Falls and fear of falling in older adults who have undergone total hip and knee arthroplasty

Abstract

Falls are the leading cause of injury in community dwelling older adults over the age of 65 years. In patients with total joint arthroplasty (TJA), falls has not been studied extensively, with conflicting reports of associated falls risk factors. The overall aim of this thesis is to report the prevalence of falls in TJA patients, and to understand how fear of falling and other factors explain falls in patients with total hip or knee replacement. A scoping review was completed to broadly map existing literature on falls in TJA participants. A cross-sectional survey was conducted with participants over the age of 60 waiting for or recovering from TJA (n=198), and controls from the community (n=100). Univariable logistic regression was used to determine factors associated with falls within TJA group and within community group. In the TJA group, 29% (n=57) reported at least one fall in the past year compared to 24% (n=24) in community controls. The mean number of risk factors for falling was significantly higher for the TJA group (6.3±3.2) as compared to community controls (3.7±2.5), p<0.001. Fear of falling was greater in the TJA group (ABC mean score=67.0±24.3) than the community controls (88.1±14.9) (p<0.01). Although TJA participants have a comparable number of falls to community dwelling older adults, they have more and different risk factors for falling and are more fearful of falling. This thesis makes a useful contribution to clinical practice by describing the prevalence of falls and factors associated with falls among people with TJA and suggesting approaches to intervention that have the potential to address falls risk. Findings from this thesis are relevant to occupational therapists and other professionals who seek to support patients before and after TJA.