Asia-pacific Journal of Applied Science and Engineering for Better Human Life

Vol.9 (2016) pp. 42-48

http://dx.doi.org/10.21742/asehl.2016.9.11

Relations among Fall Efficacy, Fear of fall, Fall Knowledge, and Fall
Prevention Behavior in the Elderly

Youngju Jee1, Eunjoo Lee2, Eunsil Jang3, Hyunhwa Hong3, Kyoungran An3
1
Dept. of Nursing, Kyungnam University
7 Kyungnamdaehak-ro, Masanhappo-gu, Changwon-si, Gyeongsangnam-do, Korea
Jeeyoungju@kyungnam.ac.kr
2
Dept. of Nursing, Kyungnam University
7 Kyungnamdaehak-ro, Masanhappo-gu, Changwon-si, Gyeongsangnam-do, Korea
Corresponding Author: abigail@kyungnam.ac.kr
3
Dept. of Nursing, Kyungnam University
7 Kyungnamdaehak-ro, Masanhappo-gu, Changwon-si, Gyeongsangnam-do, Korea
es528@kyungnam.ac.kr
hongnaive@kyungnam.ac.kr
baboran80@kyungnam.ac.kr

Abstract. The purpose of this study was to determine the relationships among fall efficacy, fear
of fall, fall Knowledge, and fall prevention behavior in the elderly over 65 years. This descrip-
tive correlational study surveyed 152 elderly subjects visiting a senior academy in C. Data were
analyzed with descriptive statistics, t-test, ANOVA, and Pearson’s correlation coefficient. 23.7%
of the subjects experienced falls. There was no significant difference between faller and non-
faller groups. As for the correlations between the variables, the fall efficacy had negative corre-
lation with the fear of fall(r=-.631, p<.001), and positive correlation with the fall prevention be-
havior(r=.188, p=.020). The fall knowledge had positive correlation with the fall prevention be-
havior(r=.323, p<.001). Therefore, to prevent the community-dwelling elderly from falls, practi-
cal measures should be developed to prevent falls, increase the fall efficacy and knowledge and
decrease the fear of falling.

Keywords: Fall, Efficacy, Fear, Knowledge, Prevention

1 Introduction

Falls may occur at any stage of life but are one of the most important nursing issues to the elderly,
given increasing medical costs due to fall injuries, compromised quality of life and increasing risk of
mortality[1]. 20-30% of the elderly experience falls across the world [2]. Likewise, 21-25% of the
elderly experience falls every year in Korea[3]. Particularly, as falls can cause fractures whose unit
cost for treatment is high[4], falls matter to the elderly both physically and socio-economically.
Previous studies established diverse factors affecting falls. First, the fall efficacy refers to one's
self-efficacy about not falling while performing certain activities[5], and was reported to contribute to
decreasing falls [6]. The fear of falls referring to a negative feeling about falls was found to limit
physical activities including the activities of daily living and cause falls [7]. Also, to prevent falls, it
is highly important to acquire fall-related knowledge and fall prevention behavior [8]. Thus, to de-
crease the risks of falls in the elderly, it is necessary to understand fall-related critical factors and
their correlations.
The present study surveyed the elderly visiting a senior academy to establish the correlations be-
tween fall efficacy, fear of fall, fall knowledge and fall prevention behavior and thus to provide some
reference data for the development of effective nursing intervention programs for fall prevention

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Vol.9 (2016) pp. 42-48

2 Method

2.1 Design

The present descriptive correlational study surveyed the elderly visiting a senior college to deter-
mine the fall-related efficacy, knowledge, fear and prevention behavior, and to identify the correla-
tions between such factors.

2.2 Subjects and Data Collection

The present study surveyed the elderly aged 65 and over visiting a senior academy in C, Korea.
The participant elderly were informed of the objective, questionnaire content, voluntary participation,
privacy protection, commitment to using the results only for the purpose of this study and the free-
dom to drop out. To determine the number of subjects, G Power 13 was used. As a result, the mini-
mum sample size was found to be 134 subjects based on the correlation analysis which highlighted a
medium effect size of 0.3, α of .05, and statistical power of .95. Considering a dropout rate of 15%,
152 subjects were included.

2.3 Instrument

1) Fall efficacy
The Korea Falls Efficacy Scale (FES-K) was used to measure the fall efficacy of the elderly subjects.
The FES-K is based on the Falls Efficacy Scale-International(FES-I) developed by Yardiey et al. [9]
and adapted by Huh, Lim & Lee [10] considering the characteristics of Korean language and culture
as well as the local elderly. It consists of a total of 12 question items. Higher scores mean higher
levels of fall efficacy. The relevant Cronbach's α was .953 here.

2) Fear of fall
The Fear of Falling Questionnaire (FOFQ) developed by Tideiksaar [11] and used by Choi [12] was
used here to measure the fear of fall. The instrument consists of a total of 11 question items. Higher
scores mean greater fear of fall. Originally, the instrument's Cronbach's α was .911, whereas it
was .923 here.

3) Fall-related knowledge
Kim's [16] instrument was used based on the 15 question items concerning fall-related knowledge
developed by Kim (2002) [13], revised by Kim [14] with an item on drugs added, and rewritten by
Hwang [15] to help the elderly respondents to better understand the questions. The instrument con-
sists of 18 question items. High scores mean greater fall-related knowledge. As for the reliability of
the instrument, Cronbach's α values were .86 and .803 in Hwang [15] and in this study, respectively.

4) Fall prevention behavior

The 14-item instrument developed by Gu et al.,[17] was used. Higher scores indicated higher levels
of practicing the fall prevention behavior. Its original Cronbach's α was .78. Here, it was .727.

2.4 Data Analysis

Data were analyzed in terms of descriptive statistics, t-test, ANOVA, and Pearson’s correlation coef-
ficient using SPSS/Win 23.0 program.

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Vol.9 (2016) pp. 42-48

3 Results

3.1. General Characteristics

The subjects consisted of 44 males(28.9%) and 108 females(71.1%). Their mean age was
75.22(5.66) years old. As for education, primary education accounted for the highest percent-
age(34.2%, n=52), followed by high school (25.7%, n=39), middle school(21.7%, n=33) and univer-
sity(13.2%, n= 20). The mean height was 157.61(13.62)cm. The mean weight was 60.01(12.11)kg.
As for marital status, 76 subjects(50%) were married and living with a spouse, while 71 sub-
jects(46.7%) was married and living without a spouse. The mean number of family members was
2.30(1.83). 36 subjects had experienced falls(23.7%), whereas 116 subjects had not(76.3%). Among
those who had experienced falls, 15(41.7%), 18(50.0%) and 3 (8.4%) subjects had fallen once, twice
and more than three times, respectively (Table 1).

Table 1. General Characteristics (N=152)

Characteristics Categories n(%) M(SD)

Female 108(71.1)
Gender
Male 44(28.9)

Age(yr) 75.22(5.66)

No education 8(5.3)

Elementary school 52(34.2)

Education Middle school 33(21.7)

High school 39(25.7)

≥ College 20(13.2)

Height(cm) 157.61(13.62)

Weight(kg) 60.01(12.11)

Never married 5(3.3)

Marital status Separated, divorced, widowed 71(46.7)

Marriage 76(50.0)

Number of family members 2.30(1.83)

Yes 36(23.7)
Fall experience
No 116(76.3)

Number of fall 1 15(41.7)

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Vol.9 (2016) pp. 42-48

2 18(50.0)

3≤ 3(8.4)

Fall efficacy 37.74(7.01)

Fear of falling 16.35(6.03)

Fall knowledge 28.24(4.04)

Fall prevention behavior 25.25(2.31)

3.2. Differences in general characteristics and main variables by fall experience

No significant differences were found in general characteristics of subjects and main varia-
bles based on the presence or absence of fall experience(Table 2).

Table 2. Differences in General Characteristics and Main Variables based on Fall Experience
(N=152)

Faller Non-faller
x² or t p
Characteristics Categories (n=36) (n=116)

n(%) or M+SD n(%) or M+SD

Female 28(77.8) 80(69) 1.03 .401

Gender
Male 8(22.2) 36(31)

Age(yr) 74.47(5.79) 75.45(5.63) -.90 .368

No education 2(5.6) 6(5.2) .64 .958

Elementary school 11(30.6)

41(35.3)
Education Middle school 8(22.2)

High school 9(25.0)

≥ College 6(16.7)

Height(cm) 159.33(8.02) 157.08(14.92) .86 .387

Weight(kg) 60.17(8.90) 59.97(12.98) .08 .931

Never married 1(2.8) 4(3.4) .58 .746

Marital status Separated, divorced, wid-

15(41.7) 56(48.3)
owed

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Vol.9 (2016) pp. 42-48

Marriage 20(55.6) 56(48.3)

Number of family 2.17(1.38) 2.34(1.95) .96 .329

member

Fall efficacy 37.36(7.34) 37.86(6.93) -.373 .709

Fear of falling 16.80(6.43) 16.20(5.91) .519 .604

Fall knowledge 28.72(3.65) 28.09(4.15)

Fall prevention
25.13(1.94) 25.3(2.72) -.491 .62
behavior

3.3. Correlations among Fall Efficacy, Fear of fall, Fall Knowledge and Fall Prevention Behav-
ior
Subjects' fall efficacy was negatively correlated with the fear of fall (r=-.631, p<.001), and posi-
tively with the fall prevention behavior(r=.188, p=.020). The fall knowledge was positively correlat-
ed with the fall prevention behavior(r=.323, p<.001)(Table 3).

Table 3. Correlations among Fall Efficacy, Fear of fall, Fall Knowledge and Fall Prevention
Behavior (N=152)

Fall Fall prevention behav-

Fear of falling Fall knowledge
efficacy ior

-.631** .188*
1 .153
Fall efficacy

1 -.156 -.011
Fear of
falling
.323**
1
Fall
knowledge

1
Fall prevention
behavior

4 Conclusions

23.7% of the subjects had experienced falls at least once in this study. This finding paralleled a
recent survey result on the status of safety in Korean senior citizens that 25.1% of respondents had
experienced falls[3]. Given the subjects in this study were the elderly visitors to a senior academy
who could do activities of daily living or use cars or public transports, the overall fall experience in
the entire elderly population would be much greater than the present finding. There was no signifi-
cant difference between the faller and non-faller groups in this study. Concerning the falls in the
elderly community centers, Yoo and Choi [18] found statistically significant differences between the

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Vol.9 (2016) pp. 42-48

groups in terms of gender, age, education and experience of coming close to falling. The different
findings between the present study and Yoo & Choi[18] may be attributable to the smaller number of
fallers than non-fallers in this study, and to individual differences in the perception of falls among
the elderly.
As for the correlations between main variables, the fall prevention behavior had positive correla-
tions with the fall-related knowledge(r= .323, p<.001) and the fall efficacy(r= .188, p= .020). The
relationship between fall-related knowledge and the prevention behavior is well documented, and
demonstrated in previous studies on falls in the elderly[19]. Also, Kim [20] found a positive correla-
tion between fall efficacy and fall prevention behavior in frail elderly subjects staying at home.
In addition, fall efficacy was negatively correlated with the fear of fall(r= -.631, p<.001). The
positive sense of fall efficacy was inversely proportional to the fear of falls[5]. Likewise, greater fall
efficacy led to less fear of falls [21]. Even when one had not experienced falls, the fear of falls could
limit one's activities of daily living and could negatively affect falls(Han, 2015). Hence, to prevent
falls with greater fall efficacy, psychological and emotional approaches should be taken particularly
to decrease the psychological anxiety or fear of falls in elderly subjects.
In conclusion, to prevent the elderly who can manage activities of daily living from falls, it is
necessary to enhance their fall efficacy and relevant knowledge and to decrease their fear of falls by
developing proper measures conducive to the fall prevention behavior in practice.

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