Strength and Balance as Determinants of Falls-Related Confidence in Community-Dwelling Older Adults
Poster #: 093
Session/Time: B
Author:
Shannon Prakash, BS
Mentor:
Brittany Samulski DPT, PhD
Research Type: Clinical Research
Abstract
INTRODUCTION:
Fear of falling has been identified as a strong and independent predictor of fall risk in community-dwelling older adults, in some cases, exceeding the predictive value of cognitive status.1 Reduced falls-related confidence, often termed "fear of falling," if associated with activity restriction, decreased quality of life, and increased likelihood of future falls. While psychosocial factors clearly play a role, it remains unclear whether physical impairments, such as weakness in the lower limbs or impaired balance, directly contribute to reduced confidence. Clarifying these relationships is essential for designing interventions that can be tailored toward cognitive-behavioral strategies, physical rehabilitation, or a hybrid approach. The aim of this secondary analysis was to identify whether leg strength and balance measures predict falls-related confidence as measured by the Modified Falls Efficacy Scale (MFES) in community-dwelling older adults.
METHODS:
A secondary analysis was performed using deidentified data from a community-based fall risk assessment program. The dataset comprised 166 participants (70±7years,67% female). Each participant completed the long-form Physiological Profile Assessment (PPA), Montreal Cognitive Assessment (MoCA), Modified Falls Efficacy Scale (MFES), and five 20-foot overground walking trials on a pressure-sensitive walkway at both preferred and maximal gait speeds.
RESULTS:
A binomial logistic regression was conducted to examine whether lower extremity strength (ankle dorsiflexion, knee extension, knee flexion), standing balance (measures of static and dynamic balance such as sway on floor and foam with eyes open and closed, as well as maximal balance range and co-stability), along with covariates (age, sex, fall history), predicted falls-related confidence status on the MFES (low concern vs. elevated concern). The full model was statistically significant, χ2(9,166) = 52.489, p<.001, indicating that stronger quadriceps (B=-0.082, SE=0.034, Wald=5.920, p=.015; OR=0.921, 95% CI [0.862, 0.984]) and greater balance range (B=-0.020, SE=0.006, Wald=10.122, p=.00; OR=0.980, 95% CI [0.968, 0.992]) were protective against elevated concern, while older age (B=-0.112, SE=0.032, Wald=12.098, p<.001; OR=0.894, 95% CI [0.840, 0.952]) was associated with reduced falls-related confidence. Ankle dorsiflexion strength, knee flexion strength, costability, static standing balance measures (sway on floor and foam with eyes open and closed), fall history, and biological sex were not significant predictors in the final model. The final model demonstrated good fit (Nagelkerke R2= .377; Hosmer-Lemeshow p=.754) and correctly classified 76.5% of cases, with high specificity (89.2% for low-concern individuals) but moderate sensitivity (50.9% for elevated-concern individuals).
CONCLUSION:
Findings suggest that falls-related confidence is tied to both physical capacity and aging, with quadriceps strength and dynamic balance emerging as key protective factors. Older adults may accurately perceive their fall risk, as reduced confidence aligns with decrements in lower limb strength and balance. Therefore, interventions should not only target physical performance through strength and balance training, but also address self-efficacy related to these tasks. A comprehensive approach that integrates physical rehabilitation with confidence-building strategies may be most effective for reducing fear of falling and subsequent fall risk in older adults.
Fear of falling has been identified as a strong and independent predictor of fall risk in community-dwelling older adults, in some cases, exceeding the predictive value of cognitive status.1 Reduced falls-related confidence, often termed "fear of falling," if associated with activity restriction, decreased quality of life, and increased likelihood of future falls. While psychosocial factors clearly play a role, it remains unclear whether physical impairments, such as weakness in the lower limbs or impaired balance, directly contribute to reduced confidence. Clarifying these relationships is essential for designing interventions that can be tailored toward cognitive-behavioral strategies, physical rehabilitation, or a hybrid approach. The aim of this secondary analysis was to identify whether leg strength and balance measures predict falls-related confidence as measured by the Modified Falls Efficacy Scale (MFES) in community-dwelling older adults.
METHODS:
A secondary analysis was performed using deidentified data from a community-based fall risk assessment program. The dataset comprised 166 participants (70±7years,67% female). Each participant completed the long-form Physiological Profile Assessment (PPA), Montreal Cognitive Assessment (MoCA), Modified Falls Efficacy Scale (MFES), and five 20-foot overground walking trials on a pressure-sensitive walkway at both preferred and maximal gait speeds.
RESULTS:
A binomial logistic regression was conducted to examine whether lower extremity strength (ankle dorsiflexion, knee extension, knee flexion), standing balance (measures of static and dynamic balance such as sway on floor and foam with eyes open and closed, as well as maximal balance range and co-stability), along with covariates (age, sex, fall history), predicted falls-related confidence status on the MFES (low concern vs. elevated concern). The full model was statistically significant, χ2(9,166) = 52.489, p<.001, indicating that stronger quadriceps (B=-0.082, SE=0.034, Wald=5.920, p=.015; OR=0.921, 95% CI [0.862, 0.984]) and greater balance range (B=-0.020, SE=0.006, Wald=10.122, p=.00; OR=0.980, 95% CI [0.968, 0.992]) were protective against elevated concern, while older age (B=-0.112, SE=0.032, Wald=12.098, p<.001; OR=0.894, 95% CI [0.840, 0.952]) was associated with reduced falls-related confidence. Ankle dorsiflexion strength, knee flexion strength, costability, static standing balance measures (sway on floor and foam with eyes open and closed), fall history, and biological sex were not significant predictors in the final model. The final model demonstrated good fit (Nagelkerke R2= .377; Hosmer-Lemeshow p=.754) and correctly classified 76.5% of cases, with high specificity (89.2% for low-concern individuals) but moderate sensitivity (50.9% for elevated-concern individuals).
CONCLUSION:
Findings suggest that falls-related confidence is tied to both physical capacity and aging, with quadriceps strength and dynamic balance emerging as key protective factors. Older adults may accurately perceive their fall risk, as reduced confidence aligns with decrements in lower limb strength and balance. Therefore, interventions should not only target physical performance through strength and balance training, but also address self-efficacy related to these tasks. A comprehensive approach that integrates physical rehabilitation with confidence-building strategies may be most effective for reducing fear of falling and subsequent fall risk in older adults.