Review Article
Fear of Falling and Gait Variability in Older Adults: A Systematic Review and Meta-Analysis

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Abstract

Background

Fear of falling (FOF) and increased gait variability are both independent markers of gait instability. There is a complex interplay between both entities. The purposes of this study were (1) to perform a qualitative analysis of all published studies on FOF-related changes in gait variability through a systematic review, and (2) to quantitatively synthesize FOF-related changes in gait variability.

Methods

A systematic Medline literature search was conducted in May 2014 using the Medical Subject Heading (MeSH) terms “Fear” OR “fear of falling” combined with “Accidental Falls” AND “Gait” OR “Gait Apraxia” OR “Gait Ataxia” OR “Gait disorders, Neurologic” OR “Gait assessment” OR “Functional gait assessment” AND “Self efficacy” OR “Self confidence” AND “Aged” OR “Aged, 80 and over.” Systematic review and fixed-effects meta-analysis using an inverse-variance method were performed.

Results

Of the 2184 selected studies, 10 observational studies (including 5 cross-sectional studies, 4 prospective cohort studies, and 1 case-control study) met the selection criteria. All were of good quality. The number of participants ranged from 52 to 1307 older community-dwellers (26.2%–85.0% women). The meta-analysis was performed on 10 studies with a total of 999 cases and 4502 controls. In one study, the higher limits of the effect size's confidence interval (CI) were lower than zero. In the remaining studies, the higher limits of the CI were positive. The summary random effect size of 0.29 (95% CI 0.13–0.45) was significant albeit of small magnitude, and indicated that gait variability was overall 0.29 SD higher in FOF cases compared with controls.

Conclusions

Our findings show that FOF is associated with a statistically significant, albeit of small magnitude, increase in gait variability.

Section snippets

Literature Search

A systematic Medline literature search was conducted in May 2014 without restriction of date and language, using the Medical Subject Heading (MeSH) terms “Fear” OR “fear of falling” combined with “Accidental Falls” AND “Gait” OR “Gait Apraxia” OR “Gait Ataxia” OR “Gait disorders, Neurologic” OR “Gait assessment” OR “Functional gait assessment” AND “Self efficacy” OR “Self confidence” AND “Aged” OR “Aged, 80 and over.” An iterative process was used to ensure all relevant articles had been

Results

All studies were judged of good quality using the Newcastle-Ottawa Scale (see Appendix 2). Supplementary Table 1 summarizes the 10 studies included in this review and meta-analysis.6, 10, 21, 22, 23, 24, 25, 26, 27, 28 Data collection was based on cross-sectional design for 5 studies,8, 21, 22, 27, 28 on prospective observational cohort design for 4 studies,23, 24, 25, 26 and on case-control design for 1 study.6 Population ranged from 5224 to 1307,26 and was most frequently female with a

Discussion

This systematic review and meta-analysis shows that FOF is associated with a small, significant increase in gait variability (ie, worst performance of gait). In addition, mixed results of qualitative analysis suggest that this association may be influenced by other covariables that should be taken into account when examining it.

Four studies of the 10 selected have shown a significant FOF-related increase in gait variability.6, 25, 27, 28 In these studies, FOF was assessed either by the ABC

Acknowledgments

We thank Melinda Beaudenon, MS, Jennifer Gautier, BS, Simon Romain, MS, and Anastasiia Kabeshova, MS, from Angers University Memory Clinic, France, for daily assistance. There was no compensation for this contribution. We are also grateful to Jeffrey Hausdorff, Orna Donoghue, and Ryuichi Sawa for their cooperation, and more precisely for providing supplementary data from their published study that was required to perform a meta-analysis.

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    C.A. has served as an unpaid consultant for Ipsen Pharma Company, and serves as an associate editor for Gériatrie, Psychologie et Neuropsychiatrie du Vieillissement, and for the Journal of Alzheimer's Disease. He has no relevant financial interest in this manuscript. O.B. has served as an unpaid consultant for Ipsen Pharma Company, and serves as an associate editor for Gériatrie, Psychologie et Neuropsychiatrie du Vieillissement. He has no relevant financial interest in this manuscript.

    This study was funded by Biomathics. The sponsors had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

    The authors declare no conflicts of interest.

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