Award Date

12-1-2021

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Interdisciplinary Studies

First Committee Member

Merrill Landers

Second Committee Member

Daniel Young

Third Committee Member

James Navalta

Fourth Committee Member

Nirmala Lekhak

Number of Pages

202

Abstract

Fear of falling (FOF) is a significant concern among individuals with Parkinson’s disease (PD) and older adults in general. This FOF can lead to avoidance behavior resulting in activity restriction. Some level of fear of falling avoidance behavior (FFAB) may be protective (adaptive) and decrease the likelihood of falls, especially among individuals with physical limitations and high fall risk. However, excessive (maladaptive) avoidance behavior may lead to downstream consequences such as further physical and psychological decline and an increased likelihood of falls, especially when there is a disparity between the FFAB and physiological fall risk. While poor physical functioning, disease severity, and comorbidities have been associated with FFAB, maladaptive avoidance behavior has also been identified among individuals in the early stages of PD with good physical abilities and low fall risk. Limited evidence is available for what activities are most impacted by FFAB and interventions to target maladaptive FFAB, especially among individuals with PD. Therefore, this dissertation sought to gain a greater understanding of FFAB among individuals with PD and older adults to inform clinical evaluation and intervention by exploring treatment targets to mitigate FFAB. A scoping review was conducted to gain insight into the current state of the literature regarding FFAB and individuals with PD (Chapter 1). To examine how FFAB impacts individuals with PD and explore treatment targets, a descriptive analysis of the Modified Fear of Falling Activity Avoidance Behavior Questionnaire was performed to determine which activities were avoided most and what demographic factors were associated with FFAB (Chapter 2). To further explore psychological treatment targets, the relationship between psychological variables, such as depression, anxiety, catastrophizing, and FFAB was investigated among individuals with PD (Chapter 3). Lastly, a national data set of older adults, including those with PD and other neurodegenerative disorders, was examined to identify psychological factors associated with FFAB and explore the characteristics of those without FOF, with FOF only, and with FFAB (Chapter 4). Overall, the findings of this dissertation provide insight into how FFAB impacts activity restriction and what psychological factors are associated with FFAB among individuals with PD and older adults. These findings add to the current literature of potential treatment targets to mitigate FFAB. Further research is needed to determine the causal relationship between the psychological constructs and FFAB. Moreover, further research is necessary to determine if targeting avoided activities and psychological constructs, such as catastrophizing, can mitigate FFAB and the downstream consequences.

Keywords

Activity Restriction; Fall Prevention; Occupational Therapy; Participation; Physical Therapy; Rehabilitation

Disciplines

Family, Life Course, and Society | Geriatrics | Medicine and Health Sciences | Mental and Social Health

File Format

pdf

File Size

1499 KB

Degree Grantor

University of Nevada, Las Vegas

Language

English

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

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