| Objectives:This study aims to reveal the current situation of fear of falling among elderly residents in nursing homes,and to explore the relationship and mechanism among fear of falling and health outcomes of elderly residents in nursing homes.Find the intervention targets and provide theoretical basis to formulate intervention measures.Methods:A cross-sectional design was used.The research was conducted among the elderly in 27 nursing homes in Jinan from March to June in 2018.Three hundred and seventeen eligible elderly residents were recruited,acquired 316 effective questionnaires.Data were collected through survey questionnaires including the general information of the residents and the facilities,the Short Falls Efficacy Scale-International,the Social Activity Participation Questionnaire,the Mini-mental State Examination,the Barthel Index,the Short Physical Performance Battery,the Patient Health Questionnaire,and the quality of life scale for residents in long-term care facilities.The data analysis was conducted in SPSS20.0 and Mplus7.0,including descrnptive analysis,chi-square test,student-t test,one-way ANOVA and path analysis.Results:1)30.4%of elderly residents in this study had falling history in the past year,and 79.1%of the residents suffered from the fear of falling.2)Path analysis showed fear of falling was negatively correlated with health outcomes:fear of falling and daily life activity ability(path coefficient =-0.123,P=0.022),fear of falling and lower limb function(path coefficient =-0.192,P<0.001),fear of falling and depression(path coefficient =0.169,P=0.002),fear of falling and quality of life(path coefficient =-0.174,P<0.001).3)Activity participation and cognitive function played a chain mediating role between fear of falling and health outcomes.Among them,fear of falling and daily life activity ability:the total indirect effect of activity participation and cognitive function was-0.03 1,accounting for 20.1%of the total effect.The confidence interval tested by bootstrap(-0.071,-0.006).The model fit indexes were x2=71.559,x2/df=1.556,CFI=0.928,TLI =0.897,SRMR=0.057,RMSEA=0.042;Fear of falling and lower limb function:the total indirect effect of activity participation and cognitive function was-0.030,accounting for 13.5%of the total effect.The confidence interval tested by bootstrap(-0.065,-0.001).The model fit indexes were x2=40.864,X2/df=2.554,CFI=0.914,TLI=0.849,SRMR=0.060,RMSEA=0.070;Fear of falling and depression:the total indirect effect of activity participation and cognitive function was 0.023,accounting for 12.0%of the total effect.The confidence interval tested by bootstrap(0.002,0.057).The model fit indexes were x2=22.735,x2/df=1.895,CFI=0.970,TLI=0.947,SRMR=0.055,RMSEA=0.053;Fear of falling and quality of life:the total indirect effect of activity participation and cognitive function was-0.044,accounting for 20.2%of the total effect.The confidence interval tested by bootstrap(-0.086,-0.002).The model fit indexes were x2=153.583,x;2/df=1.920,CFI=0.943,TLI= 0.926,SRMR=0.062,RMSEA=0.054.4)Multiple-group analysis showed:The relationship and pathway between fear of falling and health outcomes were the same among the residents with or without a falling history.Multiple-group analysis of fear of falling and daily life activity ability(P value of ?x2 is 0.148);Fear of falling and lower limb function(P value of ?x2 is 0.067);Fear of falling and depression(P value of ?x2 is 0.202);Fear of falling and quality of life(P value of ?x2 is 0.538).Conclusions:1)Fear of falling is a common health problem among the elderly residents in nursing homes.The incidence is high and requires urgent attention.2)Fear of falling is an important factor related to poor health outcomes among the elderly residents in nursing homes.3)Activity participation and cognitive function play a chain mediating role between fear of falling and health outcomes.4)The relationship and pathway between fear of falling and health outcomes are the same among the residents with or without a falling history. |
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