Activity Restriction Induced by Fear of Falling and Objective and Subjective Measures of Physical Function : A Prospective Cohort Study

Fear of falling (FF) has been recognized as a serious and common problem in older persons1,2 that may not necessarily be preceded by an actual fall.3 In an attempt to avoid fall-related morbidity and social embarrassment,4 many fearful older persons resort to activity restriction. Although in the short term curtailment of activities or avoidance may protect against falls, in the long term, activity restriction can diminish the physical and mental health of an older person and may further increase risk of future falls.5,6 Two cross-sectional studies have reported poorer balance and lower muscle strength in older persons who restrict their activities as a consequence of FF than in those who do not.5,7 These initial findings have led researchers to suggest that fear-induced activity restriction could be an important psychological factor in decline in physical function and increase in disability, although it is possible that only fearful older individuals who have poor balance and lower muscle strength resort to activity restriction. The cross-sectional design of these studies does not allow temporal sequence, which may suggest the existence of a causal pathway between fear-induced activity restriction and accelerated decline in physical function, to be established. Therefore, prospective evidence is needed to substantiate predictive significance of fear-associated activity restriction in accelerated increase in disability and decline in physical function. The first objective of this study was to examine the differences in self-reported disability and physical function of elderly people who do not restrict their activities, those who moderately restrict their activities, and those who severely restrict their activities because of FF. The second objective was to determine whether fear-induced activity restriction can contribute to increase in disability and decline in physical function over time, independent of baseline physical function.