SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, California.
Psychiatry, University of California, San Diego, California.
Int J Geriatr Psychiatry. 2020 May;35(5):498-506. doi: 10.1002/gps.5261. Epub 2020 Jan 28.
Fear of falling (FoF) is common and associated with poorer functional outcomes after hip fracture. We sought to differentiate patterns of FoF at 4 and 12 weeks after surgical repair for hip fracture and examine predictors of FoF.
METHODS/DESIGN: Secondary analysis of existing data from a 52-week prospective study examining recovery after hip fracture. Participants (N = 263) were aged 60 and older with recent hip fracture recruited from eight hospitals. FoF was measured 4 and 12 weeks postfracture with the Short Falls Efficacy Scale-International. Latent class mixed models were constructed to identify distinct patterns of FoF from 4 to 12 weeks postfracture and predictors of FoF. Predictors examined included age, gender, neuroticism, depression, negative affect, perceived social support, medical comorbidity, functional ability, cognition, and pain.
Three latent classes of FoF were identified: a group with minimal FoF at weeks 4 and 12 (72%), a group with high FoF that decreased (17%), and a group with high FoF that increased from week 4 to 12 (11%). In a multivariate model, higher neuroticism was associated with greater risk for high FoF (increasing or decreasing), whereas higher premorbid medical comorbidity was associated with increasing FoF, poorer premorbid functional ability was associated with decreasing FoF, and social support was not significantly associated.
Older adults with higher neuroticism are more likely to have FoF in the first 12 weeks after a hip fracture. Screening for neuroticism in health care settings might identify individuals who would benefit from interventions to improve outcomes during recovery.
对髋部骨折术后 4 周和 12 周时的恐惧跌倒（FoF）进行区分，并探讨其预测因子。
方法/设计：对一项为期 52 周、前瞻性研究中髋部骨折康复情况的现有数据进行二次分析。参与者（N=263）为年龄在 60 岁及以上、近期发生髋部骨折的患者，从 8 家医院招募而来。骨折后 4 周和 12 周时使用国际跌倒效能量表-Short Falls Efficacy Scale-International （SFES-I）测量 FoF。采用潜在类别混合模型，从骨折后 4 周到 12 周识别 FoF 的不同模式，并预测 FoF。检查的预测因子包括年龄、性别、神经质、抑郁、负性情绪、感知社会支持、合并症、功能能力、认知和疼痛。
确定了 FoF 的 3 种潜在类别：4 周和 12 周时 FoF 极小的组（72%）、FoF 高但逐渐下降的组（17%）、以及 FoF 高且从第 4 周到第 12 周逐渐增加的组（11%）。在多变量模型中，较高的神经质与较高 FoF（增加或减少）的风险增加相关，而较高的预患病合并症与 FoF 增加相关，较差的预患病前功能能力与 FoF 减少相关，社会支持与 FoF 之间无显著相关性。
髋部骨折后 12 周内，神经质较高的老年人更有可能出现 FoF。在医疗保健环境中筛查神经质可能会识别出那些在康复期间从干预中获益的个体。
