title: Fear of falling after hip fracture in vulnerable older persons rehabilitating in a skilled nursing facility.
abstract: OBJECTIVE
  To identify factors that explain differences in patients with high and low levels of fear of falling after a hip fracture.
  
  
  METHODS
  Cross-sectional study in 10 skilled nursing facilities in the Netherlands.
  
  
  METHODS
  A total of 100 patients aged ≥ 65 years admitted to a skilled nursing facility after a hip fracture.
  
  
  METHODS
  Participants were divided into 2 groups; low and high level of fear of falling, based on median Falls Efficacy Score - International. Data relating to factors that might explain fear of falling were collected, including demographic variables, aspects of functioning, psychological factors, and comorbidities. For every factor a univariate logistic regression was conducted. For the multivariate regression model a backward procedure was used in which variables with p < 0.05 were included.
  
  
  RESULTS
  Walking ability and activities of daily living before fracture, number of complications, activities of daily living after fracture, anxiety and self-efficacy were significantly associated univariately with fear of falling. Multivariate analysis showed that walking ability before fracture (odds ratio (OR) 0.34, 95% confidence interval (CI) 0.14-0.83), activities of daily living after fracture (OR 0.89, 95% CI 0.80-0.99), and anxiety (OR 1.22, 95% CI 1.05-1.42) were independently associated with fear of falling.
  
  
  CONCLUSIONS
  Impaired walking ability before fracture, impaired activities of daily living after fracture, and increased anxiety help distinguish between older persons with high and low levels of fear of falling after hip fracture. Because the last 2 factors are modifiable, this information enables the development of specific interventions for older persons with a high level of fear of falling.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2300 RC Leiden, The Netherlands. jan.visschedijk@zorggroepsolis.nl, janmarique@telfort.nl.
authors.forename: Jan H M
authors.initials: JH
authors.lastname: Visschedijk
authors.forename: Monique A A
authors.initials: MA
authors.lastname: Caljouw
authors.forename: Romke
authors.initials: R
authors.lastname: van Balen
authors.forename: Cees M P M
authors.initials: CM
authors.lastname: Hertogh
authors.forename: Wilco P
authors.initials: WP
authors.lastname: Achterberg
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D051346:Mobility Limitation; D015233:Models, Statistical; D015999:Multivariate Analysis; D009426:Netherlands; D020377:Self Efficacy; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D016896:Treatment Outcome