The impact of fear of falling on self-awareness of falls in community-dwelling older adults with type 2 diabetes

doi:10.3761/j.issn.0254-1769.2026.01.003

Abstract

Abstract:

Objective To investigate the impact and threshold effect of fear of falling on self-awareness of falls in community-dwelling older adults with type 2 diabetes，providing a basis for fall prevention. Methods A convenience sample of 250 older patients with type 2 diabetes from a community health center in Kunshan was surveyed between March and July 2025. Data were collected using a general information questionnaire，the Self-Awareness of Falls in Elderly Scale，and Fear of Falling Questionnaire-Reversed Scale. Multiple linear regression was used to analyze the impact of fear of falling on self-awareness of falls，followed by threshold effect analysis. Results A total of 245 valid questionnaires were collected，yielding a response rate of 98.0%. The mean score for fear of falling was（36.34 ± 11.46） points，and the self-awareness of falls score was（56.87 ± 15.47） points. Fear of falling independently explained 9.7% of the variance in self-awareness of falls. Fitting curve results revealed a nonlinear relationship between fear of falling and self-awareness of falls（P<0.001）. When the fear of falling score was below 32 points，self-awareness of falls decreased as the fear of falling score increased（P<0.05）. Conclusion Community-dwelling elderly patients with type 2 diabetes have a relatively high level of self-awareness of falls and a moderate level of fear of falling. A non-linear association exists between fear of falling and self-awareness of falls. When fear of falling is <32 points，it can be used as a starting point for psychological interventions to improve patients’ self-awareness of falls by alleviating fear of falling.

Key words: Aged, Type 2 Diabetes, Fear of Falling, Falls Self-Awareness, Threshold Effect, Nursing Care

摘要：

目的探讨跌倒恐惧对社区老年2型糖尿病患者跌倒警觉度的影响及阈值效应，为预防老年人跌倒提供依据。方法便利选取2025年3—7月昆山市某社区卫生服务中心250例老年2型糖尿病患者作为调查对象。采用一般资料调查表、老年人跌倒警觉度量表、修订版跌倒恐惧量表进行调查，通过分层线性回归探究跌倒恐惧对社区老年2型糖尿病患者跌倒警觉度的影响，并进行阈值效应分析。结果回收有效问卷245份，有效问卷回收率为98.00%。社区老年2型糖尿病患者跌倒恐惧得分为（36.34±11.46）分，跌倒警觉度得分为（56.87±15.47）分。分层线性回归分析结果显示，跌倒恐惧可独立解释社区老年2型糖尿病患者跌倒警觉度9.7%的变异度。拟合曲线结果提示，跌倒恐惧和跌倒警觉度呈非线性关系（P<0.001），跌倒恐惧得分<32分时，跌倒警觉度随跌倒恐惧得分的增加而降低（P<0.05）。结论社区老年2型糖尿病患者跌倒警觉度处于较高水平，跌倒恐惧呈中等程度，且跌倒恐惧与跌倒警觉度存在非线性关联，当跌倒恐惧<32分时，可将其作为心理干预切入点，通过缓解跌倒恐惧提升患者的跌倒警觉度。

关键词: 老年人, 2型糖尿病, 跌倒恐惧, 跌倒警觉度, 阈值效应, 护理

LU Qinyi, LU Chengqian, ZHAO Yafen, JIN Xueqin. The impact of fear of falling on self-awareness of falls in community-dwelling older adults with type 2 diabetes[J]. Chinese Journal of Nursing, 2026, 61(1): 23-29.

陆沁怡, 陆程倩, 赵亚芬, 金学勤. 跌倒恐惧对社区老年2型糖尿病患者跌倒警觉度的影响研究[J]. 中华护理杂志, 2026, 61(1): 23-29.

Figures/Tables 4

Table 1 Univariate analysis of general data and self-awareness of falls in elderly community-dwelling patients with type 2 diabetes（n=245）

Table 2 Assignment of independent variables

Table 3 Linear regression analysis of self-awareness of falls in elderly community-dwelling patients with type 2 diabetes（n=245）

Table 4 Results of threshold effect analysis between fear of falling and self-awareness of falls（n=245）

References 29

[1]	蔡佩萱, 梁怡青, 王晶晶, 等. 中青年2型糖尿病患者饮食行为依从性变化轨迹及影响因素分析[J]. 中华护理杂志, 2024, 59(13):1592-1599. DOI URL
	Cai PX, Liang YQ, Wang JJ, et al. Analysis of the trajectory of changes in dietary behavioral adherence in young and middle-aged patients with type 2 diabetes mellitus and the influencing factors[J]. Chin J Nurs, 2024, 59(13):1592-1599. DOI URL
[2]	姬春晖, 李月, 董正惠, 等. 远程饮食与运动干预在老年2型糖尿病合并肌少症患者中的应用研究[J]. 中华护理杂志, 2024, 59(21):2565-2571. DOI URL
	Ji CH, Li Y, Dong ZH, et al. A study of a tele-diet combined exercise intervention program in elderly patients with type 2 diabetes mellitus combined with sarcopenia[J]. Chin J Nurs, 2024, 59(21):2565-2571. DOI URL
[3]	Sun LN, Fu JL, Mu ZJ, et al. Association between body fat and sarcopenia in older adults with type 2 diabetes mellitus:a cross-sectional study[J]. Front Endocrinol, 2023,14:1094075.
[4]	章毅, 王欣格, 黎春常, 等. 7种运动训练对糖尿病周围神经病变患者平衡功能影响的网状Meta分析[J]. 中华护理杂志, 2022, 57(1):89-97. DOI URL
	Zhang Y, Wang XG, Li CC, et al. The effect of 7 different exercise training in balance function of patients with diabetic peripheral neuropathy:a network meta-analysis[J]. Chin J Nurs, 2022, 57(1):89-97.
[5]	Freire LB, Brasil-Neto JP, da Silva ML, et al. Risk factors for falls in older adults with diabetes mellitus:systematic review and meta-analysis[J]. BMC Geriatr, 2024, 24(1):201. DOI
[6]	鲍冠君, 罗烨, 刘苑菲, 等. 社区老年人跌倒风险感知量表的编制及信效度检验[J]. 护理学杂志, 2022, 37(24):9-13.
	Bao GJ, Luo Y, Liu YF, et al. Development of Fall Risk Perception Scale for Community-Dwelling Older Adults:reliability and validity testing[J]. J Nurs Sci, 2022, 37(24):9-13.
[7]	Shyu ML, Huang HC, Wu MJ, et al. Development and validation of the Self-Awareness of Falls in Elderly Scale among elderly inpatients[J]. Clin Nurs Res, 2018, 27(1):105-120. DOI URL
[8]	赵宏霞, 王衍富, 吕学瑞, 等. 老年2型糖尿病住院患者衰弱、认知功能与跌倒恐惧的相关性[J]. 中华老年多器官疾病杂志, 2022, 21(2):125-129.
	Zhao HX, Wang YF, Lü XR, et al. Correlation of frailty and cognitive function with fear of falling in the elderly inpatients with type 2 diabetes mellitus[J]. Chin J Mult Organ Dis Elder, 2022, 21(2):125-129.
[9]	Xiong WH, Wang D, Ren W, et al. The global prevalence of and risk factors for fear of falling among older adults:a systematic review and meta-analysis[J]. BMC Geriatr, 2024, 24(1):321. DOI
[10]	姚晶, 刘伟, 李娜, 等. 老年人跌倒警觉度研究进展[J]. 护理学杂志, 2023, 38(24):109-112.
	Yao J, Liu W, Li N, et al. Self-awareness of falls in the elderly:a literature review[J]. J Nurs Sci, 2023, 38(24):109-112.
[11]	《中国老年型糖尿病防治临床指南》编写组. 中国老年2型糖尿病防治临床指南(2022年版)[J]. 中国糖尿病杂志, 2022, 30(1):2-51.
	The Writing Group of the Clinical Guidelines for the Prevention and Treatment of Diabetes in the Elderly in China. Clinical guidelines for the prevention and treatment of type 2 diabetes in the elderly in China(2022 edition)[J]. Chin J Diabetes, 2022, 30(1):2-51.
[12]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation in quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[13]	Bower ES, Wetherell JL, Merz CC, et al. A new measure of fear of falling:psychometric properties of the Fear of Falling Ques-tionnaire Revised(FFQ-R)[J]. Int Psychogeriatr, 2015, 27(7):1121-1133. DOI URL
[14]	王蕾, 王颖, 鲁志卉, 等. 修订版跌倒恐惧问卷的汉化及信效度研究[J]. 护理研究, 2022, 36(7):1134-1138.
	Wang L, Wang Y, Lu ZH, et al. Study on the chinesination and its reliability and validity of the Fear of Falling Question-naire-Reversed(FFQ.R)[J]. Chin Nurs Res, 2022, 36(7):1134-1138.
[15]	谭铮可可, 杨丽, 唐雯桢, 等. 腹部大手术患者首次下床跌倒恐惧的潜在剖面分析及护理启示[J]. 中华护理杂志, 2024, 59(20):2479-2486. DOI URL
	Tan ZKK, Yang L, Tang WZ, et al. Fear of falling in the initial ambulation day among patients undergoing major abdominal surgery:latent profile analysis and nursing implications[J]. Chin J Nurs, 2024, 59(20):2479-2486.
[16]	赵宏霞. 老年2型糖尿病患者衰弱、认知功能与跌倒恐惧的相关性研究[D]. 大连: 大连医科大学, 2021.
	Zhao HX. Correlation between weakness,cognitive function and fear of falling in elderly patients with type 2 diabetes mellitus[D]. Dalian: Dalian Medical University, 2021.
[17]	吕磊, 车腾雨, 成杰, 等. 老年脑卒中住院病人跌倒警觉度现状及影响因素[J]. 护理研究, 2025, 39(11):1917-1923.
	Lü L, Che TY, Cheng J, et al. Status quo and influencing factors of fall awareness in hospitalized elderly patients with stroke[J]. Chin Nurs Res, 2025, 39(11):1917-1923.
[18]	孙海超, 路丰源, 张熙雅, 等. 老年人跌倒警觉度的概念分析[J]. 护理学杂志, 2025, 40(13):66-70,114.
	Sun HC, Lu FY, Zhang XY, et al. Conceptual analysis of fall alertness in the elderly[J]. J Nurs Sci, 2025, 40(13):66-70, 114.
[19]	邓潇, 李德威, 伍祯, 等. 农村老年高血压患者跌倒警觉度现状及影响因素研究[J]. 护理学杂志, 2024, 39(22):103-106,111.
	Deng X, Li DW, Wu Z, et al. Current status and influencing factors of fall alertness in older hypertensive patients in rural areas[J]. J Nurs Sci, 2024, 39(22):103-106,111.
[20]	Jung J, Kim MG, Kang YJ, et al. Vibration perception threshold and related factors for balance assessment in patients with type 2 diabetes mellitus[J]. Int J Environ Res Public Health, 2021, 18(11):6046. DOI URL
[21]	张海燕, 于卫华, 张利, 等. 2型糖尿病老年患者生活空间移动性受限风险预测模型研究[J]. 护理学报, 2023, 30(22):13-19. DOI
	Zhang HY, Yu WH, Zhang L, et al. Research on a risk prediction model for life-space mobility restriction in older adults with type 2 diabetes mellitus[J]. J Nurs (China), 2023, 30(22):13-19.
[22]	蒯春玲, 王晓宇, 舒宁波, 等. 老年糖尿病视网膜病变患者跌倒风险感知现状及影响因素分析[J]. 生命科学仪器, 2024, 22(4):164-166.
	Kuai CL, Wang XY, Shu NB, et al. Analysis of Perception of Fall Risk And Its Influencing Factors in Elderly Patients with Diabetic Retinopathy[J]. Life Sci Instrum, 2024, 22(4): 164-166.
[23]	张海燕, 于卫华, 张利, 等. 老年糖尿病患者心理痛苦与跌倒恐惧的相关性研究[J]. 军事护理, 2023, 40(10):5-8.
	Zhang HY, Yu WH, Zhang L, et al. Correlation between diabetes distress and fear of falling in elderly diabetes mellitus patients[J]. Mil Nurs, 2023, 40(10):5-8.
[24]	亓倩倩, 辛红菊, 周洲薇, 等. 老年综合征对老年2型糖尿病患者的躯体功能和跌倒风险的影响[J]. 中华全科医学, 2022, 20(3):424-427,502.
	Qi QQ, Xin HJ, Zhou ZW, et al. Effect of geriatric syndrome on physical function and fall risk in elderly patients with type-2 diabetes[J]. Chin J Gen Pract, 2022, 20(3):424-427,502.
[25]	Bayrak M, Kaşali K, Güner M, et al. Risk factors influencing fall risk in geriatric patients with type 2 diabetes:a comprehensive analysis[J]. Aging Male, 2025, 28(1):2469614. DOI URL
[26]	周白云, 马睿婕, 陆敏, 等. 社区老年糖尿病共病患者内在能力的潜在类别分析[J]. 护理学杂志, 2025, 40(3):6-11.
	Zhou BY, Ma RJ, Lu M, et al. Latent class analysis of intrinsic capacity among community-dwelling elderly diabetes mellitus patients with multimorbidity[J]. J Nurs Sci, 2025, 40(3):6-11.
[27]	张海燕, 于卫华, 张利, 等. 社区老年人跌倒风险感知潜在剖面分析及影响因素研究[J]. 军事护理, 2024, 41(10):52-56.
	Zhang HY, Yu WH, Zhang L, et al. Potential profile analysis and influencing factors of falls risk perception among elder adults in community[J]. Mil Nurs, 2024, 41(10):52-56.
[28]	de Oliveira Lima RA, Piemonte GA, Nogueira CR, et al. Efficacy of exercise on balance,fear of falling,and risk of falls in patients with diabetic peripheral neuropathy:a systematic review and meta-analysis[J]. Arch Endocrinol Metab, 2021, 65(2):198-211.
[29]	聂作婷, 陈龙, 曾凯, 等. 老年人跌倒风险感知研究现状及其对老年人主动跌倒预防的启示[J]. 中国全科医学, 2024, 27(19):2395-2400. DOI
	Nie ZT, Chen L, Zeng K, et al. Current status of research on fall risk perception and its implications for active fall prevention in older adults[J]. Chin Gen Pract, 2024, 27(19):2395-2400.