title: Fear of falling and its association with life-space mobility of older adults: a cross-sectional analysis using data from five international sites.
abstract: fear of falling (FOF) is a major health concern among community-dwelling older adults that could restrict mobility.
  
  
  
  to examine the association of FOF with life-space mobility (i.e. the spatial area a person moves through in daily life) of community-dwelling older adults from five diverse sites.
  
  
  
  in total, 1,841 older adults (65-74 years) were recruited from Kingston, Canada; Saint-Hyacinthe, Canada; Tirana, Albania; Manizales, Colombia and Natal, Brazil. FOF was assessed using the Fall Efficacy Scale-International (FES-I total score), and the life space was quantified using the Life-Space Assessment (LSA), a scale that runs from 0 (minimum life space) to 120 (maximum life space).
  
  
  
  the overall average LSA total score was 68.7 (SD: 21.2). Multiple-linear regression analysis demonstrated a significant relationship of FOF with life-space mobility, even after adjusting for functional, clinical and sociodemographic confounders (B = -0.15, 95% confidence interval (CI) -0.26 to -0.04). The FOF × site interaction term was significant with a stronger linear relationship found in the Canadian sites and Tirana compared with the South American sites. After adjusting for all confounders, the association between FOF with LSA remained significant at Kingston (B = -0.32, 95% CI -0.62 to -0.01), Saint-Hyacinthe (B = -0.81, 95% CI -1.31 to -0.32) and Tirana (B = -0.57, 95% CI -0.89 to -0.24).
  
  
  
  FOF is an important psychological factor that is associated with reduction in life space of older adults in different social and cultural contexts, and the strength of this association is site specific. Addressing FOF among older adults would help improve their mobility in local communities, which in turn would improve social participation and health-related quality of life.
authors.affiliation: School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Auais
authors.affiliation: Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Alvarado
authors.affiliation: Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Guerra
authors.affiliation: Faculty of Health Sciences, Universidad de Caldas, Manizales, Colombia.
authors.forename: Carmen
authors.initials: C
authors.lastname: Curcio
authors.affiliation: School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Freeman
authors.affiliation: Faculty of Medicine, Institute of Public Health, Ministry of Health, Tirana, Albania.
authors.forename: Alban
authors.initials: A
authors.lastname: Ylli
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Guralnik
authors.affiliation: School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
authors.forename: Nandini
authors.initials: N
authors.lastname: Deshpande
mesh_terms: D000058:Accidental Falls; D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000523:psychology*; D000415:Albania; D001938:Brazil; D002170:Canada; D003105:Colombia; D003430:Cross-Sectional Studies; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D011788:Quality of Life; D058992:Social Participation; D011795:Surveys and Questionnaires
keywords: community mobility; falls efficacy; fear of falling; international; life-space mobility; older people; site-related differences; study