling, no separate sampling procedure was used. The 76 old people who were resident in the home at the time of the study and who accepted to take part were included in the research. Ethical approval for the research was obtained from the Ethics Committee of Celal Bayar University Medical Faculty, and the necessary legal permission was obtained from Manisa Municipality.  Informed consent was obtained in writing from the old people who accepted to take part in the study.
A demographics form (form consisted of 18 questions) and Tinetti\'s Falls Efficacy Scale (FES) (form consisted of 10 questions and Likert type, between 0 and 1 scores) were used in the collection of data.10 Statistical analysis of data was performed by means of the Statistical Package for Social Science (SPSS) version 15.0, using numerical, mean and standard deviation values and t-test.
Table-1 shows the identifying characteristics of the old people residing in the nursing home.  It was found that 46% of them were in the 65-74 year age group and 36.8% were aged 75-84; 22.4% were female and 77.6% were male; 97.4% were single, widowed or separated; 25% were illiterate and 44.7% had primary-level education; 35.5% had one or more children, and 75% had a chronic illness (Table-1).


Responses given by the old people residing in the nursing home on the Tinetti Falling Efficacy Scale are examined in Table-2. In all, 57.9% of the old people feared falling while taking a bath, 42.1% while taking things from a cupboard, 28.9% while meeting their need for food in the institution, 47.4% while walking in the garden, 59.2% (45) while going to bed or getting up, 31.6% while answering the door or the telephone, 53.6% while sitting down or getting up from a chair, 44.7% while getting dressed or undressed, 48.7% while working in their rooms, and 43.4% while shopping (Table-2).


The mean score of the residents of the nursing home on the Tinetti FES was found to be 4.57±3.80 (min=0 max=10).
Of the total study population 56.6% had hypertension, 17.1% had diabetes mellitus, 18.4% had cardiovascular disease, 26.3% had vision problems, 31.6% had hearing difficulties, 21.1% had sleeping problems, 10.5% had COPD, 5.3% had urinary incontinence, 1.3% suffered from depression, and 2.6% had arthritis. The relationship between chronic illnesses in the subjects and their mean fear of falling score was examined and it was found that those with a chronic illness, sleep problems or urinary incontinence had significantly higher scores (p <0.01).
No significant relationship was found between the identifying characteristics of the subjects such as age, sex or education level and mean fear of falling scores (p >0.05).


Conclusion and Discussion

Old people residing in nursing homes have a fear of falling. Our study revealed that chronic diseases, sleeping problems or urinary incontinence were the highly feared factors.

References

1. Uz Tunçay S, Özdinçler AR, Erdinçler DS. The effect of risk factors for falls on activities of daily living and quality of life ?n geriatric patients. Turkish J Geriatrics 2011; 14: 245-52.
2. WHO/OMS. Fifty Facts From The World Health Report 1998. [Online] [cited 15 May 2013]. Available from: URL: https://apps.who.int/whr/1998/factse.htm
3. TC BA?BAKANLIK. [Turkey Public Prime Ministry] General Directorate of Social Sectors Coordination, National Plan of Action on Ageing and Situation of Elderly People in Turkey. Publication Number dpt: 2741, 2007: 5-9.
4. I??k A.T. Geriatrik olgularda dü?melerin de?erlendirilmesi [Evaluation of falls in geriatric patients], 2006. [Online] [cited 15 May 2013]. Available from: URL: http://www.gata.edu.tr/ dahilibilimler/geriatri/seminer/falling-son.doc.
5. Savc? C., Kaya H., Acaro?lu R., Kaya N., Bilir A., Kahraman H., Gökerler N. [Nöroloji Ve Nöro?irürji Kliniklerinde Hastalar?n Dü?me Riski Ve Al?nan Önlemlerin Belirlenmesi]. The Determination Of Patients\' Falling Risk and Taken Preventive Measures in Neurology and Neurosurgery Clinics. [Maltepe Üniversitesi Hem?irelik Bilim ve Sanat? Dergisi] Maltepe University J Nursing Sci Art] 2009; 2: 21-25.
6. Kutsal Gökçe Y. Ya?l?larda Dü?me [Falling in the Elderly], [Online] [cited 07 June 2013]. Available from: URL: http://www.gebam.hacettepe.edu.tr/oneri/yaslilarda_dusme.pdf
7. Erden Aki Ö. Ya?l?larda Dü?me Korkusu [Fear of Falling in the Elderly], [Online] [cited 07 June 2013]. Available from: URL: http://hacettepeftr.org/sunumlar5/Ozlem_Erden_Aki.pdf.
8. WHO. WHO global report on prevention of falls in older age, 2007. [Online] [cited 07 June 2013] . Available from: URL: http://www.who.int/ageing/publications/Falls_prevention7March.pdf
9. Myers H. Hospital fall risk assessment tools: A critique of the literature. Int J Nurs Pract 2003; 9: 223-35.
10. Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling. J Gerontol 1990; 45: 234-43.
11. Duyur Çak?t B, Nac?r B, Erdem HR., Karagöz A, Saraço?lu M. Fear of Falling, Fall Risk and Disability in Patients with Rheumatoid Arthritis. Turkish J Rheumatol 2011; 26: 217-25.
12. Legters K. Fear of falling. Physical Therapy 2002; 82: 264-27.
13. Gillespie SM., Friedman SM. Fear of falling in new long-term care enrollees. J Am Med Dir Assoc 2007; 8: 307-13.
14. Erdem M., Emel FH. [Ya?l?larda Mobilite Düzeyi Ve Dü?me Korkusu] Mobility Levels and Fear of Falling in the Elderly. [Atatürk Üniversitesi Hem?irelik Yüksekokulu Dergisi]. Ataturk University Journal of Nursing] 2004; 7: 1-10.
15. Linattiniemi S, Jokelainen J, Luukinen H. Falls risk among a very old home-dwelling population. Scand J Prim Health Care 2009; 27: 25-30.
16. Kuzeyli YY, Karadakovan A. The relationship between fear of falling, activities of daily living and quality of life among elderly individuals. Turkish J Geriatrics 2004; 7: 78-83.
17. Resnick B., Junlapeeya P. Falls in a community of older adults: findings and implications for practice. Applied Nursing Research 2004; 17: 81-91.
18. Chou KL., Yeung FK., Wong EC. Fear of falling and depressive symptoms in Chinese elderly living in nursing homes: fall efficacy and activity level as mediator or moderator?. Aging Ment Health 2005; 9: 255-61.
19. Kaymak US, Peker S, Fiahin CE, Soygür AH. Ya?l?larda uyku sorunlar? [Sleep Problems in the Geriatric Population]. J Acad Geriatrics 2010; 2: 61-70.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: