86 Fear of Falling as Measured by the Falls Efficacy Scale International Indicates Gait and Balance Abnormalities in Community Dwelling Older People

Abstract

Background Falls are common in community dwelling older people, and gait and balance abnormalities (GABAb) are a key modifiable risk factor, through strength and balance training. In addition, there is a strong relationship between fear of falling (FoF) and GABAb, though Falls Efficacy Scale-International version (FES-I) scores have never been examined in this context. Our aim was to determine whether FoF, as measured by the FES-I, is associated with GABAb, as determined by commonly used gait and balance tests. Methods Consecutive patients attending our community falls prevention service completed FES-I questionnaires, and had Gait Speed (GS), Five Times Sit to Stand (FTSTS) and Timed Up and Go (TUG) tests assessed as part of a multifactorial falls prevention assessment. Cut-offs for falls risk are provided in the table. Sensitivity and specificity values for a 16-item FES-I cut-off score of 23.5 (>23 signifying significant FoF) were evaluated using the area under a receiver operating characteristic curve (AUROC), along with positive and negative likelihood ratios (LR+/LR-). Results There were 991 participants, 352 male, 639 female, mean age 74.5 years, mean FES-I score 28.7 and 57.0% had experienced at least one fall in the previous year. Gait and balance test scores were moderately associated with FoF per FES-I ≥23.5 as shown in the table. Specificities and sensitivities for all three are similar to commonly used diagnostic tests such as exercise testing versus coronary angiography for coronary artery disease. Test AUROC 95% Confidence intervals Sensitivity Specificity LR+ LR-Gait speed (<0.8 m/s) 0.77 0.74, 0.80 81% 55.2% 1.8 0.34 TUG (>14 s) 0.78 0.74, 0.81 87.1% 50% 1.74 0.26 FTSTS (>15s) 0.80 0.78, 0.83 82.9% 62.3% 2.2 0.27 Conclusions FoF as measured by the FES-I is associated with scores on commonly used gait and balance tests that indicate a high risk of falling. This study highlights the potential of using FES-I as a screening tool to identify community dwelling older adults at risk of falling who may benefit from strength and balance training rather than relying on physical tests that are rarely performed outside falls clinics and physiotherapy departments. This application may have utility both in opportunistic individual screening and community screening programmes. [ABSTRACT FROM AUTHOR]