title: Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention.
abstract: OBJECTIVE
  Previous cross-sectional studies have shown a correlation between falls and fear of falling, but it is unclear which comes first. Our objectives were to determine the temporal relationship between falls and fear of falling, and to see whether these two outcomes share predictors.
  
  
  METHODS
  A 20-month, population-based, prospective, observational study.
  
  
  METHODS
  Salisbury, Maryland. Each evaluation consisted of a home-administered questionnaire, followed by a 4- to 5-hour clinic evaluation.
  
  
  METHODS
  The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations. At baseline, subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher.
  
  
  METHODS
  Demographics, visual function, comorbidities, neuropsychiatric status, medication use, and physical performance-based measures were assessed. Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation, first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors.
  
  
  RESULTS
  Falls at baseline were an independent predictor of developing fear of falling 20 months later (odds ratio (OR) = 1.75; P <.0005), and fear of falling at baseline was a predictor of falling at 20 months (OR = 1.79; P <.0005). Women with a history of stroke were at risk of falls and fear of falling at follow-up. In addition, Parkinson's disease, comorbidity, and white race predicted falls, whereas General Health Questionnaire score, age, and taking four or more medications predicted fear of falling.
  
  
  CONCLUSIONS
  Individuals who develop one of these outcomes are at risk for developing the other, with a resulting spiraling risk of falls, fear of falling, and functional decline. Because falls and fear of falling share predictors, individuals who are at a high risk of developing these endpoints can be identified.
authors.affiliation: University of Rochester School of Medicine and Dentistry, New York, USA. susan_friedman@urmc.rochester.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Friedman
authors.forename: Beatriz
authors.initials: B
authors.lastname: Munoz
authors.forename: Sheila K
authors.initials: SK
authors.lastname: West
authors.forename: Gary S
authors.initials: GS
authors.lastname: Rubin
authors.forename: Linda P
authors.initials: LP
authors.lastname: Fried
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D005239:Fear / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015233:Models, Statistical; D011446:Prospective Studies; D012306:Risk; D011795:Surveys and Questionnaires