"From the moment I started standing again, I was worried about falls": Fear of Falling in ICU Survivors over 12 Months.

Abstract

Rationale: Post Intensive Care Syndrome is a significant challenge for survivors of critical illness. However, little is understood about fear of falls - the concern for falls.

Objective: This study sought to quantify the prevalence of fear of falls within the first year after hospital discharge and identify factors associated with high fear of falls.

Methods: Mixed methods approach. Fear of falls was assessed using the Falls Efficacy Scale International short form questionnaire with participants dichotomised into low/moderate (7-12) and high fear of falls (13-28). Persistence was defined as high fear of falls across at least two assessment time points. Data were also collected on physical parameters, frailty, cognition, mood, quality of life and physical activity levels. Participants were assessed at hospital discharge, 3, 6, and 12 months.

Results: A high fear of falls was reported in 66 participants in the first 12 months with 41% reporting persistent high fear. High fear primarily commenced at hospital discharge (79%). Hospital discharge factors associated with reduced odds of experiencing high fear of falls in the first 12 months were: higher cognition, strength; physical function; balance; and health-related quality of life. Whereas increased odds of experiencing high fear were: older age, comorbidities; ICU-delirium; frailty; delayed quadriceps time to peak force and mental health impairments. The final multivariate model found that ICU survivors who had ICU delirium were more likely to have high fear of falls (OR 4.67; 95%CI: 1.18-18.48) whilst those with better balance were less likely to do so (OR 0.83, 95%CI 0.74-0.94). High fear of falls was not predictive of physical activity or function at 6 months however it was a significant predictor of depression. Qualitative data highlighted participant concern for further incapacitation through injury and loss of independence. Perceived causes were reduced strength, balance and fatigue. Participants described strategies they adopted to reduce their risk of falling including environmental scanning, gait aid use, and slow deliberate movement.

Conclusions: Fear of falls is a significant and persistent challenge for ICU survivors. Modifiable discharge factors exist such as strength, physical function/balance, ICU-related delirium and mood which may be the target of future post hospital interventions.