The prevalence and risk factors of falling and fear of falling among lower extremity amputees

Abstract

Objective: To estimate the falling experience and fear of falling status and to describe characteristics associated with falling and fear of falling.

Design: Population-based consecutive sample survey and chart review.

Setting: Two Canadian, regional, university-affiliated outpatient amputee clinics.

Participants: The sample (n = 435; mean age, 62 +/- 15.7 yr) of community-living participants was mostly male (71%), had unilateral (below knee 73%; above knee 27%) amputations primarily for vascular (53% vs 47% nonvascular) reasons.

Intervention: Review patient charts and survey questionnaires to determine sociodemographic information (eg, social support), information about the amputation (eg, cause, level, problems), physical health and function (eg, pain, limitations, comorbidity), and psychologic state (depression, adaptation).

Main outcome measures: Occurrence of a fall in the past 12 months and presence of a fear of falling.

Results: Exactly 52.4% subjects reported falling in the past year, whereas 49.2% reported a fear of falling. Logistic regression analyses revealed falling was related to having an above knee amputation (odds ratio [OR] = 2.78; 95% confidence interval [CI] = 1.71-4.51), back (OR = 1.96; 95% CI = 1.08-3.54) and joint (OR = 1.67; 95% CI = 1.01-2.74) pain, and multiple stump and prosthesis problems (OR = 3.09; 95% CI = 1.58-6.04). Having had the amputation > or = 4 years in the past was protective (OR =.53; 95% CI =.29-.89). Factors related to an increase risk of fear of falling included having to concentrate on each step while walking (OR = 4.06; 95% CI = 2.46-6.71) and having a fall in the past 12 months (OR = 1.62; 95% CI = 1.04-2.54), whereas being male (OR = 0.35; 95% CI =.21-.57) and having good to excellent perceived health (OR =.35; 95% CI =.21-.58) were protective.

Conclusions: Falling and fear of falling are pervasive among amputees. Comprehensive and ongoing intervention and education should be considered. Research is required to assess the consequences of falling and fear of falling.