Activity Restriction Induced by Fear of Falling and Objective and Subjective Measures of Physical Function: A Prospective Cohort Study

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Abstract
OBJECTIVES: To examine whether activity restriction specifically induced by fear of falling (FF) contributes to greater risk of disability and decline in physical function. DESIGN: Prospective cohort study. SETTING: Population‐based older cohort. PARTICIPANTS: Six hundred seventy‐three community‐living elderly (≥65) participants in the Invecchiare in Chianti Study who reported FF. MEASUREMENTS: FF, fear‐induced activity restriction, cognition, depressive symptoms, comorbidities, smoking history, and demographic factors were assessed at baseline. Disability in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and performance on the Short Performance Physical Battery (SPPB) were evaluated at baseline and at the 3‐year follow‐up. RESULTS: One‐quarter (25.5%) of participants did not report any activity restriction, 59.6% reported moderate activity restriction (restriction or avoidance of <3 activities), and 14.9% reported severe activity restriction (restriction or avoidance of ≥3 activities). The severe restriction group reported significantly higher IADL disability and worse SPPB scores than the no restriction and moderate restriction groups. Severe activity restriction was a significant independent predictor of worsening ADL disability and accelerated decline in lower extremity performance on SPPB over the 3‐year follow‐up. Severe and moderate activity restriction were independent predictors of worsening IADL disability. Results were consistent even after adjusting for multiple potential confounders. CONCLUSION: In an elderly population, activity restriction associated with FF is an independent predictor of decline in physical function. Future intervention studies in geriatric preventive care should directly address risk factors associated with FF and activity restriction to substantiate long‐term effects on physical abilities and autonomy of older persons.