Improved Fall-Related Efficacy in Older Adults Related to Changes in Dynamic Gait Ability

Abstract

Low fall-related efficacy is associated with the number and severity of future falls in older adults with balance disorders. The purpose of this study was to examine whether improvements in clinical measures of balance after an intervention program were associated with changes in efficacy. A prospective, nonexperimental, pretest-posttest design was used. Sixty-three people (43 men, 20 women; mean [±SD] age=76.6±4.9 years) with a history of at least 2 falls in the previous 12 months were enrolled between 2004 and 2008 to participate in a 12-week home exercise program. Balance deficits were identified using the Berg Balance Scale (BBS) and the Dynamic Gait Index (DGI), and participants were evaluated monthly. Hierarchical linear regression was used to assess the relationship between measures of balance (BBS and DGI) and efficacy (Falls Efficacy Scale) before intervention. A second model examined the relationship between changes in balance and changes in efficacy after participation in the program. Preintervention scores of efficacy were significantly associated with age, depression, and BBS and DGI scores. After controlling for age, depression, and strength (force-generating capacity), BBS and DGI scores together accounted for 34% of the variance in preintervention efficacy. Significant improvements were noted in efficacy, BBS and DGI scores, and depression after intervention. When controlling for preintervention efficacy and changes in depression, the changes in DGI and BBS scores together explained 11% of the variance in the change in fall-related efficacy; however, only DGI scores contributed uniquely. Limitations These results are tempered by the absence of a control group to examine the role of time on changes in efficacy. The results suggest that increased emphasis on mobility during rehabilitation leads to improved confidence to perform activities of daily living without falling.