Racial/Ethnic Differences in the Longitudinal Effects of Fear of Falling on Falls

Introduction: Recent evidence suggests that the effects of fear of falling on falls may differ by race/ethnicity. This study investigated whether race/ethnicity (white, black, and Hispanic) moderated the longitudinal effects of fear of falling on the incidence of falling and having a repeated fall among community-dwelling older adults. Methods: We used data from 2011 to 2018 of the National Health and Aging Trends Study (NHATS). These included a total of 19,516 person-intervals from 5,113 respondents. Any self-reported fall in the past year was the outcome variable with baseline fear of falling as the predictor and race/ethnicity as the moderator. Covariates included self-reported sociodemographic information, probable depression, chronic conditions, functional impairment, pain, insomnia symptoms, the Clock Drawing Test, the Short Physical Performance Battery, and grip strength. Results: Among respondents who had no experience of falling at baseline, baseline fear of falling increased the odds of having a new onset of fall at 1-year follow-up significantly among blacks, compared to whites (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.44-2.38). No significant difference was found for Hispanics. Among respondents who already fell at baseline, baseline fear of falling increased the odds of having a repeated fall at 1-year follow-up significantly among Hispanics, compared to whites (OR = 1.91, 95% CI = 1.06-3.44). No significant difference was found for blacks. Conclusions: Clear evidence of racial/ethnic differences was found in the relationship between fear of falling and falls among community-dwelling older adults in the USA. Special attention should be paid to black older adults with a fear of falling but have not fallen down recently and Hispanics with fear of falling and have fallen in the past year. Readily available educational programs should be actively advertised to older adults to reduce the fear of falling, and at the same time, culturally tailored educational programs should be developed for older adults from racial/ethnic minority backgrounds.