Hostname: page-component-7dd5485656-k8lnt Total loading time: 0 Render date: 2025-10-29T14:34:30.175Z Has data issue: false hasContentIssue false
  • English
  • Français

A new measure of fear of falling: psychometric properties of the fear of falling questionnaire revised (FFQ-R)

Published online by Cambridge University Press:  31 July 2014

Emily S. Bower ,
Julie Loebach Wetherell ,
C. Caroline Merz ,
Andrew J. Petkus ,
Vanessa L. Malcarne  and
Eric J. Lenze
Emily S. Bower
Affiliation:
SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
Julie Loebach Wetherell*
Affiliation:
VA San Diego Healthcare System, San Diego, California, USA Department of Psychiatry, University of California, San Diego, San Diego, California, USA
C. Caroline Merz
Affiliation:
Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
Andrew J. Petkus
Affiliation:
SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, California, USA VA Long Beach Healthcare System, Long Beach, California, USA
Vanessa L. Malcarne
Affiliation:
SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, California, USA Department of Psychology, San Diego State University, San Diego, California, USA
Eric J. Lenze
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
*
Correspondence should be addressed to: Prof. Julie Wetherell, PhD, University of California, San Diego 9500 Gilman Drive, Dept. 9111N-1 La Jolla, CA 92093-9111, USA. Phone: +1-858-552-8585/2752; Fax: +1-858-552-4321 Email: jwetherell@ucsd.edu.
Get access

Abstract

Background:

Although fear of falling is prevalent among older adults recovering from hip fracture, current instruments are inadequate due to focus on specific situations and measurement of self-efficacy rather than fear.

Methods:

The authors revised and tested a form of the Fear of Falling Questionnaire with three groups of older adults: 405 recovering from hip fracture, 89 healthy community dwelling, and 42 with severe fear of falling. Test-retest reliability was evaluated in a subsample of 16 hip fracture patients. Internal consistency was compared across all groups. Construct validity was established through factor analysis, convergent validity with a measure of fall-related self-efficacy, and discriminant validity with measures of depression and affect.

Results:

A revised two-factor, six-item scale appears to have adequate psychometric properties. Scores were lower in the healthy comparison group relative to the hip fracture and fear of falling groups. Cronbach's α ranged from 0.72–0.83, with test-retest reliability of 0.82. Correlations with a measure of fall-related self-efficacy were moderate for the hip fracture group (0.42) and high with the healthy comparison (0.68) and fear of falling (0.70) groups. Correlations with depression and negative and positive affect were low to moderate.

Conclusions:

The Fear of Falling Questionnaire – Revised shows promise as a self-report measure of fear of falling, and is one of the first to be tested in older adults recovering from hip fracture. Advantages are that it is global rather than situation-specific and measures fear rather than self-efficacy. Future research on this scale is recommended in other older adult samples for whom fear of falling is relevant.

Keywords

fear of fallingassessmenthip fracturequestionnaire

Information

Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Special Issue 7: Late Life Anxiety , July 2015 , pp. 1121 - 1133
Copyright
Copyright © International Psychogeriatric Association 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Alexander, B. H., Rivara, F. P. and Wolf, M. E. (1992). The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health, 82, 1020–1023.CrossRefGoogle ScholarPubMed
Arfken, C. L., Lach, H. W., Birge, S. J. and Miller, J. P. (1994). The prevalence and correlates of fear of falling in elderly persons living in the community. American Journal of Public Health, 84, 565–570. doi:10.2105/AJPH.84.4.565.CrossRefGoogle ScholarPubMed
Campbell, A. J., Reinken, J., Allan, B. C. and Martinez, G. S. (1981). Falls in old age: a study of frequency and related clinical factors. Age and Ageing, 10, 264–270.CrossRefGoogle ScholarPubMed
Carlson, M. et al. (2011). Psychometric properties of reverse-scored items on the CES-D in a sample of ethnically diverse older adults. Psychological Assessment, 23, 558–562. doi:10.1037/a0022484.CrossRefGoogle Scholar
Dayhoff, N. E., Baird, C., Bennett, S. and Backer, J. (1994). Fear of falling: measuring fear and appraisals of potential harm. Rehabilitation Nursing Research, 3, 97–104.Google Scholar
Duhachek, A. and Iacobucci, D. (2004). Alpha's Standard Error (ASE): an accurate and precise confidence interval estimate. Journal of Applied Psychology, 89, 792–808. doi:10.1037/0021-9010.89.5.792.CrossRefGoogle ScholarPubMed
Friedman, S. M., Munoz, B., West, S. K., Rubin, G. S. and Fried, L. P. (2002). Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. Journal of the American Geriatrics Society, 50, 1329–1335. doi:10.1046/j.1532-5415.2002.50352.x.CrossRefGoogle Scholar
Greenberg, S. A. (2012). Analysis of measurement tools of fear of falling for high-risk, community-dwelling older adults. Clinical Nursing Research, 21, 113–130. doi:10.1177/1054773811433824.CrossRefGoogle ScholarPubMed
Jørstad, E. C., Hauer, K., Becker, C. and Lamb, S. E. (2005). Measuring the psychological outcomes of falling: a systematic review. Journal of American Geriatrics Society, 53, 501–510. doi:10.1111/j.1532-5415.2005.53172.x.CrossRefGoogle ScholarPubMed
Kempen, G. I. J. M. et al. (2008). The Short FES-I: a shortened version of the Falls Efficacy Scale – International to assess fear of falling. Age and Ageing, 37, 45–50. doi:10.1093/ageing/afm157.CrossRefGoogle ScholarPubMed
Lachman, M. E., Howland, J., Tennstedt, S., Jette, A., Assmann, S. and Peterson, E. W. (1998). Fear of falling and activity restriction: the Survey of Activities and Fear of Falling in the Elderly (SAFE). Journal of Gerontology: Psychological Sciences, 53B, P43–P50. doi:10.1093/geronb/53B.1.P43.CrossRefGoogle Scholar
Lazarus, R. S. (1991). Emotion and Adaptation. New York, NY: Oxford University Press.CrossRefGoogle Scholar
Lazarus, R. S. and Folkman, S. (1984). Stress, Appraisal, and Coping. New York, NY: Springer.Google Scholar
Lenze, E. J. (2012). Hip fracture study. Unpublished raw data.Google Scholar
MacKinnon, A., Jorm, A. F., Christensen, H., Korten, A. E., Jacomb, P. A. and Rodgers, B. (1999). A short form of the Positive and Negative Affect Schedule: evaluation of factorial validity and invariance across demographic variables in a community sample. Personality and Individual Differences, 27, 405–416. doi:10.1016/S0191-8869(98)00251-7.CrossRefGoogle Scholar
Marottoli, R. A., Berkman, Cooney, L. F., Jr, L. M.. (1992). Decline in physical function following hip fracture. Journal of the American Geriatrics Society, 40, 861–866.CrossRefGoogle ScholarPubMed
Miller, M. D. et al. (1992). Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Research, 41, 237–248. doi:10.1016/0165-1781(92)90005-N.CrossRefGoogle ScholarPubMed
Montgomery, S. A. and Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389.CrossRefGoogle ScholarPubMed
Scheffer, A. C., Schuurmans, M. J., van Dijk, N., van der Hooft, T. and de Rooij, S. E. (2008). Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age and Ageing, 37, 19–24.CrossRefGoogle ScholarPubMed
Sherrington, C. and Lord, S. R. (1998). Increased prevalence of fall risk factors in older people following hip fracture. Gerontology, 44, 340–344.CrossRefGoogle ScholarPubMed
Smith, G. T., McCarthy, D. M. and Anderson, K. G. (2000). On the sins of short-form development. Psychological Assessment, 12, 102–111. doi:10.1037/1040-3590.12.1.102.CrossRefGoogle ScholarPubMed
Spasser, M. A., Greenblatt, R. B. and Weismantel, A. (2006). Mapping the literature of rehabilitation nursing. Journal of the Medical Library Association, 94 (Suppl. 2), E137–E142.Google ScholarPubMed
Stevens, J. A., Mack, K. A., Paulozzi, L. J. and Ballesteros, M. F. (2008). Self-reported falls and fall-related injuries among persons aged ≥65 years – United States, 2006. Journal of Safety Research, 39, 345–349. doi:10.1016/j.jsr.2008.05.002.CrossRefGoogle Scholar
Tinetti, M. E., Speechley, M. and Ginter, S. F. (1988). Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 319, 1701–1707. doi:10.1056/nejm198812293192604.CrossRefGoogle ScholarPubMed
Uher, R. et al. (2008). Measuring depression: comparison and integration of three scales in the GENDEP study. Psychological Medicine, 38, 289–300. doi:10.1017/S0033291707001730.CrossRefGoogle ScholarPubMed
Visschedijk, J., Achterberg, W., van Balen, R. and Hertogh, C. (2010). Fear of falling after hip fracture: a systematic review of measurement instruments, prevalence, interventions, and related factors. Journal of the American Geriatrics Society, 58, 1739–1748. doi:10.1111/j.1532-5415.2010.03036.x. CrossRefGoogle ScholarPubMed
Visschedijk, J., van Balen, R., Hertogh, C. and Achterberg, W. (2013). Fear of falling in patients with hip fractures: prevalence and related psychological factors. Journal of the American Medical Directors Association, 14, 218–220.CrossRefGoogle ScholarPubMed
Wetherell, J. L. (2013). Fear of falling study. Unpublished raw data.Google Scholar
Yardley, L., Beyer, N., Hauer, K., Kempen, G., Piot-Ziegler, C. and Todd, C. (2005). Development and initial validation of the Falls Efficacy Scale – International (FES-I). Age and Ageing, 34, 614–619. doi:10.1093/ageing/afi196.CrossRefGoogle ScholarPubMed
Zuckerman, J. D., Koval, K. J., Aharonoff, G. B., Hiebert, R. and Skovron, M. L. (2000a). A functional recovery score for elderly hip fracture patients: I. Development. Journal of Orthopaedic Trauma, 14, 20–25.CrossRefGoogle ScholarPubMed
Zuckerman, J. D., Koval, K. J., Aharonoff, G. B. and Scovron, M. L. (2000b). A functional recovery score for elderly hip fracture patients: II. Validity and reliability. Journal of Orthopaedic Trauma, 14, 26–30.CrossRefGoogle ScholarPubMed