Health  Vol.6 No.12 , June 2014
Influence of Proxies on the Reported Frequency of Falls, Fear of Falling and Activity Restriction in Older People
ABSTRACT
Introduction: In older populations, the help of a third person may be necessary for a certain number of individuals in order to fill in questionnaires. The influence of this assistance on the collected information can raise questions, among others concerning the concordance between the information provided by the persons themselves and by their proxies, or the introduction of a potential bias. Our study’s objective is to examine, among older people, the differences in the reported frequency of falls, fear of falling and activity restriction due to fear of falling, according to the fact that people had filled in a questionnaire with or without the help of a third person. Methods: The data used come from the secondary analysis of a cross-sectional survey using a self-administered questionnaire and conducted in 2006 in a Belgian semi-rural town among non-institutionalised persons aged 65 years and over. Results: Among the 501 questionnaires, 16.4% were filled in with the help of another person. In bivariate analysis, the persons who needed help reported fall history, fear of falling and activity restriction significantly more often. In multivariable analysis, when considering concurrently the covariates (sex, age, living alone and fall history for fear of falling and for activity restriction), the influence of having received help to fill in the survey was only significant for activity restriction. Conclusion: Our study shows that it is important to know whether or not a person has received help to fill in a questionnaire. This can actually influence the reported frequency of certain outcomes, even, for activity restriction, when considering simultaneously the effect of other covariates. Given the current and future ageing of our populations, it seems that more extensive exploration is needed of the influence of proxies on the collected information about falls, fear of falling and activity restriction among older people.

Cite this paper
da Costa, E. , Godin, I. , Pepersack, T. , Dramaix, M. , Coppieters, Y. , Bantuelle, M. and Levêque, A. (2014) Influence of Proxies on the Reported Frequency of Falls, Fear of Falling and Activity Restriction in Older People. Health, 6, 1512-1521. doi: 10.4236/health.2014.612186.
References
[1]   Pison, G. (2013) Tous les Pays du Monde (2013). Population & Sociétés, 503, 1-8.

[2]   United Nations, Department of Economic and Social Affairs, Population Division (2013) World Population Prospects. The 2012 Revision. Volume I: Comprehensive tables ST/ESA/SER.A/336. United Nations, New York.
http://esa.un.org/wpp/Documentation/pdf/WPP2012_Volume-I_Comprehensive-Tables.pdf

[3]   Lynn Snow, A., Cook, K.F., Lin, P.S., Morgan, R.O. and Magaziner, J. (2005) Proxies and Other External Raters: Methodological Considerations. Health Services Research, 40, 1676-1693.
http://dx.doi.org/10.1111/j.1475-6773.2005.00447.x

[4]   Magaziner, J., Zimmerman, S.I., Gruber-Baldini, A.L., Hebel, J.R. and Fox, K.M. (1997) Proxy Reporting in Five Areas of Functional Status. Comparison with Self-Reports and Observations of Performance. American Journal of Epidemiology, 146, 418-428.
http://dx.doi.org/10.1093/oxfordjournals.aje.a009295

[5]   Elliott, M.N., Beckett, M.K., Chong, K., Hambarsoomians, K. and Hays, R.D. (2008) How Do Proxy Responses and Proxy-Assisted Responses Differ from What Medicare Beneficiaries Might Have Reported about their Health Care? Health Services Research, 43, 833-848.
http://dx.doi.org/10.1111/j.1475-6773.2007.00820.x

[6]   Neumann, P.J., Araki, S.S. and Gutterman, E.M. (2000) The Use of Proxy Respondents in Studies of Older Adults: Lessons, Challenges, and Opportunities. Journal of the American Geriatrics Society, 48, 1646-1654.

[7]   Magaziner, J., Bassett, S.S., Hebel, J.R. and Gruber-Baldini, A. (1996) Use of Proxies to Measure Health and Functional Status in Epidemiologic Studies of Community-Dwelling Women Aged 65 years and Older. American Journal of Epidemiology, 143, 283-292.
http://dx.doi.org/10.1093/oxfordjournals.aje.a008740

[8]   Long, K., Sudha, S. and Mutran, E.J. (1998) Elder-Proxy Agreement Concerning the Functional Status and Medical History of the Older Person: The Impact of Care-giver Burden and Depressive Symptomatology. Journal of the American Geriatrics Society, 46, 1103-1111.

[9]   Ball, A.E., Russell, E.M., Seymour, D.G., Primrose, W.R. and Garratt, A.M. (2001) Problems in Using Health Survey Questionnaires in Older Patients with Physical Disabilities. Can Proxies be Used to Complete the SF-36? Gerontology, 47, 334-340.
http://dx.doi.org/10.1159/000052824

[10]   The Medical Research Council Cognitive Function and Ageing Study (2000) Survey into Health Problems of Elderly People: A Comparison of Self-Report with Proxy Information. International Journal of Epidemiology, 29, 684-697.

[11]   Magaziner, J., Simonsick, E.M., Kashner, T.M. and Hebel, J.R. (1988) Patient-Proxy Response Comparability on Measures of Patient Health and Functional Status. Journal of Clinical Epidemiology, 41, 1065-1074.
http://dx.doi.org/10.1016/0895-4356(88)90076-5

[12]   Shaw, C., McColl, E. and Bond, S. (2001) Functional Abilities and Continence: The Use of Proxy Respondents in Research Involving Older People. Quality of Life Research, 9, 1117-1126.
http://dx.doi.org/10.1023/A:1016660724376

[13]   Ostbye, T., Tyas, S., McDowell, I. and Koval, J. (1997) Reported Activities of Daily Living: Agreement between Elderly Subjects with and without Dementia and their Caregivers. Age and Ageing, 26, 99-106.
http://dx.doi.org/10.1093/ageing/26.2.99

[14]   Vuorisalmi, M., Sarkeala, T., Hervonen, A. and Jylha, M. (2012) Among Nonagenarians, Congruence between Self-Rated and Proxy-Rated Health Was Low but Both Predicted Mortality. Journal of Clinical Epidemiology, 65, 553-559.
http://dx.doi.org/10.1016/j.jclinepi.2011.11.001

[15]   Higashi, T., Hays, R.D., Brown, J.A., Kamberg, C.J., Pham, C., Reuben, D.B., et al. (2005) Do Proxies Reflect Patients’ Health Concerns about Urinary Incontinence and Gait Problems? Health and Quality of Life Outcomes, 3, 75.
http://dx.doi.org/10.1186/1477-7525-3-75

[16]   Bassett, S.S., Magaziner, J. and Hebel, J.R. (1990) Reliability of Proxy Response on Mental Health Indices for Aged, Community-Dwelling Women. Psychology and Aging, 5, 127-132.
http://dx.doi.org/10.1037/0882-7974.5.1.127

[17]   Heller, K., Viken, R.J. and Swindle, R.W. Jr. (2013) What Do Network Members Know? Network Members as Reporters of Depression among Caucasian-American and African-American Older Women. Aging & Mental Health, 17, 215-225.
http://dx.doi.org/10.1080/13607863.2012.721113

[18]   Pierre, U., Wood-Dauphinee, S., Korner-Bitensky, N., Gayton, D. and Hanley, J. (1998) Proxy Use of the Canadian SF-36 in Rating Health Status of the Disabled Elderly. Journal of Clinical Epidemiology, 51, 983-990.
http://dx.doi.org/10.1016/S0895-4356(98)00090-0

[19]   Sitoh, Y.Y., Lau, T.C., Zochling, J., Cumming, R.G., Lord, S.R., Schwarz, J., et al. (2003) Proxy Assessment of Health-Related Quality of Life in the Frail Elderly. Age and Ageing, 32, 459-461.
http://dx.doi.org/10.1093/ageing/32.4.459

[20]   Rubenstein, L.Z. and Josephson, K.R. (2002) The Epidemiology of Falls and Syncope. Clinics in Geriatric Medicine, 18, 141-158.
http://dx.doi.org/10.1016/S0749-0690(02)00002-2

[21]   Hartholt, K.A., van Beeck, E.F., Polinder, S., van der Velde, N., van Lieshout, E.M., Panneman, M.J., et al. (2011) Societal Consequences of Falls in the Older Population: Injuries, Healthcare Costs, and Long-Term Reduced Quality of Life. The Journal of Trauma, 71, 748-753.
http://dx.doi.org/10.1097/TA.0b013e3181f6f5e5

[22]   Jorstad, E.C., Hauer, K., Becker, C. and Lamb, S.E. (2005) Measuring the Psychological Outcomes of Falling: A Systematic Review. Journal of the American Geriatrics Society, 53, 501-510.
http://dx.doi.org/10.1111/j.1532-5415.2005.53172.x

[23]   Howland, J., Lachman, M.E., Peterson, E.W., Cote, J., Kasten, L. and Jette, A. (1998) Covariates of Fear of Falling and Associated Activity Curtailment. The Gerontologist, 38, 549-555.
http://dx.doi.org/10.1093/geront/38.5.549

[24]   Lach, H.W. (2005) Incidence and Risk Factors for Developing Fear of Falling in Older Adults. Public Health Nursing, 22, 45-52.
http://dx.doi.org/10.1111/j.0737-1209.2005.22107.x

[25]   Yardley, L. and Smith, H. (2002) A Prospective Study of the Relationship between Feared Consequences of Falling and Avoidance of Activity in Community-Living Older People. The Gerontologist, 42, 17-23.
http://dx.doi.org/10.1093/geront/42.1.17

[26]   Friedman, S.M., Munoz, B., West, S.K., Rubin, G.S. and Fried, L.P. (2002) Falls and Fear of Falling: Which Comes First? A Longitudinal Prediction Model Suggests Strategies for Primary and Secondary Prevention. Journal of the American Geriatrics Society, 50, 1329-1335.
http://dx.doi.org/10.1046/j.1532-5415.2002.50352.x

[27]   Murphy, S.L., Williams, C.S. and Gill, T.M. (2002) Characteristics Associated with Fear of Falling and Activity Restriction in Community-Living Older Persons. Journal of the American Geriatrics Society, 50, 516-520.
http://dx.doi.org/10.1046/j.1532-5415.2002.50119.x

[28]   Zijlstra, G.A., van Haastregt, J.C., van Eijk, J.T., van Rossum, E., Stalenhoef, P.A. and Kempen, G.I. (2007) Prevalence and Correlates of Fear of Falling, and Associated Avoidance of Activity in the General Population of Community-Living Older People. Age and Ageing, 36, 304-309.
http://dx.doi.org/10.1093/ageing/afm021

[29]   Tinetti, M.E., Mendes de Leon, C.F., Doucette, J.T. and Baker, D.I. (1994) Fear of Falling and Fall-Related Efficacy in Relationship to Functioning among Community-Living Elders. Journal of Gerontology, 49, M140-M147.
http://dx.doi.org/10.1093/geronj/49.3.M140

[30]   Foran, S., McCarron, M. and McCallion, P. (2013) Expanding Assessment of Fear of Falling among Older Adults with an Intellectual Disability: A Pilot Study to Assess the Value of Proxy Responses. ISRN Geriatrics, 2013, Article ID: 493042.

[31]   Lamb, S.E., Jorstad-Stein, E.C., Hauer, K., Becker, C. on Behalf of the Prevention of Falls Network Europe and Outcomes Consensus Group (2005) Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus. Journal of the American Geriatrics Society, 53, 1618-1622.
http://dx.doi.org/10.1111/j.1532-5415.2005.53455.x

[32]   Mendes da Costa, E., Pepersack, T., Godin, I., Bantuelle, M., Petit, B. and Leveque, A. (2012) Fear of Falling and Associated Activity Restriction in Older People. Results of a Cross-Sectional Study Conducted in a Belgian Town. Archives of Public Health, 70, 1.
http://dx.doi.org/10.1186/0778-7367-70-1

[33]   Milat, A.J., Watson, W.L., Monger, C., Barr, M., Giffin, M. and Reid, M. (2011) Prevalence, Circumstances and Consequences of Falls among Community-Dwelling Older People: Results of the 2009 NSW Falls Prevention Baseline Survey. New South Wales Public Health Bulletin, 22, 43-48.
http://dx.doi.org/10.1071/NB10065

[34]   Demarest, S., Drieskens, S., Gisle, L., Van der Heyden, J. and Tafforeau, J. (2010) Enquête de santé, 2008. Rapport VI-La Santé des Personnes Agées. IPH/EPI Reports No. 2010/056. Direction Opérationnelle Santé Publique et Surveillance, Institut Scientifique de Santé Publique, Bruxelles.
https://his.wiv-isp.be/fr/Documents%20partages/Elderly_HS_FR_2008.pdf

[35]   Delbaere, K., Van Den Noortgate, N., Bourgois, J., Vanderstraeten, G., Tine, W. and Cambier, D. (2006) The Physical Performance Test as a Predictor of Frequent Fallers: A Prospective Community-Based Cohort Study. Clinical Rehabilitation, 20, 83-90.
http://dx.doi.org/10.1191/0269215506cr885oa

[36]   Filiatrault, J., Desrosiers, J. and Trottier, L. (2009) An Exploratory Study of Individual and Environmental Correlates of Fear of Falling among Community-Dwelling Seniors. Journal of Aging and Health, 21, 881-894.
http://dx.doi.org/10.1177/0898264309340694

[37]   Fletcher, P.C. and Hirdes, J.P. (2004) Restriction in Activity Associated with Fear of Falling among Community-Based Seniors Using Home Care Services. Age and Ageing, 33, 273-279.
http://dx.doi.org/10.1093/ageing/afh077

[38]   De Breucker, S., Nkodo Mekongo, Y.P., Ibebeke, B. and Pepersack, T. (2007) Les Chutes du Patient Agé: Aspects Médicaux. Revue Médicale de Bruxelles, 28, 177-182.

[39]   Stevens, J.A., Baldwin, G.T., Ballesteros, M.F., Noonan, R.K. and Sleet, D.A. (2010) An Older Adult Falls Research Agenda from a Public Health Perspective. Clinics in Geriatric Medicine, 26, 767-779.
http://dx.doi.org/10.1016/j.cger.2010.06.006

[40]   Deandrea, S., Lucenteforte, E., Bravi, F., Foschi, R., La Vecchia, C. and Negri, E. (2010) Risk Factors for Falls in Community-Dwelling Older People: A Systematic Review and Meta-Analysis. Epidemiology, 21, 658-668.
http://dx.doi.org/10.1097/EDE.0b013e3181e89905

[41]   Kempen, G.I., van Haastregt, J.C., McKee, K.J., Delbaere, K. and Zijlstra, G.A. (2009) Socio-Demographic, Health-Related and Psychosocial Correlates of Fear of Falling and Avoidance of Activity in Community-Living Older Persons Who Avoid Activity Due to Fear of Falling. BMC Public Health, 9, 170.
http://dx.doi.org/10.1186/1471-2458-9-170

[42]   The Medical Research Council Cognitive Function and Ageing Study (2000) Survey into Health Problems of Elderly People: Multivariate Analysis of Concordance between Self-Report and Proxy Information. International Journal of Epidemiology, 29, 698-703.

[43]   Robbins, J.M., Wolfson, C.M., Bergman, H., Clarfield, A.M., Kleiman, S., Bilker, W. and Baumgarten, M. (2000) Agreement between Older Subjects and Proxy Informants on History of Surgery and Childbirth. Journal of the American Geriatrics Society, 48, 975-979.

[44]   Tamim, H., McCusker, J. and Dendukuri, N. (2002) Proxy Reporting of Quality of Life Using the EQ-5D. Medical Care, 40, 1186-1195.
http://dx.doi.org/10.1097/00005650-200212000-00006

[45]   Pol, M.C., Buurman, B.M., de Vos, R. and de Rooij, S.E. (2011) Patient and Proxy Rating Agreements on Activities of Daily Living and the Instrumental Activities of Daily Living of Acutely Hospitalized Older Adults. Journal of the American Geriatrics Society, 59, 1554-1556.
http://dx.doi.org/10.1111/j.1532-5415.2011.03514.x

 
 
Top