“From the moment I started standing again, I was worried about falls”: fear of falling in intensive care unit survivors over 12 months

Rationale: Post–intensive care syndrome is a significant challenge for survivors of critical illness. However, little is understood about fear of falls and 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: Using a mixed-methods approach, fear of falls was assessed using the Falls Efficacy Scale International short-form questionnaire with participants dichotomized into low/moderate (7-12) and high (13-28) fear of falls. Persistence was defined as high fear of falls across at least 2 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 and at 3, 6, and 12months postdischarge. 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. Increased odds of experiencing high fear were shown with older age, comorbidities, ICU delirium, frailty, delayed quadriceps time to peak force, and mental health impairments. The final multivariate model found that intensive care unit (ICU) survivors who had ICU delirium were more likely to have high fear of falls (odds ratio [OR], 4.67 [95% CI, 1.18-18.48]) whereas those with better balance were less likely to have high fear (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 could be the target of future posthospital interventions.