Does Alignment between Balance Confidence and Fall-Risk Predict Future Falls in Older Adults?

Objective: Low balance confidence in older adults has been used as a target for fall prevention interventions to reduce fear of falling. Less is known about how balance confidence is related to known fall-risk based on past fall history, and how this relationship may be associated with future falls. We found in previous work that 30-40% of older subjects reported higher confidence despite being at higher fall-risk, which may expose them to further falls. Accordingly, we explored how alignment between balance confidence and fall-risk is associated with prospectively reported falls. Methods: Activity-specific Balance Confidence (ABC) and fall history data were gathered from adults aged 60 or older during interviews for larger studies. Alignment was categorized as: Congruent (moderate ABC score and moderate fall-risk based on fall history), Timid (low ABC score and low fall-risk), or Overconfident (high ABC score and high fall-risk). Participants then kept daily fall logs for up to 56 weeks of follow-up. Cox survival models were evaluated using time to reported first fall as the outcome measure.

Results: There were 264 subjects (67% female; mean age = 79+6.9 years). Most (68%) were Congruent, 28% were Overconfident, and 3% were Timid. Congruent subjects experienced their first fall significantly sooner than Overconfident subjects (Wald = 6.12, p = .013); no other contrasts were different. Conclusion: Subjects reporting higher balance confidence despite higher fall-risk experienced delays in subsequent falls compared to others. This finding suggests that increasing confidence in older adults with known higher fall-risk may delay future falls.