Validating Falls Efficacy and Balance Confidence Scales as Windows Into Real-Time Fall Anxiety in Older Adults

Fear of falling (FOF) is a common concern among older adults that can affect balance control. The Falls Efficacy Scale-International (FES-I) and the Activities-specific Balance (ABC) scale, while commonly used for assessing FOF, were originally validated for measuring concern about falling and balance confidence during imagined activities. This study aimed to validate the use of FES-I and ABC as measures of fall-related state anxiety during unpredictable balance challenges by examining their relationship with skin conductance levels (SCLs) as a measure of psychophysiological state anxiety. Additionally, we aimed to compare state anxiety responses during sudden balance perturbations between older adults with high versus low concern about falls.

Sixteen community-dwelling and ambulatory older adults (mean age, 70.29 ± 5.31 years) were exposed to 3 unpredictable trip perturbations. Outcomes included FES-I and ABC, Subjective Units of Distress Scale (SUDS, measuring state anxiety), and SCL. The Wilcoxon signed rank test compared SCL before and after perturbations. Spearman's correlations analyzed relationships between SCL change and FES-I and ABC scores. The Mann-Whitney U test compared SUDS between participants with low (FES-I <23) and high (FES-I ≥23) concern about falls.

SCL significantly increased from pre- to post-trip perturbation (P = .03), indicating perturbation-induced state anxiety. This increase correlated positively with both FES-I (rho = 0.62, P = .01) and ABC (rho = -0.59, P = .02) scores. Subjective Units of Distress Scale scores differed significantly (P = .01) between older adults with high vs low concern for falls.

Results suggest that FES-I and ABC scores are related to perturbation-induced state anxiety in older adults during balance challenges. Additionally, older adults with high concern about falls report higher levels of subjective state anxiety during these challenges. These findings provide initial evidence for the criterion validity of these clinical scales in relation to fall-related state anxiety. Further investigations with larger cohorts encompassing a wider range of falls efficacy and balance confidence levels are warranted.