Associations of Demographic, Functional, and Behavioral Characteristics with Activity-Related Fear of Falling Among Older Adults Transitioning to Frailty


Address correspondence to Steven L. Wolf, PhD, Department of Rehabilitation Medicine, 1441 Clifton Road NE, Atlanta, GA 30322.


OBJECTIVES: To determine, in a cohort of older individuals transitioning to frailty (defined by Speechley and Tinetti, 1991) who have previously fallen, whether there are significant associations between demographic, functional, and behavioral characteristics and activity-related fear of falling, using both the Falls Efficacy Scale (FES) and the Activities-Specific Balance Confidence Scale (ABC).

DESIGN: Baseline cross-sectional analysis in a prospective cohort intervention study.

SETTING: Twenty independent senior living facilities in Atlanta.

PARTICIPANTS: Seventeen male and 270 female subjects (n = 287), age 70 and older (mean ± standard deviation, 80.9 ± 6.2), with Mini-Mental State Examination score ≥24, transitioning to frailty, ambulatory (with or without assistive device), medically stable, and having fallen in the past year.

MEASUREMENTS: Activity-related fear of falling was evaluated with the FES and ABC Scale. Because of the comparable data derived from each scale, associations with functional measures-related analyses were expressed using the latter. Depression was measured by Center for Epidemiological Studies Depression Scale. Functional measurements included timed 360° turn, functional reach test, timed 10-meter walk test, single limb stands, picking up an object, and three chair stands.

RESULTS: No statistically significant association was found between activity-related fear of falling and age. For the proposed activities, about half (ABC, 48.1%; FES, 50.1%) of the subjects were concerned about falling or showed lack of confidence in controlling their balance. A statistically significant inverse correlation was found between FES and ABC (r = −0.65; P < .001).

CONCLUSIONS: Activity-related fear of falling was present in almost half of this sample of older adults transitioning to frailty. The significant association of activity-related fear of falling with demographic, functional, and behavioral characteristics emphasizes the need for multidimensional intervention strategies to lessen activity-related fear of falling in this population.