Abstract
BackgroundRisk for falls in older adults has been associated with falls efficacy (self-perceived confidence in performing daily physical activities) and postural balance, but available evidence is limited and mixed. We examined the interaction between falls efficacy and postural balance and its association with future falls. We also investigated the association between falls efficacy and gait decline.MethodsFalls efficacy, measured by the Modified Falls Efficacy Scale (MFES), and standing postural balance, measured using computerized posturography on a balance board, were obtained from 247 older adults with a falls-related emergency department visit. Six-month prospective fall rate and habitual gait speed at 6 months post baseline assessment were also measured.ResultsIn multivariable proportional odds analyses adjusted for potential confounders, falls efficacy modified the association between postural balance and fall risk (interaction P = 0.014): increasing falls efficacy accentuated the increased fall risk related to poor postural balance. Low baseline falls efficacy was strongly predictive of worse gait speed (0.11 m/s [0.06 to 0.16] slower gait speed per IQR decrease in MFES; P < 0.001).ConclusionOlder adults with high falls efficacy but poor postural balance were at greater risk for falls than those with low falls efficacy; however, low baseline falls efficacy was strongly associated with worse gait function at follow-up. Further research into these subgroups of older adults is warranted.Trial registrationClinicalTrials.gov identifier: NCT01713543.
Highlights
Risk for falls in older adults has been associated with falls efficacy and postural balance, but available evidence is limited and mixed
When adjusted for covariates, there was no significant association between fall risk and Modified Falls Efficacy Scale (MFES), velocity-ML (IQR-OR, 1.00 [CI, 0.77 to 1.29]; P = 0.98) or velocity-AP measures (IQR-OR, 1.05 [CI, 0.82 to 1.36]; P = 0.69)
When MFES level was high, greater center of pressure (CoP) velocity-AP was closely associated with greater fall risk; this association weakened with decreasing MFES levels (Fig. 1)
Summary
Risk for falls in older adults has been associated with falls efficacy (self-perceived confidence in performing daily physical activities) and postural balance, but available evidence is limited and mixed. We examined the interaction between falls efficacy and postural balance and its association with future falls. We investigated the association between falls efficacy and gait decline. Low falls efficacy, defined as low selfperceived confidence in engaging in activities of daily living without falling, and impaired postural balance are. Our study aimed to examine the associations of falls efficacy, postural balance, and their interaction with fall risk (defined as the number of incident falls over a 6-month period) in a sample of older adults with fallsrelated ED visits. To further clarify the clinical significance of falls efficacy, we examined its association with future gait limitations
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