Fear of Falling and Balance Confidence in Older Adults With Type 2 Diabetes Mellitus: A Scoping Review

Type 2 diabetes mellitus is highly prevalent in older adults (≥65 years of age) and increases fall risk. Fear of falling and low balance confidence are reported in both fallers and nonfallers and can potentially be more debilitating than a fall itself. Therefore, the objective of this scoping review was to examine and map the current research evidence of balance confidence and fear of falling in older adults with type 2 diabetes. A search of CINAHL, EMBASE and PubMed was conducted. The search included MeSH terms and the key terms diabet* AND fear OR falls AND self-efficacy OR balance confidence. Inclusion criteria were 1) population: older adults (≥65 years of age) with type 2 diabetes; and 2) outcome measure: balance confidence or fear of falling. We included 21 studies: fear of falling (n=14); balance confidence (n=7). We categorized them into 4 themes: prevalence, severity, determinants and interventions. Determinants were further categorized into physical, psychosocial and health-related domains. Fear of falling and low balance confidence were highly prevalent and more severe in older adults with type 2 diabetes. Determinants of fear of falling and balance confidence occurred beyond the physical domain and the presence of diabetic peripheral neuropathy. Targeted group-based interventions (e.g. gait and balance training, tai chi, yoga) appear to be beneficial in reducing fear of falling and improving balance confidence. Future work is needed to generate best practices related to fear of falling and low balance confidence in older adults with type 2 diabetes.