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    • SQ 22536 Then we demonstrated the major

    2018-11-05

    Then, we demonstrated the major role of frailty in the relationship between falling and social participation. The construction of the frailty SQ 22536 (Fried et al., 2001; Santos-Eggimann et al., 2009) was based on its physical component. In this manner, frailty and falling were very close constructs. They shared similar risk factors, such as mobility disorders or bone density, and they had similar consequences in terms of disability or mortality. Moreover, we showed that they had similar consequences in terms of social participation. Thus, it may be difficult to distinguish between the two concepts and to identify a specific impact of falling (Nowak & Hubbard, 2009). However, our analyses showed that the continuity in or disengagement from social activities was due to a long-term process that was amplified by health events, rather than by the falls themselves. In this stress proliferation process, falls can also be considered secondary stressors in the relationship between frailty and social participation; fallers indeed exhibited lower odds of long-term social participation than non-fallers, and this effect was even more marked among fallers with initial frailty than among fallers classified as non-frail or pre-frail. Our study included both middle-aged and older people and revealed, after controlling for age, significant effects of falling on social participation and on social support. Although the objective of our paper was not to distinguish the differential effects of falling among age groups, we also tested the interaction effect between falling and age (not shown), which was not significant. There was evidence that the circumstances of falls are different for middle-aged and active people, who are more often affected by outdoor falls and falls during social or physical activities, than for older and frail people, who fall more frequently at home (Li et al., 2006). Such studies, and our own findings, have highlighted the necessity to take into account criteria other than age for analysing the consequences of fall events. Finally, while social support is often described as buffering the stressful effect of life events (Smith & Christakis, 2008; Thoits, 1995; Thoits, 2011), we did not find a similar result for the relationship between falling and social participation. Our results differed from previous studies that showed that social relationships (Mortimore et al., 2008) or social support (Kempen et al., 2003; Kempen, Scaf-Klomp, Ranchor, Sanderman, & Ormel, 2001) buffered the effect of fall-related injuries on the recovery process. In addition to the differences in the measurements of falling and social dimensions, the strong interaction between falling and frailty may also explain this difference, as falls were signs of the frailty process, which causes a progressive and irreversible reduction of social activities. The increased social support provided to fallers may, therefore, be aimed at addressing their losses in mobility and functional health, but it was not able to alleviate the social disengagement. This study has several limitations. First, we used the existing measures from the SHARE survey and were not able to add some measures that may be more appropriate for estimating the impact of falling. For example, we could not explore the stressful characteristics of this event or the coping strategies of the respondents. Moreover, the reports of falls did not correspond to validated and recommended assessments. Falls were to be reported over a period of six months, along with other physical symptoms, such as dizziness and urinary incontinence. The Prevention of Falls Network Europe (PROFANE) recommended that the question of whether the respondents experienced a fall during the past year should be asked (Lamb, Jörstad-Stein, Hauer, & Becker, 2005). Consequently, the prevalence of falls in the SHARE survey was significantly lower than that in other epidemiological studies in community-dwelling older people. However, the relationships between falls and physical indicators were consistent with previous findings. Another limitation was the small number of follow-up cases and the difference in time intervals between waves. These analyses should be replicated with surveys performed at shorter time intervals and/or with a larger number of follow-up cases to distinguish between the short- and long-term effects of falling on different life spheres.