Background: Activity-specific cautiousness refers to the degree of extra attention paid to performing a task out of concern for falling. Such behavior is often seen in older adults and could be related to balance performance. Fear of falling, which represents fall-related anxiety, could also possibly be associated with both cautiousness and balance. The aim of this study was to investigate whether there is an association between activity-specific cautiousness and balance performance and how the association could be affected by fear of falling.
Method: Sixty-five community-dwelling older adults participated in the study and went through six balance performance tests, including maximum voluntary sway range, lowest chair height to raise, and timed near-tandem stance, one-leg stance, sit-to-stand for five repetitions, and up-and-go. The Fall Efficacy Scale International (FES-I) was used to assess the degree of activity-specific cautiousness. The level of fear of falling was assessed by a 5-point Likert scale, based on which subjects were classified into three groups, NO-Fear (no fear at all), LOW-Fear (a little bit), and HIGH-Fear (moderate, quite a lot, extreme fear). Between-group differences were examined by one-way ANOVA. The data of the six actual balance tasks were transformed into a performance index by principal-components analysis and used in the Pearson correlation to determine its association with the FES-I score in the three groups individually. Fisher’s z test was then used to compare the between-group difference in correlation coefficients.
Result: The three groups did not differ significantly in age, sex, or previous history of falling. The NO-Fear group had significantly lower FES-I scores than either the LOW- or HIGH-Fear group (p < .001). The NO-Fear group also performed significantly better than the other two groups in timed near-tandem stance and sit-to-stand for 5 repetitions (p < .001). For the association between cautiousness and balance performance, significant correlations were found in the LOW- (r = .66) and HIGH-Fear (r = .81) groups but not in the NO-Fear group (r = .18). All the between-group differences in the correlation coefficient of cautiousness and balance performance reached significance (p < .001).
Discussion and Conclusion: The study showed increased strength of correlation between degree of cautiousness and balance performance with increasing fear of falling in older adults. Fear of falling has been shown to be related to poor balance performance. A greater fear of falling might lead to greater self-imposed restriction in activity, which in turn could lead to poorer balance and consequently even greater fear of falling. Such a vicious circle might explain why stronger association between cautiousness and balance performance was found in elders with greater fear of falling. Different associations between activity-specific cautiousness and balance performance in relation to fear of falling should be taken into consideration when assessing and planning fall-prevention programs.