The role of postural instability/gait difficulty and fear of falling in predicting falls in non-demented older adults

Introduction: Postural instability/gait difficulty (PIGD) and fear of falling (FoF) frequently co-exist, but their individual predictive values for falls have not been compared in aging. This study aims to determine both independent and combined effect of PIGD and FoF to falls in older adults without dementia. Methods: PIGD and other extrapyramidal signs were systematically assessed in 449 community-dwelling participants without Parkinson's disease (76.48 +/- 6.61 ys; 56.8% female) enrolled in this longitudinal cohort study. Presence of FoF was measured by a single-item question (Do you have a FoF?) and self-confidence by the Activities-specific Balance Confidence scale (ABC scale). Results: One hundred sixty-nine participants (38%) had an incident fall over a mean follow-up of 20.1 +/- 12.2 months. PIGD was present in 32% and FoF in 23% of the participants. Both PIGD (adjusted hazard ratio (aHR): 2.28; p = 0.016) and self-confidence (aHR: 0.99; p = 0.040) predicted falls when entered simultaneously in the Cox model. However, presence of FoF (aHR: 1.99; p = 0.021) and self-confidence (aHR: 0.98; p = 0.006) predicted falls only in individuals with PIGD. Conclusions: PIGD and FoF were associated with future falls in older adults without dementia but FoF was a fall's predictor only in individuals with PIGD. (C) 2016 Elsevier Ireland Ltd. All rights reserved.