title: Balance Confidence and Fear of Falling Avoidance Behavior Are Most Predictive of Falling in Older Adults: Prospective Analysis.
abstract: BACKGROUND
  Evidence suggests that there are several fall predictors in the elderly population, including previous fall history and balance impairment. To date, however, the role of psychological factors has not yet been thoroughly vetted in conjunction with physical factors as predictors of future falls.
  
  
  OBJECTIVE
  The purpose of this study was to determine which measures, physical and psychological, are most predictive of falling in older adults.
  
  
  METHODS
  This was a prospective cohort study.
  
  
  METHODS
  Sixty-four participants (mean age=72.2 years, SD=7.2; 40 women, 24 men) with and without pathology (25 healthy, 17 with Parkinson disease, 11 with cerebrovascular accident, 6 with diabetes, and 5 with a cardiovascular diagnosis) participated. Participants reported fall history and completed physical-based measures (ie, Berg Balance Scale, Dynamic Gait Index, self-selected gait speed, Timed "Up & Go" Test, Sensory Organization Test) and psychological-based measures (ie, Fear of Falling Avoidance Behavior Questionnaire, Falls Efficacy Scale, Activities-specific Balance Confidence Scale). Contact was made 1 year later to determine falls during the subsequent year (8 participants lost at follow-up).
  
  
  RESULTS
  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: Activities-specific Balance Confidence Scale (38.7% of the variance), Fear of Falling Avoidance Behavior Questionnaire (5.6% additional variance), and Timed "Up & Go" Test (4.9% additional variance).
  
  
  CONCLUSIONS
  Falls were based on participant recall rather than a diary.
  
  
  CONCLUSIONS
  Balance confidence was the best predictor of falling, followed by fear of falling avoidance behavior, and the Timed "Up & Go" Test. Fall history, presence of pathology, and physical tests did not predict falling. These findings suggest that participants may have had a better sense of their fall risk than with a test that provides a snapshot of their balance.
authors: M.R. Landers, PT, DPT, PhD, OCS, Department of Physical Therapy, University of Nevada, Las Vegas, 4505 Maryland Pkwy, Box 453029, Las Vegas, NV (USA). merrill.landers@unlv.edu.
authors: Merrill R
authors: MR
authors: Landers
authors: S. Oscar, BA, Department of Physical Therapy, University of Nevada, Las Vegas.
authors: Sarrie
authors: S
authors: Oscar
authors: J. Sasaoka, BS, Department of Physical Therapy, University of Nevada, Las Vegas.
authors: Jessica
authors: J
authors: Sasaoka
authors: K. Vaughn, BS, Department of Physical Therapy, University of Nevada, Las Vegas.
authors: Kyle
authors: K
authors: Vaughn
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D001362:Avoidance Learning; D002318:Cardiovascular Diseases / Q000503:physiopathology; D016022:Case-Control Studies; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000503:physiopathology; D005080:Exercise Test; D005239:Fear; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000503:physiopathology; D004856:Postural Balance / Q000502:physiology*; D020521:Stroke / Q000503:physiopathology