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Fear of Falling, Attitudes Toward Aging, and Balance in Older Adults


Fear of falling (FoF) increases fall risk and is associated with functional problems. Identifying factors that predict or maintain FoF could improve fall prevention and functional ability for older adults. The relationship between FoF and attitudes toward aging, a potential predictor of FoF, is not known. Additionally, despite the well-documented relationship between falls and cognition, the neuropsychological correlates of FoF are not well-characterized. The current study aimed to evaluate the relationships among FoF, attitudes toward aging, and balance (Study 1), and characterize the neuropsychological correlates of FoF (Study 2).

Both studies were cross-sectional and included participants from a larger study. The short Falls Efficacy Scale International (FES-I) was used to measure FoF. Study 1 included 69 adults aged 65-83. Attitudes toward aging were assessed with the Age Implicit Association Test and the Attitudes to Ageing Questionnaire (AAQ). Balance was operationalized as postural sway and assessed with a force platform. The relationships among attitudes toward aging, FoF, and balance were examined with linear regression analyses. Study 2 was a secondary analysis of 136 adults aged 62-85. Processing speed, memory, executive function, working memory, anxiety, and depression were assessed with the NIH Toolbox Cognition Battery and PROMIS scales. The neuropsychological profile of FoF was examined using hierarchical linear regression analyses.

Study 1 did not find support for a significant relationship between postural sway and FoF or attitudes toward aging, nor between FoF and attitudes toward aging. Post hoc analyses revealed higher scores on the AAQ Psychological Growth subscale were associated with increased risk of FoF. Contrary to hypotheses, Study 2 found higher FoF was associated with better working memory and poorer episodic memory. Fear of falling was not significantly associated with executive function, processing speed, anxiety, or depression.

Findings suggest that postural sway may not be sensitive to balance problems associated with FoF and attitudes toward aging. Furthermore, FoF within the current sample may have represented a realistic appraisal of fall risk rather than excessive fear. Future studies should assess multiple balance components and differentiate realistic from excessive FoF. The associations of FoF with working memory and episodic memory deserve further study.

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