Balance Confidence and Fear of Falling Avoidance Behavior Are Most Predictive of Falling in Older Adults: Prospective Analysis

Evidence suggests that there are several fall predictors in the elderly, including previous fall history and balance impairment. To date, however, the role of psychological factors have not yet been thoroughly vetted in conjunction with physical factors as predictors of future falls. The objective of this study was to determine which measures, physical and psychological, are most predictive of falling in older adults through a prospective cohort study. Included were sixty-four participants (age 72.2±7.2 years; 40 women, 24 men) with and without pathology (25 healthy, 17 with Parkinson’s disease, 11 with cerebrovascular accident, 6 with diabetes, and 5 with a cardiovascular diagnosis) participated. Participants reported fall history and completed physical-based measures (i.e., Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Self-Selected Gait Velocity (SSGV), Timed Up and Go Test (TUGT), Sensory Organization Test (SOT)) and psychological-based measures (i.e., Fear of Falling Avoidance Belief Questionnaire (FFABQ), Falls Efficacy Scale (FES), Activities-Specific Balance Confidence Scale (ABC)). Contact was made one year later to determine falls during the subsequent year (8 participants lost at follow-up). Using multiple regression, fall history, pathology, and all measures were entered as predictor candidates. Three variables were included in the final model, explaining 49.2% of the variance: ABC (38.7% of the variance), FFABQ (5.6% additional variance) and TUGT (4.9% additional variance).

In conclusion balance confidence was the best predictor of falling, followed by fear of falling avoidance behavior, and the TUGT. Neither fall history, presence of pathology, nor physical tests predicted falling. These findings suggest that participants may have had a better sense of their fall risk than a test that provides a snapshot of their balance.