The Interplay Between Fear of Falling, Balance Performance, and Future Falls: Data From the National Health and Aging Trends Study.

Background and purpose: Fear of falling is common in older adults and greatly increases their risk for falls. Interventions aimed at reducing fall risk in older adults with a fear of falling typically aim to improve balance. However, this approach has limited success, and the idea that balance performance impacts fall risk in this population is largely based on research in the general older adult population. The aim of this study was to assess whether presence of fear of falling modifies the relationship between balance performance and future falls in a sample of nationally representative older adults.

Methods: We analyzed data from 5151 community-dwelling Medicare beneficiaries (65 years or older) from waves 1 and 2 of the National Health and Aging Trends Study. In this prospective cohort study, balance performance and fear of falling were recorded during wave 1, while a report of a fall was recorded during wave 2 (1-year follow-up). The interplay between fear of falling, balance performance, and fall risk was analyzed using logistic regression with fear of falling as a moderating variable while controlling for common confounding variables.

Results: Twenty-seven percent of participants reported a fear of falling at wave 1 while 32.7% reported a fall at wave 2. Reduced balance performance was significantly associated with increased future fall likelihood in individuals with and without a fear of falling ( P = .008). Further, the presence of fear of falling did not modify the association between balance and future falls ( P = .749). Fear of falling was associated with increased future fall likelihood independent of balance performance ( P < .001).

Conclusion: These findings demonstrate that fear of falling did not modify the relationship between balance performance and future fall risk, thus suggesting that balance training is appropriate to reduce falls in older adults with a fear of falling. However, balance training alone may be insufficient to optimally reduce falls in older adults with a fear of falling, as the presence of this fear increased future fall risk independent of balance performance.