Volume 15, Issue 4 (Winter 2021)                   Salmand: Iranian Journal of Ageing 2021, 15(4): 506-523 | Back to browse issues page

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Bastani F, Hajaty S, Hoseini R S. Anxiety and Fear of Falling in Older Adults With Fall-related Orthopedic Surgery. Salmand: Iranian Journal of Ageing 2021; 15 (4) :506-523
URL: http://salmandj.uswr.ac.ir/article-1-2023-en.html
Anxiety and Fear of Falling in Older Adults With Fall-related Orthopedic Surgery
Farideh Bastani1 , Saeede Hajaty 2, Raziye Sadat Hoseini3
1- Department of Nursing, Age and Community Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
2- Department of Age Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran. , hajatysaeede@yahoo.com
3- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
Keywords: Older adults, Fear of falling, Orthopedic surgery, Anxiety
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1. Introduction
Old age is associated with various health threats, including falling, which have psychological, physical and social consequences, one of which is the fear of falling, especially after orthopedic surgery. On the other hand, reduced psychological and social activities of people in old age can increase feelings of hopelessness, isolation, anxiety, stress, low self-esteem and even death [1]. Effective planning in this area requires full knowledge and awareness of the fear of falling in the elderly and eliminating the factors that may be related to it. Therefore, this study aims to investigate the level of anxiety and fear of falls in the elderly with a history of fall-related orthopedic surgery.

2. Methods & Materials
In this descriptive correlational study with cross-sectional design, participants were 280 elderly men and women with a history of fall-related orthopedic surgery referred to the orthopedic clinic of hospitals affiliated to Iran University of Medical Sciences in 2018 who were selected using a convenience sampling method. The sample size (n=280) was determined at 95% confidence level using the Formula 1: 

 

Inclusion criteria were: age 60-75 years (younger elderlies according to WHO classification), having an Abbreviated Mental Test (AMT) score of 7 out of 10, ability to answer questions, no any neurological disorders (e.g. stroke), ability to communicate, and no any known mental illness. Data collection tools were a demographic form (surveying age, gender, level of education, marital status, economic status, employment status, living arrangements, the number and type of diagnosed chronic diseases, and history of orthopedic surgery), AMT, 16-item Falls Efficacy Scale International (FES-I) [2], and the Depression Anxiety Stress Scales-21 (DASS-21) where items 2, 4, 7, 9, 15, 19, 20 are used to measure anxiety [3].
 


3.Results:
This study consisted 280 elderly participants with a Mean±SD age of 69.05±4.29 years, 182 females and 98 males. Results reported that 98.6% of the elderly
had high fear of falling (FES-I score >32). According to the results of regression analysis, being female, being single, good economic status and living with a spouse with standard coefficients of 0.236, 0.545, 0.047, and 0.545, respectively, had the greatest effect on «fear of falling». According to the results, the fear of falling was significantly higher in the elderly with chronic diseases (P=0.013). Moreover, it had a statistically significant relationship with the number of medications for chronic diseases (P=0.020). Fear of falling was significantly higher in the elderly who had more than one chronic disease (P=0.001). Fear of falling was significantly higher among the elderly with high blood pressure (P=0.035), blood lipids (P=0.007) and pelvic surgery history (P=0.015). 
Results also showed that about 80% of the elderly had mild to severe anxiety (DASS-21 score >10). According to the results of Scheffe test, anxiety was significantly higher in illiterate subjects than in those with high school diploma (P=0.004); in widow/widower subjects compared to married ones (P=0.013); in subjects with poor economic status compared to those with moderate economic status (P<0.001); In subjects who live with children compared to those living with spouse (P=0.002); In housekeepers compared to employed ones (P=0.010); and in unemployed subjects compared to retired ones (P=0.014). According to the results of linear regression analysis, being female with a standard coefficient of 0.183 had the greatest effect on «anxiety».

4. Conclusion
Most of the elderly with a history of fall-related orthopedic surgery has high fear of falling. There is statistically significant and direct relationship between fear of falling and anxiety in them. The results of this study can be helpful in the field of nursing education and management as well as in the clinical studies, and can be the basis for developing comprehensive care programs and educational/counseling interventions to prevent and reduce the fear of falling in the elderly. Due to the significant relationship between anxiety in the elderly with chronic diseases and the drug use following these diseases, it seems that promoting health screening and educational programs especially for hypertensive diseases, diabetes and psychological diseases, can be useful to improve the quality of life of the elderly and achieve a healthy and successful old age.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by Iran University of Medical Sciences (Code: IR.IUMS.REC.1397.505).

Funding
The paper was extracted from the MSc. thesis avd extracted from a research project of the second author at Department of Age Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran. 

Authors' contributions
Conceptualization: Saeedeh Hajati, Farideh Bastani; References: Saeedeh Hajati; Supervision and management: Farideh Bastani, Raziye Sadat Hosseini; Research: Farideh Bastani, Saeedeh Hajati; Editing and finalizing: Saeedeh Hajati; Financing: Farideh Bastani, Saeedeh Hajati, Raziye Sadat Hosseini; Sample collection: Saeedeh Hajati.

Conflicts of interest
The authors declared no conflict of interest.

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Type of Study: Research | Subject: gerontology
Received: 2020/05/03 | Accepted: 2020/10/20 | Published: 2021/01/01
References
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