Authors (including presenting author) :
Chan Y (1), Yung PH (1), Lo NP (1), Chu CY (1), Lui NF (1), Tiu KL (2), Lee KB (2), Li KK (2)
Affiliation :
(1) Occupational Therapy Department, Queen Elizabeth Hospital
(2) Department of Orthopedics & Traumatology, Queen Elizabeth Hospital
Introduction :
Fear of fall is one of the known risk factors in fall incidents (Leung, Chi, Lou & Chan, 2010). It is commonly reported by patients who have fall related injuries such as fragility hip fracture (Bower et al., 2016). Comprehensive assessments and treatments addressing fear of fall may be one of the fall reduction strategies. Occupational therapist will assess fall risks of elderly in daily activities and improve their insight and confidence in fall prevention while reinforce the knowledge of home and community safety.
Objectives :
This study evaluates fall risks in patients with fear of fall after fragility hip fracture to direct future interventions.
Methodology :
Patients aged 65 or above with histories of hip fracture and attended Fragility Fracture Clinic (FFC) between January 2018 to September 2022 were included in this retrospective study. Multidisciplinary FFC aimed at managing bone health, preventing secondary fall and reinforcing community safety of fallers. All the subjects underwent either conservative or surgical interventions and successfully returned to the community after hospitalization. Fear of fall was interviewed and fall risk assessment was conducted with Fall Risk Assessment Test (FRAT). Subjects were then categorized into two groups: Group A is patients with fear of fall while Group B is patients without fear. Data was analyzed by Statistical Package for Social Sciences (SPSS Version. 29). The relationship between fall risks among two groups with fear of fall was compared by using independent t-test.
Result & Outcome :
Results:
576 patients (133 males, 443 females) were included and mean age was 81.9. Near 60% patients (n=342) had fear of fall and 40% patients (n=243) reported no fear of fall. For fall risk, 80% patients were classified in Low Risk, 16% in Medium Risk and 2.3% in High Risk in FRAT score. Statistics showed almost 20% of patients with fear of fall categorized in Medium and High Risk. Also, there was statistically significant difference (p< 0.05) in FRAT score between Group A and B. Besides, group A with fear of fall tended to have higher score in FRAT (p=0.014) when compared to Group B. Among the risk items in FRAT, psychological factor, is statistically significant difference (p< 0.05) between Group A and B, especially higher in Group A (p=0.03). The result indicated that patients with fear of fall might have higher fall risk tendency.
Conclusion:
Patients with fear of fall tend to have higher fall risks in FRAT. Results showed that psychological factors including poor insight and judgment are significantly related to a higher fall tendency. Self-efficacy related to fall is substantial to fall prevention (Kamide et al., 2019). To improve current service, comprehensive assessment including exploring fear of fall and self-efficacy in different ADL tasks can be enhanced. Future occupational therapy intervention emphasized on fear of fall on specific ADL activities can be adopted.
