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Balance Confidence and Fear of Falling Avoidance Behavior Are Most Predictive of Falling in Older Adults: Prospective Analysis

Merrill R. Landers, Sarrie Oscar, Jessica Sasaoka, Kyle Vaughn
DOI: 10.2522/ptj.20150184 Published 1 April 2016
Merrill R. Landers
M.R. Landers, PT, DPT, PhD, OCS, Department of Physical Therapy, University of Nevada, Las Vegas, 4505 Maryland Pkwy, Box 453029, Las Vegas, NV (USA).
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Sarrie Oscar
S. Oscar, BA, Department of Physical Therapy, University of Nevada, Las Vegas.
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Jessica Sasaoka
J. Sasaoka, BS, Department of Physical Therapy, University of Nevada, Las Vegas.
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Kyle Vaughn
K. Vaughn, BS, Department of Physical Therapy, University of Nevada, Las Vegas.
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Abstract

Background Evidence suggests that there are several fall predictors in the elderly population, including previous fall history and balance impairment. To date, however, the role of psychological factors has not yet been thoroughly vetted in conjunction with physical factors as predictors of future falls.

Objective The purpose of this study was to determine which measures, physical and psychological, are most predictive of falling in older adults.

Design This was a prospective cohort study.

Methods Sixty-four participants (mean age=72.2 years, SD=7.2; 40 women, 24 men) with and without pathology (25 healthy, 17 with Parkinson disease, 11 with cerebrovascular accident, 6 with diabetes, and 5 with a cardiovascular diagnosis) participated. Participants reported fall history and completed physical-based measures (ie, Berg Balance Scale, Dynamic Gait Index, self-selected gait speed, Timed “Up & Go” Test, Sensory Organization Test) and psychological-based measures (ie, Fear of Falling Avoidance Behavior Questionnaire, Falls Efficacy Scale, Activities-specific Balance Confidence Scale). Contact was made 1 year later to determine falls during the subsequent year (8 participants lost at follow-up).

Results Using multiple regression, fall history, pathology, and all measures were entered as predictor candidates. Three variables were included in the final model, explaining 49.2% of the variance: Activities-specific Balance Confidence Scale (38.7% of the variance), Fear of Falling Avoidance Behavior Questionnaire (5.6% additional variance), and Timed “Up & Go” Test (4.9% additional variance).

Limitations Falls were based on participant recall rather than a diary.

Conclusions Balance confidence was the best predictor of falling, followed by fear of falling avoidance behavior, and the Timed “Up & Go” Test. Fall history, presence of pathology, and physical tests did not predict falling. These findings suggest that participants may have had a better sense of their fall risk than with a test that provides a snapshot of their balance.

Footnotes

  • Dr Landers provided concept/idea/research design, project management, participants, data analysis, and facilities/equipment. All authors provided writing. Ms Oscar, Ms Sasaoka, and Mr Vaughn provided consultation (including review of manuscript before submission).

  • This study was approved by the Institutional Review Board of the University of Nevada, Las Vegas.

  • Received March 31, 2015.
  • Accepted August 9, 2015.
  • © 2016 American Physical Therapy Association
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Vol 96 Issue 4 Table of Contents
Physical Therapy: 96 (4)

Issue highlights

  • Confidence and Fear of Falling Avoidance Behavior in Older Adults
  • Reliability of the ECHOWS Tool
  • Functional Gait Assessment in Older Adults
  • Community-Based Exercise for People With Stroke
  • Knee Osteoarthritis and Promoting Exercise Adherence
  • Test Comparisons in Predicting Falls in Parkinson Disease
  • Scapular Position Using the Protractor Method
  • Physical Activity and Physical Fitness in Autism
  • Disability and Active Video Gaming
  • BNDF Genotype and Brain Function After Stroke
  • Electrodiagnostic Evaluation and Individuals With Volumetric Muscle Injury
  • Regenerative Rehabilitation and Advanced Technologies in Physical Therapy
  • Physical Therapists and Mechanotherapy
  • Translating Genomic Advances to Physical Therapist Practice
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Balance Confidence and Fear of Falling Avoidance Behavior Are Most Predictive of Falling in Older Adults: Prospective Analysis
Merrill R. Landers, Sarrie Oscar, Jessica Sasaoka, Kyle Vaughn
Physical Therapy Apr 2016, 96 (4) 433-442; DOI: 10.2522/ptj.20150184

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Balance Confidence and Fear of Falling Avoidance Behavior Are Most Predictive of Falling in Older Adults: Prospective Analysis
Merrill R. Landers, Sarrie Oscar, Jessica Sasaoka, Kyle Vaughn
Physical Therapy Apr 2016, 96 (4) 433-442; DOI: 10.2522/ptj.20150184
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  • Predictors of Reduced Frequency of Physical Activity 3 Months After Injury: Findings From the Prospective Outcomes of Injury Study
  • Effects of Locomotor Exercise Intensity on Gait Performance in Individuals With Incomplete Spinal Cord Injury
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Subjects

  • Geriatrics
    • Falls and Falls Prevention
  • Psychosocial
    • Fear-Avoidance
  • Diagnosis/Prognosis
    • Diagnosis/Prognosis: Other
  • Neurology/Neuromuscular System
    • Balance

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