Alignment between balance confidence and fall risk in later life: Has over-confidence been overlooked?

Abstract

Falls in later life have long been identified as an important public health problem worthy of investigation and intervention because they are preventable and are associated with excess disability and mortality. Interventions to prevent falls in older people have focused on physiological risk factors and psychological risk factors. Fear of falling is the most extensively studied and targeted psychological risk factor for falls. Less is known about the extent to which older adults might express higher balance confidence despite being at known high fall risk based on fall history. The present study examined older adults' self-reported balance confidence in the context of known fall risk, and determined the degree of alignment between their balance confidence and known fall risk. Based on this alignment, older adults were classified as timid (lower balance confidence and lower fall risk), congruent (lower confidence and higher risk, or higher confidence and lower risk), or over-confident (higher confidence and higher risk). In a sample of community dwelling adults aged 62 or older with a history of fall-related incidents (n = 329), between 26% and 42% of sample members were found to be over-confident, while less than 10% were classified as timid. Subjects aged less than 75 years old were more likely than their older counterparts to be categorised as over-confident, while the likelihood of over-confidence was not associated with gender or depressive symptom severity. Research, practice, and policy implications of the phenomena of alignment between balance confidence and known fall risk, and over-confidence, are discussed.