A structural equation modelling approach to the complex path from postural stability to morale in elderly people with fear of falling

Abstract

Purpose. To test a model of the path from Activity Limitation (postural instability) to participation (morale), taking account of the influence of psychological variables of appraisal, emotion and self-efficacy. Also to attempt to define whether elderly people with fear of falling are fearful because they are posturally unstable or because they are generally anxious.

Method. Elderly inpatients (n = 153, age: 67–95, 31% men) were assessed shortly before their discharge home. They were invited to complete tests of postural stability and questionnaires about consequences of falling, previous experience of falls, subjective unsteadiness, emotional state, balance confidence, concern and fear about falling and morale. Results were treated with Pearson correlations and structural equation modelling.

Results. All variables related to morale, the highest correlation being with anxiety and depression. However, there was no direct path from postural instability to morale. Balance confidence and fear of falling formed separate end points, neither affecting morale.

Conclusions. Morale alone is not an adequate outcome of rehabilitation. Increased balance confidence and reduced fear of falling need to be addressed in their own right and assessed independently of morale in elderly rehabilitation.

Keywords:

• Falls
• elderly
• structural equation modeling
• ICF

Acknowledgements

We thank an anonymous reviewer of a previous version of this article. J. Simpson was supported by the Lady Youde Charitable Trust and C. Worsfold was funded by an NHS South Thames project grant.