Self-perceived balance confidence is independently associated with any subsequent falls and injurious falls among community-dwelling older fallers: A prospective cohort study

Introduction: Balance confidence contributes to activity restriction, decline in physical function, and falls, potentially. This study aimed at examining whether balance confidence is a significant fall predictor independent of physical function measures in community-dwelling older adults. Methods: This was an observational cohort study. Self-perceived balance confidence was measured by the Activities-specific Balance Confidence scale (ABC) and the short form of it, ABC-6. Other potential predictors included gait speed, Five Times Sit-to-Stand Test, Physiological Profile Assessment (PPA), age, sex, cognition, depression, arthritis, body mass index, recurrent fall history, number of comorbidities, number of prescribed medications, and the use of walking aids. Fall occurrence and subsequent injuries were followed up trimonthly for 12 months. The association of the potential predictors with falls was examined with multivariable logistic regression analyses. Sensitivity analysis for their association with injurious falls in a year was performed. Results: 461 community-dwelling older adults with a fall history in the past year completed the 12-month follow-up (mean age 70.6±7.1 years, range 60–92 years; 81% females). Participants with high balance confidence (ABC score ≥76 and ABC-6 score ≥64) were less likely to fall in the subsequent year, independently of the physical function measures and other covariates (adjusted OR 0.51-0.57, 95%CI 0.30-0.97, p<0.05). Conclusion: Balance confidence is a significant fall predictor independent of physical function measures and other covariates in community-dwelling older adults with a history of falls. Future studies might investigate the causal effects of balance confidence on the risk of falling with randomized controlled trials.