Assessing Fear of Falling Using the iconFES Mobile Application

• iconFES is a new app for the iPad that assesses fear of falling in older adults.
• iconFES records accurate data essential for assessing fall risk and creating fall prevention strategies, and trials also indicate that people find the app both simple and fun.

Fear of falling in older adults

Fear of falling often leads to a reduction in activity levels and community participation. Fear of falling may reflect a realistic appraisal of reduced functional abilities. However, fear of falling has also been associated with needless restriction in physical and social activities. This can have a substantial impact on a person’s quality of life.

Understanding a person’s fear of falling is necessary to properly determine their risk of falling as the two are reportedly linked. Our research has shown that fear of falling itself can increase the risk of falls independent of physiological fall risk, and is strongly associated with neurotic personality traits and depressive symptoms.

The Iconographical Falls Efficacy Scale (iconFES)

The Iconographical Falls Efficacy Scale (iconFES) is the first scale using pictures and including physically challenging activities. The use of pictures allows us to provide more detailed contextual elements to participants. For example, a person is very concerned about taking a bath but less concerned if there is a steady handrail to hold on to. A person’s level of concern about falls during a daily activity will most likely be influenced by the extent to which such environmental factors differ. The addition of pictures along with verbal phrases helps ensure all participants are envisaging the same situation when they answer the question in relation to their fear of falling.

iconFES has been used successfully in people with dementia. The iconFES is the first measure of fear of falling which compensates for reduced abstract abilities by using pictures to match the verbal descriptions. The iconFES response categories are presented as facial expressions as line drawings, which can facilitate completion of the scale and has been used successfully in people with dementia to assess mood.

Research translation into mobile apps

The transformation of our work into an app for the Apple iPad allows us to disseminate our knowledge and tools to more people across the world than previously possible. In order for health care to move forward, it is crucial to provide health professionals with up-to-date knowledge and resources to assist them in their clinical work. The app is designed for use by clinicians and doctors primarily and allow for quick and reliable assessment in clinical practice.

iconFES gives clinicians the opportunity to assess fear of falling more regularly in their older patients and for the results to be interpreted and shared with patients immediately. Furthermore, iconFES has promise as a treatment utility tool to identify activities that need guided exposure as part of a cognitive behavioural therapy program. In order to appropriately target older adults in falls prevention strategies, it is crucial to know a person’s level of fear of falling in different circumstances relative to their fall risk.

From a research point-of-view, advantages of using our apps assures highly reliable data as the data is entered just once (by the subject) and is saved verbatim for later analyses.

Older adults – regardless of whether they are tech-savvy or not – have been enjoying ‘having a go’ with the iPad. The large, vibrant screen makes the pictures more visible and the questions easier (and fun) to answer.

iconFES App specifications

Within the app, each user is able to individualise the settings. The settings for each app are accessible through the iPad settings.

• Low price
• Short (10 questions) and long (30 questions) form versions
• Easy to see high contrast images
• Available in a wide range of languages (a list we will keep updating through upgrades)
• Available for different living circumstances – people living in a house, in an apartment, in highly populated cities
• Immediate updates as research results become available, e.g. provision of normative values
• Results can be sent via email and synced with a computer via iTunes
• Validated by research - see link below

The iconFES has now been validated in research published in the Journals of Gerontology May 2013.

Here's what to do next:

1) Find out more:For further information you can find out more about the iconFES app development or more about NeuRA apps.

2) Contribute: Let us know what you think in the comments below. Have you used the iconFES in your work? Share your experiences with the profane community.

3) Share: If you know of someone who would find this article useful, please forward them a link.

4) Buy: Have an iPad and want to try for yourself? It's only £2.99/$4.99

About the Author

Kim Delbaere is a Research Fellow and Group Leader at Neuroscience Research Australia (www.neura.edu.au). Kim Delbaere is an emerging leading international researcher in the area of falls and fear of falling in older people. Her research has enhanced the understanding interrelationships between falls and various physiological, psychological and cognitive factors. Her future work focuses on finding a feasible solution to deliver self-management programs for falls prevention. The overall aim of her research group at NeuRA is to find a feasible solution which supports independent ageing, ideally in a home environment.