title: Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy.
abstract: BACKGROUND
  Patients with diabetic peripheral neuropathy (DPN) demonstrate gait alterations compared with their nonneuropathic counterparts, which may place them at increased risk for falling. However, it is uncertain whether patients with DPN also have a greater fear of falling.
  
  
  METHODS
  A voluntary group of older adults with diabetes was asked to complete a validated fear of falling questionnaire (Falls Efficacy Scale International [FES-I]) and instructed to walk 20 m in their habitual shoes at their habitual speed. Spatiotemporal parameters of gait (eg, stride velocity and gait speed variability) were collected using a validated body-worn sensor technology. Balance during walking was also assessed using sacral motion in the mediolateral and anteroposterior directions. The level of DPN was quantified using vibration perception threshold from the great toe.
  
  
  RESULTS
  Thirty-four diabetic patients (mean ± SD: age, 67.6 ± 9.2 years; body mass index, 30.9 ± 5.7; hemoglobin A1c, 7.9% ± 2.3%) with varying levels of neuropathy (mean ± SD vibration perception threshold, 34.6 ± 22.9 V) were recruited. Most participants (28 of 34, 82%) demonstrated moderate to high concern about falling based on their FES-I score. Age (r = 0.6), hemoglobin A1c level (r = 0.39), number of steps required to reach steady-state walking (ie, gait initiation) (r = 0.4), and duration of double support (r = 0.44) were each positively correlated with neuropathy severity (P < .05). Participants with a greater fear of falling also walked with slower stride velocities and shorter stride lengths (r = -0.3 for both, P < .05). However, no correlation was observed between level of DPN and the participant's actual concern about falling.
  
  
  CONCLUSIONS
  Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy.
authors.affiliation: Advocate Illinois Masonic Medical Center, Chicago, IL.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Kelly
authors.forename: Adam
authors.initials: A
authors.lastname: Fleischer
authors.forename: Sai
authors.initials: S
authors.lastname: Yalla
authors.forename: Gurtej S
authors.initials: GS
authors.lastname: Grewal
authors.forename: Rachel
authors.initials: R
authors.lastname: Albright
authors.forename: Dana
authors.initials: D
authors.lastname: Berns
authors.forename: Ryan
authors.initials: R
authors.lastname: Crews
authors.forename: Bijan
authors.initials: B
authors.lastname: Najafi
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000453:epidemiology; D005239:Fear / Q000523:psychology*; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D004856:Postural Balance / Q000502:physiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016138:Walking / Q000502:physiology