title: The role of postural instability/gait difficulty and fear of falling in predicting falls in non-demented older adults.
abstract: BACKGROUND
  Postural instability/gait difficulty (PIGD) and fear of falling (FoF) frequently co-exist, but their individual predictive values for falls have not been compared in aging. This study aims to determine both independent and combined effect of PIGD and FoF to falls in older adults without dementia.
  
  
  METHODS
  PIGD and other extrapyramidal signs were systematically assessed in 449 community-dwelling participants without Parkinson's disease (76.48±6.61 ys; 56.8% female) enrolled in this longitudinal cohort study. Presence of FoF was measured by a single-item question (Do you have a FoF?) and self-confidence by the Activities-specific Balance Confidence scale (ABC scale).
  
  
  RESULTS
  One hundred sixty-nine participants (38%) had an incident fall over a mean follow-up of 20.1±12.2months. PIGD was present in 32% and FoF in 23% of the participants. Both PIGD (adjusted hazard ratio (aHR): 2.28; p=0.016) and self-confidence (aHR: 0.99; p=0.040) predicted falls when entered simultaneously in the Cox model. However, presence of FoF (aHR: 1.99; p=0.021) and self-confidence (aHR: 0.98; p=0.006) predicted falls only in individuals with PIGD.
  
  
  CONCLUSIONS
  PIGD and FoF were associated with future falls in older adults without dementia but FoF was a fall's predictor only in individuals with PIGD.
authors.affiliation: Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA; Department of Clinical Neurosciences, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. Electronic address: gilles.allali@hcuge.ch.
authors.forename: Gilles
authors.initials: G
authors.lastname: Allali
authors.affiliation: Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA.
authors.forename: Emmeline I
authors.initials: EI
authors.lastname: Ayers
authors.affiliation: Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA; Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.
authors.forename: Roee
authors.initials: R
authors.lastname: Holtzer
authors.affiliation: Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA.
authors.forename: Joe
authors.initials: J
authors.lastname: Verghese
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D005239:Fear / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D009069:Movement Disorders / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D004856:Postural Balance
keywords: Aging; Extrapyramidal signs; Fall; Fear of falling; Postural instability/gait difficulty