FEAR OF FALLING AND FALL-RELATED EFFICACY IN RELATIONSHIP TO FUNCTIONING AMONG COMMUNITY-LIVING ELDERS

Background. The relationships of fear of falling and fall-related effi cacy with measures of basic and instrumental activities of daily livin g (ADL-IADL) and physical and social functioning were evaluated in a c ohort of community-living elderly persons. Methods. Sociodemographic, medical, psychological, and physical performance (e.g., gait speed, ti med hand function) measures were administered, during an in-home asses sment, to a probability sample of 1,103 residents of New Haven, Connec ticut, who were greater than or equal to 72 years of age. Falls and in juries in the past year, fear of falling, and responses to the Falls E fficacy Scale were also ascertained. The three dependent variables inc luded a 10-item ADL-IADL scale, an 8-item social activity scale, and a scale of relative physical activity level. Results. Among cohort memb ers, 57% denied fear of falling whereas 24% acknowledged fear but deni ed effect on activity; 19% acknowledged avoiding activities because of fear of falling. Twenty-four percent of recent fallers vs 15% of nonf allers acknowledged this activity restriction(chi(2) = 13.1; P <.001). Mean fall-related efficacy score among the cohort was 84.9 (SD 20.5), 79.8 (SD 23.4), and 88.1 (SD 17.9) among fallers and nonfallers, resp ectively (p less than or equal to .0001). Fall-related efficacy proved a potent independent correlate of ADL-IADL (partial correlation = .26 5, p <.001); physical (partial correlation = .234, p < .001); and soci al (partial correlation = .088, p < .01), functioning in multiple regr ession models after adjusting for sociodemographic, medical, psycholog ical, and physical performance covariates as well as history of recent falls and injuries. Fear of falling was only marginally related (p = .05) with ADL-IADL functioning and was not associated with higher leve l physical or social functioning. Conclusions. The strong independent association between self-efficacy and function found in this study sug gests that clinical programs in areas such as prevention, geriatric ev aluation and management, and rehabilitation should attempt simultaneou sly to improve physical skills and confidence. Available knowledge of the factors influencing efficacy should guide the development of these efficacy-building programs.