Differences in Balance Confidence, Fear of Falling, and Fall Risk Factors Among White and Black Community-Dwelling Older Adults

• Authors: Allison A Bay, Emory University; Smrithi Ramachandran, Emory University; Liang Ni, Emory University; Todd Prusin, Emory University; Madeleine Hackney, Emory University
• Journal Title: Journal of Geriatric Physical Therapy
• Volume: Volume 46, Number 2
• Publisher: Academy of Geriatric Physical Therapy, APTA | 2023-04-01, Pages 122-131
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1519/JPT.0000000000000364
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Nursing
• Keywords: Aged; Female; Humans; Cross-Sectional Studies; Fear; Postural Balance; Retrospective Studies; Risk Factors; White People; Black People; Male; Middle Aged; Aged, 80 and over; Accidental Falls

Abstract

Background and Purpose: Falling among older adults is common and can cause chronic health complications. Fear of falling, a lasting concern about falling that can lead an individual to avoid activities he or she can perform, is strongly associated with falling and fall risk. Although White older adults fall more often, Black older adults have more fall risk factors. The purpose of this study was to investigate factors that explain fear of falling and differences between White and Black community-dwelling older adults in fear of falling, balance confidence, and fall risk factors. Methods: Using a cross-sectional, retrospective design, 84 community-dwelling older adults (mean age [SD] = 69.0 [5.2], range: 55-80; White, n = 37, 44%; Black, n = 47, 56%, M/F = 20/64) were assessed. Assessments were conducted in a laboratory for human studies. Fall history and risk factors, and subjective fear of falling, were collected. The Montreal Cognitive Assessment (MoCA), Activities-Specific Balance Confidence (ABC) score, preferred, backward, and fast Gait Speed, Short Form-12 Physical and Mental Component Scores, fear of falling rating scale, and demographics questionnaires were administered. Analyses included a proportional odds logistic regression model to examine which factors predicted ABC score and which factors were associated with subjective fear of falling, 1-way analysis of variance for continuous variables, the Fisher exact test for categorical variables, and the Mann-Whitney-Wilcoxon test for ordinal variables. Results: Black participants had significantly fewer years of education (P =.007), lower MoCA scores (P =.002), and slower fast gait speed (P =.032) than White participants. Black participants reported less subjective fear of falling (P =.043). In the final ABC model (Akaike information criterion 208.26), lower ABC scores were predicted by White race, slower preferred and fast gait speeds, and worse Short Form-12 Mental Composite Scores. Discussion: Despite Black participants demonstrating typical characteristics of higher fall risk including lower cognitive scores, slower gait speed, and lower ABC scores, Black participants reported fewer falls. Understanding racial differences is an important factor in fear of falling and balance confidence. Conclusion: Reasons for racial differences should be examined further in fear of falling and balance confidence to facilitate the development of patient-centered falls prevention physical therapy programs.