title: Restriction in activity associated with fear of falling among community-based seniors using home care services.
abstract: BACKGROUND
  Fear of falling may lead to avoidance of activities for seniors, even though they may be able to perform these activities. Specific risk factors for fear of falling that are amenable to change among various populations have been identified within the literature; however, detailed information about the risk factors for fear of falling, specifically among community-based seniors receiving home care services, is limited.
  
  
  OBJECTIVE
  The aim of this cross-sectional study was to examine the factors associated with restriction of activity resulting from fear of falling among 2,300 seniors receiving home care services.
  
  
  METHODS
  All participants (n = 2,304) in this study were receiving home care services between 1999 and 2001 from a sample of 10 volunteering community-based agencies (Community Care Access Centres) representing the major geographic regions of Ontario, Canada. Community care access centres act as gatekeeping organisations assessing need and contracting out for a broad range of community-based services.
  
  
  METHODS
  The Minimum Data Set for Home Care, a comprehensive and standardised assessment tool used to evaluate the needs and ability levels of older adults utilising home care services, covers several key domains, such as service use, function, health and social support. Nurses trained to administer the Minimum Data Set for Home Care assessed each of the participants within their homes.
  
  
  RESULTS
  Of the 2,304 seniors within the study, 41.2% of participants expressed they restricted their activity for fear of falling. Percentages reporting fear of falling within the literature are considerably lower than the presentfindings, and probably attributable to the frailer, home care population within the present study. In the final logistic regression model, being female, having various impairments/limitations, lack of support and being a multiple faller significantly increased risk of fear of falling, whereas individuals that used antipsychotics and individuals that had Alzheimer's disease were less likely to report restricting their activity.
  
  
  CONCLUSIONS
  The results from this study provide information about a group void in the literature pertaining to activity restriction from fear of falling - community-based seniors receiving home care services. The comprehensive nature of the Minimum Data Set for Home Care allowed for a myriad of factors to be assessed and subsequently analysed with respect to the outcome variable. The inclusion of items on falls, fear of falling, and risk factors for both adverse outcomes means that home care professionals using this instrument will have a unique opportunity to identify and respond to problems that have an important impact on the client's quality of life.
authors.affiliation: Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario N2L 3C5, Canada. pfletche@wlu.ca
authors.forename: Paula C
authors.initials: PC
authors.lastname: Fletcher
authors.forename: John P
authors.initials: JP
authors.lastname: Hirdes
mesh_terms: D000058:Accidental Falls; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D005239:Fear; D005260:Female; D016330:Frail Elderly; D006699:Home Care Services; D006801:Humans; D016015:Logistic Models; D008297:Male; D009043:Motor Activity; D009864:Ontario / Q000453:epidemiology; D012307:Risk Factors