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Fear of Falling and Related Activity Restriction Among Middle-Aged African Americans

Schools of ¹ Medicine
² Public Health, Saint Louis University, St. Louis, Missouri.
³ Geriatric Research, Education, and Clinical Center, St. Louis Veterans Affairs Medical Center, Missouri.
⁴ Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri.
⁵ College of Public Health, University of Iowa, Iowa City.

Address correspondence to Margaret-Mary G. Wilson, MD, Division of Geriatric Medicine, St. Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 53104. E-mail: wilsonmg{at}slu.edu

Background. The prevalence of fear of falling and related activity restriction, and their joint distribution with falls and falls efficacy, have been inadequately addressed in population-based studies of middle-aged and African-American groups.

Methods. The African American Health project is a population-based panel study of 998 African Americans born in 1936–1950 from two areas of metropolitan St. Louis (an impoverished inner-city area and a suburban area). Fear of falling, fear-related activity restriction, and 24 frailty-related covariates were assessed during in-home evaluations in 2000–2001.

Results. We found that 12.6% of participants reported having fear of falling without activity restriction, 13.2% had fear of falling with activity restriction, and 74.2% had no fear of falling. Neither fear of falling nor fear-related activity restriction varied significantly across three birth cohorts (1946–1950, 1941–1945, and 1936–1940). Lack of overlap of these two phenomena with having a fall in the past 2 years and low falls efficacy was considerable. When examined across three groups (no fear, fear without activity restriction, and fear with activity restriction), a consistent pattern of decreasing health status and social, emotional, and physical functioning was demonstrated.

Conclusions. In this population-based sample of 49- to 65-year-old African Americans, fear of falling and fear-related activity restriction were surprisingly common and not well explained by prior falls or low falls efficacy. These phenomena were already evident by age 49–55. Further study is warranted, including detailed qualitative investigations examining the timing, precursors, and consequences of fear of falling and fear-related activity restriction in minority and majority populations.