Self-awareness of falls risk in older adults

2017-02-22T02:01:49Z (GMT) by Mihaljcic, Tijana
Falls and fall-related injuries are a significant clinical issue in the older population. Reduced awareness of falls risk has been identified as a barrier to undertaking fall prevention advice and may be associated with risk-taking behaviour. However, previous research has not comprehensively investigated self-awareness of falls risk in older adults and little is known about the prevalence, factors and outcomes associated with reduced awareness of falls risk. This may be attributed to a lack of validated measures available to assess this construct. The aim of this thesis, therefore, was to expand current understanding in this area by developing and validating a measure of falls risk self-awareness; providing initial data regarding the proportion of older adults that underestimate falls risk; and exploring some associated factors and outcomes. Participants comprised 91 older adults aged over 60 undergoing inpatient rehabilitation. Treating physiotherapists and occupational therapists also participated in the studies. The first study described the development and psychometric evaluation of the three part (intellectual, emergent and anticipatory) Self-Awareness of Falls Risk Measure (SAFRM) to be used in the older population undergoing inpatient rehabilitation. The SAFRM demonstrated a three factor structure corresponding to the theoretically developed subsections and good internal consistency, clinician inter-rater reliability, convergent validity and ecological validity. The second study utilised the SAFRM to provide initial data regarding the proportion of older adult rehabilitation inpatients that underestimate and overestimate falls risk, and explored some factors associated with reduced self-awareness. The results indicated that reduced self-awareness of falls risk is not uncommon in the older population with eight to 28 percent of patients demonstrating moderately to severely reduced self-awareness of falls risk. Moderate to severe overestimation of falls risk was relatively uncommon (1-3%). Male gender, higher educational attainment and neurological history were independent predictors of overall self-awareness. The third study investigated the relationship between self-awareness of falls risk and rehabilitation engagement, motivation for rehabilitation, and falls three months post hospital discharge. The results indicated that different types of awareness (i.e. intellectual, emergent, anticipatory, overall) may be important for engagement in specific aspects of therapy (i.e. physiotherapy, occupational therapy). Regression analyses indicated that overall self-awareness provided a unique contribution to occupational-therapist rated rehabilitation engagement when controlling for age, gender, cognition, and functional ability. However, no such relationship was found for physiotherapist-rated engagement or patient-reported motivation. Falls were reported by 29.85% of participants; however, self-awareness did not differ between fallers and non-fallers. Overall, the present thesis provided a psychometrically validated measure for the assessment of self-awareness of falls risk in older adults. It is acknowledged that further evaluation of its reliability and validity is required. Preliminary data presented highlights that underestimation of risk is not uncommon in older adults. Some key variables associated with reduced self-awareness were identified and negative outcomes such as lower rehabilitation engagement and motivation were demonstrated. Current results provide directions for future research in this area, which could examine the biopsychosocial factors and other outcomes associated with reduced awareness of falls risk in older adults.