title: Longitudinal follow-up study on fear of falling during and after rehabilitation in skilled nursing facilities.
abstract: BACKGROUND
  Fear of falling (FoF) is regarded as a major constraint for successful rehabilitation in older people. However, few studies have investigated FoF in vulnerable older people who rehabilitate in a skilled nursing facility (SNF). Therefore, this study measures the prevalence of FoF during and after rehabilitation and assesses differences between those with and without FoF. The relation between FoF and instrumental activities of daily living (IADL) after discharge was also assessed.
  
  
  METHODS
  In this longitudinal follow-up study, patients who rehabilitated in a SNF were assessed at admission and at 4 weeks after discharge. A one-item instrument was used to measure FoF at admission; based on their answer, the patients were divided into groups with no FoF and with FoF. To study FoF after discharge, the one-item instrument and the short Falls Efficacy Scale-International (FES-I) were used. IADL after discharge was assessed with the Frenchay Activities Index (FAI).
  
  
  RESULTS
  Of all participants, 62.5 % had FoF at admission. The participants with FoF were older, more often female, and had a higher average number of falls per week, more depressive symptoms and a lower level of self-efficacy. Four weeks after discharge, 82.1 % of the participants had FoF. IADL after discharge was considerably lower in patients with FoF (FAI of 27.3 vs. 34.8; p = 0.001).
  
  
  CONCLUSIONS
  FoF is common among older persons who rehabilitate in SNF. FoF seems to be persistent and may even increase after rehabilitation, thereby hampering IADL after discharge. Interventions are needed to reduce FoF to ensure better outcomes in older patients rehabilitating in a SNF.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300, RC Leiden, The Netherlands. j.visschedijk@laurens.nl.|Zorggroep Laurens, Rotterdam, The Netherlands. j.visschedijk@laurens.nl.
authors.forename: Jan H M
authors.initials: JH
authors.lastname: Visschedijk
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300, RC Leiden, The Netherlands. M.A.A.Caljouw@lumc.nl.
authors.forename: Monique A A
authors.initials: MA
authors.lastname: Caljouw
authors.affiliation: Zorginstellingen Pieter van Foreest, Delft, The Netherlands. e.bakkers@pietervanforeest.nl.
authors.forename: Eduard
authors.initials: E
authors.lastname: Bakkers
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300, RC Leiden, The Netherlands. r.vanbalen@laurens.nl.|Zorggroep Laurens, Rotterdam, The Netherlands. r.vanbalen@laurens.nl.
authors.forename: Romke
authors.initials: R
authors.lastname: van Balen
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300, RC Leiden, The Netherlands. W.P.Achterberg@lumc.nl.
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; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005239:Fear; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010351:Patient Discharge; D015995:Prevalence; D012307:Risk Factors; D020377:Self Efficacy; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D016896:Treatment Outcome