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PubMed2000

Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery.

BACKGROUND: Although it has been demonstrated that physical performance measures predict incident disability in previously nondisabled older persons, the available data have not been fully developed to create usable methods for determining risk profiles in community-dwelling populations. Using several populations and different follow-up periods, this study replicates previous findings by using the Established Populations for the Epidemiologic Study of the Elderly (EPESE) performance battery and provides equations for the prediction of disability risk according to age, sex, and level of performance. METHODS: Tests of balance, time to walk 8 ft, and time to rise from a chair 5 times were administered to 4,588 initially nondisabled persons in the four sites of the EPESE and to 1,946 initially nondisabled persons in the Hispanic EPESE. Follow-up assessment for activity of daily living (ADL) and mobility-related disability occurred from 1 to 6 years later. RESULTS: In the EPESE, compared with those with the best performance (EPESE summary performance score of 10-12), the relative risks of mobility-related disability for those with scores of 4-6 ranged from 2.9 to 4.9 and the relative risk of disability for those with scores of 7-9 ranged from 1.5 to 2.1, with similar consistent results for ADL disability. The observed rates of incident disability according to performance level in the Hispanic EPESE agreed closely with rates predicted from models developed from the EPESE sites. Receiver operating characteristic curves showed that gait speed alone performed almost as well as the full battery in predicting incident disability. CONCLUSIONS: Performance tests of lower extremity function accurately predict disability across diverse populations. Equations derived from models using both the summary score and the gait speed alone allow for the estimation of risk of disability in community-dwelling populations and provide valuable information for estimating sample size for clinical trials of disability prevention.

Activities of Daily Living↗

PubMed2001

Velocity training induces power-specific adaptations in highly functioning older adults.

OBJECTIVE: To test the efficacy of high-velocity training in healthy older persons. DESIGN: A 12-week randomized trial, with subjects blocked for gender and residence, comparing high-velocity resistance training with a self-paced walking program. SETTING: Retirement community. PARTICIPANTS: Forty-three volunteers over the age of 70 years. INTERVENTION: Power group: high-velocity leg exercises 3 times weekly with weekly increases in resistance combined with 45 minutes of moderate, nonresistance exercise weekly. Walking group: moderate intensity exercise 30 minutes daily, 6 days weekly. MAIN OUTCOME MEASURES: Variables measured included leg press peak power and leg extensor strength. Functional performance outcomes included: 6-minute walk distance, Short Physical Performance Battery, Physical Performance Test, and Medical Outcomes Study Short-Form Health Survey. RESULTS: Peak power improved 22% (p =.004) in the power group (3.7 +/- 1.0 W/kg to 4.5 +/- 1.4 W/kg) but did not change in the walking group (3.99 +/-.76 W/kg to 3.65 +/-.94 W/kg). Leg extensor power at resistance of 50%, 60%, and 70% of body weight increased 50%, 77%, and 141%, respectively, in the power group (p <.0001, repeated-measures analysis of variance). Strength improved 22% in the power-trained individuals and 12% in the walkers (p <.0001). Training did not improve functional task performance in either group. One subject developed a radiculopathy during training. CONCLUSIONS: Resistance training focusing on speed of movement improved leg power and maximal strength substantially, but did not improve functional performance in healthy high-functioning older volunteers.

Adaptation, Physiological↗

PubMed1995

Functional performance in people with chronic obstructive pulmonary disease.

The extent to which individuals with a chronic physical illness perform their day-to-day activities and maintain the independence and autonomy they desire is both an indicator of adaptation and an important clinical outcome criterion. Yet the concept of functional performance is not well understood. Studies of people with chronic obstructive pulmonary disease (COPD) have attempted to identify physiologic and psychosocial factors that contribute to functioning in this population. These studies have used a melange of terms, including functional status, functional ability, quality of life, and health status interchangeably. They have also employed a variety of instruments to operationalize functional performance and an assortment of predictors to understand the phenomena. Perhaps as a result of this disarray, no attempt has been made to synthesize the literature for nursing research and practice. The purpose of this paper is to summarize the research on functional performance in people with COPD, indicate areas of understanding and quandary, suggest possible flaws, and propose several new directions for practice and research.

Activities of Daily Living↗

PubMed1991

Physics and function of operating room suction.

A study was done to evaluate the performance of suction apparatus in the operating room. The investigation was prompted by perceived poor suction performance in a suite of new operating rooms built in accordance with Standards Australia (SA) specifications. SA performance tests were conducted on each of four suction outlets in nine operating rooms. All 36 outlets complied with SA standards for flow-rate (minimum 40 L/min) and occluded negative pressure (ONP; minimum -60 kPa). However, 24 collection units failed to comply with standards (ONP) of -40 kPa achieved in less than 4 s when a 4 L disposable suction apparatus was connected (mean time to ONP: 6.1 s, 95% confidence interval: 4.9, 7.3). When smaller capacity suction jars were substituted, more units met SA standards. The standards therefore need revision to include specification of the capacity of the collecting apparatus. Other factors that were found to degrade suction performance significantly were air leakage and defective shut-off valves. The physical principles involved in operating room suction are described. Surgeons and anaesthetists should understand these principles, and it is recommended that a simple pre-operative check of the suction apparatus should be carried out, as follows: (1) Turn the wall control knob fully on, and disconnect the suction apparatus. The gauge should register zero. (2) Connect the suction jars. If the indicated gauge pressure is in excess of -15 kPa, investigate the equipment for excessive resistance, particularly in the shut-off valve, which should be replaced with a new unit if necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗

PubMed2003

Application of constraint-induced movement therapy for an individual with severe chronic upper-extremity hemiplegia.

BACKGROUND AND PURPOSE: Constraint-induced movement therapy (CIMT) has been documented to improve motor function in the upper extremity of people with mild hemiparesis. The use of CIMT has not been documented for people with severe hemiparesis. This case report describes a CIMT program for an individual with severe upper-extremity deficits as a result of stroke. CASE DESCRIPTION: The client was a 53-year-old woman who had a stroke 15 years previously and had no isolated movement in her right upper extremity. METHODS: The client completed a 3-week CIMT program during which she restrained her left upper extremity and participated in intensive training of her right upper extremity. Task practice and shaping were the primary techniques used for training. OUTCOMES: Increased scores were noted from pretreatment to posttreatment on the Motor Activity Log, Graded Wolf Motor Function Test (GWMFT), and Fugl-Meyer Evaluation of Physical Performance. Further progress on the GWMFT was noted at the 6-month follow-up. Fugl-Meyer test scores remained higher than at pretreatment, but Motor Activity Log scores returned to near baseline by the 6-month follow-up. The speed of performance on the GWFMT did not change. Although some scores increased, the client reported and demonstrated no progress in functional use of the involved upper extremity at the end of the program. DISCUSSION: This case report describes the use of CIMT with an individual who had severe chronic motor deficits as a result of stroke. Further investigation of CIMT, as well as investigation of CIMT in combination with other motor recovery interventions, is warranted.

Activities of Daily Living↗

PubMed2005

Factors influencing results of functional capacity evaluations in workers' compensation claimants with low back pain.

BACKGROUND AND PURPOSE: Physical and psychosocial factors are hypothesized to influence performance-based assessment. The purpose of this study was to evaluate the association between performance on the Isernhagen Work System Functional Capacity Evaluation (IWS-FCE) and various clinical and psychosocial factors. SUBJECTS: The sample consisted of 170 workers' compensation claimants who were undergoing functional capacity evaluations (FCEs) for low back injuries. METHODS: In this cross-sectional study, claimants completed a battery of work-related measures, including the IWS-FCE, the Pain Disability Index (PDI), a workplace organizational policies and practices scale, and a recovery expectations questionnaire. Functional capacity evaluation performance indicators were the number of tasks in which subjects did not meet work demands and weight lifted on the floor-to-waist lift. Analysis included multivariable regression. RESULTS: Only the PDI, pain intensity, age, and sex independently contributed to floor-to-waist lift performance. The PDI, pain intensity, and duration of injury contributed to the number of failed tasks. DISCUSSION AND CONCLUSION: The results indicate that performance on FCEs is influenced by physical factors, perceptions of disability, and pain intensity. However, perceptions of workplace organizational policies and procedures were not associated with FCE results for workers' compensation claimants with chronic back pain disability. Functional capacity evaluations should be considered behavioral tests influenced by multiple factors, including physical ability, beliefs, and perceptions.

Adult↗

PubMed2005

Cognitive, emotional, physical and social effects of growth hormone treatment in adults with Prader-Willi syndrome.

BACKGROUND: Prader-Willi syndrome (PWS) is a multisystem genetic disorder characterized by short stature, muscular hypotonia, hyperphagia, obesity, maladaptive behaviour, hypogonadism and partial growth hormone (GH) deficiency (GHD). Severe GHD of other aetiologies has been shown to affect mood and quality of life negatively, and there are reports of improvements with GH replacement. We have studied cognitive, emotional, physical and social parameters in PWS adults at baseline, during and after GH treatment. PATIENTS AND METHODS: Nineteen patients, 9 females and 10 males, median age 25 years, mean BMI 35 kg/m2 participated in this study. Approximately half of the group had GHD. All patients fulfilled the clinical criteria for PWS and 13 had a positive genotype. The patients were randomized to 6 months of treatment with either GH [1.6 IU/day (0.53 mg/day)] or placebo, followed by 12 months of active GH treatment. Treatment was then stopped, and the patients were followed for an additional period of 6 months. A test battery for general cognitive evaluation and a computer-based measurement of reaction time, motor speed and fluency were employed at baseline, after 6 months and at the end of GH treatment. At the same time intervals, a self-evaluation questionnaire was answered at the end of each test session. Other questionnaires reflecting the patients' cognitive, emotional, physical and social status were answered by relatives/caretakers at baseline and at 3 and 6 months following cessation of GH treatment. RESULTS: Baseline cognitive level was estimated to be moderately to mildly impaired; IQ range was 40-90. The results from some of the cognitive and the motor performance tests improved significantly after 6 and 18 months of GH treatment. According to the questionnaires, both the patients and the relatives/caretakers evaluated physical status rather negatively at baseline, but still, impairments in both physical and social status and overall functioning were observed when GH treatment was discontinued. The self-evaluation did not change in any aspect during GH treatment. CONCLUSIONS: In this pilot study of an adult PWS cohort, we were able to document beneficial effects in mental speed and flexibility and in motor performance during GH treatment. Impairment was seen in physical and social status as well as overall functioning, when GH treatment stopped. Studies of larger cohorts are needed to further elucidate the role of GH treatment in this group of patients.

Adult↗

PubMed2006

Inverse planning--a comparative intersystem and interpatient constraint study.

PURPOSE: To compare commercial treatment-planning systems (TPS) for inverse planning (IP) and to assess constraint variations for specific IMRT indications. MATERIAL AND METHODS: For IP, OTP, XiO and BrainSCAN were used and step-and-shoot intensity-modulated radiotherapy (IMRT) delivery was assumed. Based on identical constraints, IP was performed for a prostate, head and neck, brain, and gynecologic case. IMRT plans were compared in terms of conformity/homogeneity, dose-volume histograms (DVHs), and delivery efficiency. For ten patients each of a class of indications, constraint variations were evaluated. RESULTS: IMRT plans were comparable concerning minimum target dose, homogeneity, conformity, and maximum doses to organs at risk. Larger differences were seen in dose gradients outside the target, monitor units, and segment number. Using help structures proved efficient to shape isodoses and to reduce segmentation workload. For IMRT class solutions, IP constraint variations depended on anatomic site. CONCLUSION: IP systems requiring doses as input and having objective functions based on physical parameters had a very similar performance. Constraint templates can be established for a class of IMRT indications.

Brain Neoplasms↗

PubMed2003

Early rehabilitation of facial nerve deficit after acoustic neuroma surgery.

OBJECTIVE: To determine whether an early physical rehabilitative program could improve and/or accelerate recovery from a postoperative deficit of facial nerve (FN) function. MATERIAL AND METHODS: A retrospective study of the charts of patients who presented a postoperative FN deficit after surgery for acoustic neuroma (AN) was carried out. Twenty-nine patients were enrolled and divided into 2 groups: 18 who underwent early physical rehabilitation and 11 who did not undergo rehabilitation. All the AN patients underwent translabyrinthine removal and were classified preoperatively according to the House-Brackmann staging system. Physical rehabilitation was performed according to Kabat (i.e. neuromuscular facilitation). FN function was assessed postoperatively and classified according to the House-Brackmann grading system. RESULTS: In Grade IV and V patients, early rehabilitation allowed a faster and better recovery with respect to AN patients for whom rehabilitation was not carried out. CONCLUSION: Early physical rehabilitation has proved to be effective as a helpful tool for recovery from FN deficit and it is therefore advisable to use it soon after surgery, especially for FN deficits worse than Grade IV.

Adult↗

PubMed2001

Health-related quality of life in Persian Gulf War Veterans.

OBJECTIVE: The objective of this investigation is to describe the health-related quality of life of Persian Gulf War (GW) veterans and to examine the effects of current chronic medical conditions and psychiatric status on physical functioning. METHODS: To measure health-related quality of life, the Medical Outcomes Short Form Survey (SF36) was administered approximately 4 years after the GW to a stratified, random sample of New England-area GW-deployed veterans and a group of military personnel deployed to Germany during the GW. The SF36 scores for the GW-deployed study population (N = 141) were compared with those for the Germany-deployed group (N = 46) and with published U.S. population norms. Multiple linear regression analyses were performed to identify risk factors associated with lower physical health functioning in the GW-deployed study group. RESULTS: Functional health status was significantly lower in the GW-deployed group compared with the Germany-deployed group for each of the SF36 subscales and the two summary scores (Physical Component Summary [PCS] and Mental Component Summary). Compared with the general U.S. population, the GW-deployed group median was between the 25th and 50th percentile for the Physical Functioning subscale and the PCS score. Within the GW-deployed group, lower education, psychological symptomatology, and a higher number of chronic self-reported medical conditions were significant predictors of the PCS score. CONCLUSION: GW-deployed veterans report lower functional health status compared with a group of Germany-deployed veterans and published general U.S. population norms. Within the group of GW-deployed veterans, several current medical and psychological conditions predictive of lower physical functioning levels were identified.

Adult↗

PubMedDate not supplied

Radiation detectors in nuclear medicine.

Single-photon-emitting or positron-emitting radionuclides employed in nuclear medicine are detected by using sophisticated imaging devices, whereas simpler detection devices are used to quantify activity for the following applications: measuring doses of radiopharmaceuticals, performing radiotracer bioassays, and monitoring and controlling radiation risk in the clinical environment. Detectors are categorized in terms of function, the physical state of the transducer, or the mode of operation. The performance of a detector is described by the parameters efficiency, energy resolution and discrimination, and dead time. A detector may be used to detect single events (pulse mode) or to measure the rate of energy deposition (current mode). Some detectors are operated as simple counting systems by using a single-channel pulse height analyzer to discriminate against background or other extraneous events. Other detectors are operated as spectrometers and use a multichannel analyzer to form an energy spectrum. The types of detectors encountered in nuclear medicine are gas-filled detectors, scintillation detectors, and semiconductor detectors. The ionization detector, Geiger-Müller detector, extremity and area monitor, dose calibrator, well counter, thyroid uptake probe, Anger scintillation camera, positron emission tomographic scanner, solid-state personnel dosimeter, and intraoperative probe are examples of detectors used in clinical nuclear medicine practice.

Health Physics↗

PubMed1994

Physical progress and residual impairment quantification after functional restoration. Part I: Lumbar mobility.

Quantification of human performance in chronic low back pain (CLBP) patients is essential to initiate effective treatment and guide progress in a disability-oriented functional restoration program, as well as to objectively evaluate impairment and functional limitations at the time of maximum medical improvement. One such important measure of physical ability is range of motion. Patients who suffer from CLBP almost invariably have some disturbance of mobility. The major goals of the present study were to: 1) develop a database of anticipated range of motion levels at different points in time in a representative sample of CLBP patients; 2) within the sample, determine any gender or spinal surgery-induced differences; 3) evaluate change in range of motion produced by participation in a comprehensive functional restoration treatment program; and 4) identify residual impairment of regional range of motion. Four separate groups of CLBP patients were evaluated: Group 1 (n = 92), unoperated men; Group 2 (n = 26), postdiscectomy men; Group 3 (n = 59), unoperated women; and Group 4 (n = 17) postdiscectomy women. Patients in each group were assessed for spinal range of motion measures at three points in time, for sagittal/coronal motion and validity (employing the relationship between pelvic motion and supine leg raising). Results demonstrated dramatic patient improvements in range of motion from initial referral to program completion. The most significant gains were made in pelvic motion, which returned to near normal levels, indicating that the vast majority overcame low effort or movement inhibition produced by pain or fear of injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2000

Predicting elementary school participation in children with disabilities.

OBJECTIVE: To identify predictors of participation in school activities from two sets of functional variables using classification and regression tree analysis. DESIGN: Relational study. PARTICIPANTS: A nationwide sample of 341 children with various disabling conditions, including physical and cognitive/behavioral types of impairment and various severity levels. Children attended public elementary school in 40 states in the United States. MAIN OUTCOME MEASURE: Overall participation in elementary school, combining children's participation in six different environments (transportation, transitions, classroom, cafeteria, bathroom, and playground), as measured by the newly developed School Function Assessment. The children were dichotomized into full (n = 117) and limited (n = 224) participation categories. RESULTS: Two classification trees were developed identifying a small set of predictors from variables measuring performance of functional tasks and discrete activities. Final predictive models included physical and cognitive-behavioral variables, suggested important interactions among predictors, and identified meaningful cut-off points that classified the sample into the outcome categories with about 85% accuracy. CONCLUSIONS: Limited participation was predicted by information about children's physical capabilities. Full participation was predicted by a combination of physical and cognitive-behavioral variables. Findings underscore the relative utility of functional performance compared with impairment information to predict the outcome, and suggest pathways of influence to consider in future research and intervention efforts.

Child↗

PubMed1994

Nominal and physical decision criteria in same-different judgments.

We propose a model in which the physical and nominal dimensions of letter pairs are compared independently of whether subjects use physical (shape task) or nominal (name task) identity as the decision criterion. We attempt to explain the fast-same effect, the preponderance of false-different errors, and the nominal-physical disparity as results of congruent and incongruent outputs of physical and nominal comparison devices that function in both tasks. Subjects performed both tasks with and without response deadlines. The stimuli were presented foveally or unilaterally to one or the other hemisphere. With foveal presentations, the nominal-physical disparity disappeared when congruent and incongruent cells were compared, the fast-same effect occurred only in the shape task, and there was a preponderance of false-different errors only in the name task. Response times and error patterns from centrally presented trials conformed to the predictions of the model. Performance patterns from the lateralized trials conformed only partially. The implications of the data are discussed in the context of several theoretical models of same/different judgments.

Adult↗

PubMed2000

Effects of angiotensin-converting enzyme inhibitors and digoxin on health outcomes of very old patients with heart failure. SAGE Study Group. Systematic Assessment of Geriatric drug use via Epidemiology.

BACKGROUND: Randomized trials have shown that angiotensin-converting enzyme (ACE) inhibitors reduce mortality and morbidity, and improve symptoms and exercise tolerance in selected patients with congestive heart failure (CHF). There is, however, no evidence on the effectiveness of ACE inhibitors in the typical, very old and frail patients with CHF. OBJECTIVE: To compare the effects of ACE inhibitors and digoxin on 1-year mortality, morbidity, and physical function among patients aged 85 years. METHODS: We conducted a retrospective cohort study using the SAGE database, a long-term care database linking patient information with drug utilization data. Among 64637 patients with CHF admitted to all nursing homes in 5 states between 1992 and 1995, we identified 19492 patients taking either an ACE inhibitor (n = 4911) or digoxin (n = 14890). Record of date of death was derived from Medicare enrollment files, and we used the part A Medicare files to identify hospital admissions and discharge diagnoses. As a measure of physical function, we used a scale for activities of daily living performance. The effect of ACE inhibitors was estimated using Cox proportional hazards models with digoxin users as the reference group. RESULTS: The overall mortality rate among ACE inhibitor recipients was more than 10% less than that of digoxin users (relative rate, 0.89; 95% confidence interval, 0.83-0.95). Mortality was equally reduced regardless of concomitant cardiovascular conditions and baseline physical function. Treatment with ACE inhibitors was associated with a tendency toward reduced hospital admissions that was more evident among patients with greater functional impairment. The adjusted relative rate for hospitalization for any reason was 0.96 (95% confidence interval, 0.91-1.01). The rate of functional decline was greatly reduced among ACE inhibitor recipients (relative rate, 0.74; 95% confidence interval, 0.69-0.80), and this effect was consistent and independent of background comorbidity and baseline physical function. CONCLUSIONS: These data suggest that survival and functional benefits of ACE inhibitor therapy extend to patients with CHF 85 years and older, and mostly women, both systematically underrepresented in randomized trials. Alternatively, digoxin has a detrimental effect in this population.

Activities of Daily Living↗

PubMed2001

Reliability and validity of the functional assessment of cancer therapy-ovarian.

PURPOSE: To report the reliability and validity of the Functional Assessment of Cancer Therapy-Ovarian (FACT-O) in a consecutive series of outpatients with epithelial ovarian cancer. PATIENTS AND METHODS: Two hundred thirty-two ovarian cancer patients attending an outpatient gynecologic oncology clinic completed questionnaires at baseline. The patients' FACT-O scores were compared with their performance status, disease stage, treatment status, and other factors hypothesized to be related to quality of life. Patients received a second questionnaire either one week after baseline to assess the instrument's test-retest reliability and/or two months after baseline to evaluate its sensitivity to change in performance status. RESULTS: Internal consistency and test-retest reliability of the FACT-O were adequate. Overall, the scales correlated with other measures as expected; all correlations were in the hypothesized direction. Patients with advanced disease, poor performance status, and who were receiving active treatment had lower scores on physical, functional, and ovarian cancer-specific scales. The total FACT-O and emotional well-being scores were lower for patients with poor performance status and patients in active treatment. The FACT-O total and all subscale scores except emotional well-being were sensitive to decreases in performance status. CONCLUSION: Overall, the FACT-O provides a reliable and valid assessment of the quality of life of women with ovarian cancer, and is appropriate as a brief quality of life assessment in clinical trials and descriptive studies.

Activities of Daily Living↗

PubMed1994

Measuring physical disablement: the contextual challenge.

Context is a fundamental consideration in physical therapy assessment and in the interpretation of physical disablement. Specification of context may include physical requirements of a task such as the demands for speed or a specific degree of accuracy, or the social context in which an activity is performed such as dressing for work versus dressing for leisure activities. Context also encompasses individual factors such as the importance of particular activities within the person's culture or value system, or the specific types of roles requiring physical functioning that a person resumes upon discharge from physical therapy. Data are presented to illustrate the differences in performance across related physical tasks and between self-care and mobility tasks in home and school settings in children with severe functional delays. These data highlight the potential impact of context on performance. Implications for future development of functional assessments are discussed, particularly in light of the importance of incorporating contextual information in the clinical interpretation of disablement outcomes for patient groups and individual patients.

Activities of Daily Living↗

PubMed2002

Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention.

OBJECTIVES: Previous cross-sectional studies have shown a correlation between falls and fear of falling, but it is unclear which comes first. Our objectives were to determine the temporal relationship between falls and fear of falling, and to see whether these two outcomes share predictors. DESIGN: A 20-month, population-based, prospective, observational study. SETTING: Salisbury, Maryland. Each evaluation consisted of a home-administered questionnaire, followed by a 4- to 5-hour clinic evaluation. PARTICIPANTS: The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations. At baseline, subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher. MEASUREMENTS: Demographics, visual function, comorbidities, neuropsychiatric status, medication use, and physical performance-based measures were assessed. Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation, first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors. RESULTS: Falls at baseline were an independent predictor of developing fear of falling 20 months later (odds ratio (OR) = 1.75; P <.0005), and fear of falling at baseline was a predictor of falling at 20 months (OR = 1.79; P <.0005). Women with a history of stroke were at risk of falls and fear of falling at follow-up. In addition, Parkinson's disease, comorbidity, and white race predicted falls, whereas General Health Questionnaire score, age, and taking four or more medications predicted fear of falling. CONCLUSION: Individuals who develop one of these outcomes are at risk for developing the other, with a resulting spiraling risk of falls, fear of falling, and functional decline. Because falls and fear of falling share predictors, individuals who are at a high risk of developing these endpoints can be identified.

Accidental Falls↗