Prevalence and factors influencing fear of falls in postmenopausal women with sarcopenia: A mixed study

Background Sarcopenia, a degenerative disorder of skeletal muscle associated with aging, is characterized by reduced muscle mass and diminished functional capacity. Postmenopausal women are particularly vulnerable to sarcopenia due to their naturally lower baseline muscle mass combined with significantly decreased estrogen levels after menopause, which further contributes to bone loss, osteoporosis, and sustained muscle atrophy. The condition develops when muscle mass and strength decline to critical thresholds. Statistics indicate that approximately 31% of postmenopausal women experience sarcopenia, which compromises both muscular strength and balance. These physical impairments not only increase actual fall risks but also trigger psychological fall fears. FOF refers to a mental state where individuals become anxious about falling during activities. Research reveals a prevalence of 69.2% FOF among community-dwelling seniors, peaking at over 90% in sarcopenia patients. Compared to men, female patients with sarcopenia often perceive health-threatening factors more acutely and tend to adopt protective or avoidance strategies, exacerbating FOF. This initiates a downward spiral: falls-fear-activity avoidance-deconditioning-heightened fall vulnerability, ultimately limiting daily functioning, raising injury risks, and severely impacting quality of life. Despite growing attention to fall-related fractures (FOFs) among older adults in recent years, significant gaps persist in research targeting postmenopausal women with sarcopenia. Current studies predominantly focus on quantitative analyses, lacking in-depth exploration of patients 'subjective experiences, underlying psychological mechanisms, and behavioral coping strategies. This study used a mixed approach, integrating quantitative and qualitative research designs, to systematically analyze the multidimensional causes of FOF and understand the current strategies of this group to cope with fall fear.The findings provide comprehensive empirical evidence for personalized intervention strategies, offer scientific guidance for clinical practitioners, and aim to reduce FOF incidence rates while effectively preventing falls and improving patients' quality of life. Methods In this mixed-methods study, we recruited postmenopausal women with sarcopenia from Shanxi Provincial People's Hospital through convenience sampling. We assessed patients' fall fear, balance ability, mobility capacity, and psychological state using questionnaires including a general information questionnaire, Fall Effectiveness Scale (FES-I), Berg Balance Scale (BBS), TUGT test, and Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression analysis was employed to explore factors influencing fall fear. Subsequently, 24 postmenopausal women with fall fear who completed the quantitative survey were randomly selected for paired semi-structured interviews. Colaizzi seven-step analysis method was used to analyze the collected data. Results Quantitative research findings revealed that the incidence of fall fear among postmenopausal women with sarcopenia was 58.1% (97/167). Binary logistic regression analysis demonstrated that anxiety (OR=1.267,95%CI=1.015-1.581) and prolonged TUGT test duration (OR=1.447,95%CI=1.168-1.792) were independent risk factors for fall fear, while the four limbs 'skeletal muscle index (OR=0.004,95%CI=0.000-0.229) and Berg balance ability (OR=0.853,95%CI=0.741-0.981) served as protective factors. Qualitative interviews identified three themes and twelve sub-themes, which included patients' perceptions of FOF, the impact of postmenopausal physiological and psychological changes on FOF, and coping strategies for FOF. Conclusion Postmenopausal women with sarcopenia experience dual physiological and psychological changes influenced by estrogen levels, which may increase the risk of fall-related fears. These fall-related fears primarily stem from multiple factors: misconceptions about falls, declining muscle function, reduced balance, mobility limitations, and anxiety. In this study, the main strategies for addressing fall-related fears among postmenopausal women with sarcopenia include early risk identification, developing fall prevention safety plans, and engaging in physical exercise. Future research should focus on developing targeted intervention strategies to alleviate fall-related fears in postmenopausal women with sarcopenia.