Characterization of physical health variables across fall risk appraisal groups: a cross-sectional study

Fall risk appraisal (FRA) integrates perceived fall risk (levels of fear of falling) and physiological fall risk (static balance). Established literature has defined cut-offs for four groups (congruent, incongruent, irrational, and rational), but characterization of these groups is limited to separate studies evaluating physical activity, body composition, and fall history. This study aims to characterize physical health measures in a large sample of older adults and evaluate differences between each maladaptive group (congruent, incongruent, irrational) and the adaptive (rational) group.

The sample included 381 low-income older adults (age = 74.3 ± 7.1 years; 87.7% female) from diverse backgrounds. Age, body mass index (BMI), physical activity measured through accelerometry, dynamic balance measured through the Timed Up and Go test, lower limb power measured through the 30-second chair stand test, and handgrip strength were compared across groups distinguished by perceived and physiological fall risk.

The characterization of a large and diverse sample of low-income older adults revealed a majority with maladaptive FRA. Those in the congruent group presented with greater age, BMI, and decreased physical activity, dynamic balance, lower limb power, and handgrip strength. However, those with physiological deficits but low perceived fall risk (incongruent) outperformed in physical health measures than those without physiological deficits and high fear of falling (irrational). Older adults with greater fear of falling and better static balance (congruent) show worse physical health than older adults with less fear of falling and worse static balance.

This study examines the physical health of a large group of community-dwelling older adults based on differences in fear of falling and static balance. The results reveal the greater significance of fear of falling in affecting physical health than the presence of physiological balance deficits. It further validates that FRA differentiates older adults with differences in physiological physical health and reveals the significance of applying fall risk appraisal to practice and providing tailored recommendations that decrease fall risk. Additionally, it strengthens the argument for tailored interventions to address perceived fall risk alongside physiological exercise and physical activity.

This study used data collected from a clinical trial registered on ClinicalTrials.gov on March 21, 2023 (NCT05778604).