Predictors of Incident Fear of Falling in Community-Dwelling Older Adults

Abstract

Objectives: Fear of falling (FoF) is common in older people and may lead to physical decline, disability, poor quality of life, and falls. Several risk factors for FoF have been identified in cross-sectional studies, but evidence on predictors of its incidence is scarce. We investigated the latter in community-dwelling older people undergoing a comprehensive geriatric assessment at baseline and after a 2-year follow-up.

Design: Longitudinal study.

Setting and participants: Convenience sample of community-dwelling people aged ≥60 years evaluated in an Irish university hospital.

Methods: Participants were evaluated at baseline (August 2007-May 2009) and after a 2-year follow-up. FoF was measured using the Modified Falls Efficacy Scale. Predictors of incident FoF at 2 years were investigated.

Results: At baseline, there were 563 participants (69% female, mean age 73 years). Among individuals that were not fearful at baseline, 105 (18.7%) developed FoF (incident FoF) after a median follow-up of 2.1 years. Individuals reporting incident FoF were older at baseline (P < .001), had worse performance in balance and physical function tests, and more frequently needed a walking aid (P < .001). Anxiety (P = .012) and depressive symptoms (P < .001) were more prevalent, as well as self-reported previous falls (P < .001). In multivariate analysis, older age, walking aid use, and a higher burden of depressive symptoms at baseline were predictors of incident FoF.

Conclusions and implications: Almost a fifth of older adults using a walking aid and reporting depressive symptoms at baseline developed FoF after 2 years. These identifiable prodromal factors could help design FoF prevention strategies.

Keywords: Fear of falling; balance; depression; falls; older people.