Background and Purpose: 

Fear of falling is common in older adults and greatly increases their risk for falls. Interventions aimed at reducing fall risk in older adults with a fear of falling typically aim to improve balance. However, this approach has limited success, and the idea that balance performance impacts fall risk in this population is largely based on research in the general older adult population. The aim of this study was to assess whether presence of fear of falling modifies the relationship between balance performance and future falls in a sample of nationally representative older adults.

Methods: 

We analyzed data from 5151 community-dwelling Medicare beneficiaries (65 years or older) from waves 1 and 2 of the National Health and Aging Trends Study. In this prospective cohort study, balance performance and fear of falling were recorded during wave 1, while a report of a fall was recorded during wave 2 (1-year follow-up). The interplay between fear of falling, balance performance, and fall risk was analyzed using logistic regression with fear of falling as a moderating variable while controlling for common confounding variables.

Results: 

Twenty-seven percent of participants reported a fear of falling at wave 1 while 32.7% reported a fall at wave 2. Reduced balance performance was significantly associated with increased future fall likelihood in individuals with and without a fear of falling (P = .008). Further, the presence of fear of falling did not modify the association between balance and future falls (P = .749). Fear of falling was associated with increased future fall likelihood independent of balance performance (P < .001).

Conclusion: 

These findings demonstrate that fear of falling did not modify the relationship between balance performance and future fall risk, thus suggesting that balance training is appropriate to reduce falls in older adults with a fear of falling. However, balance training alone may be insufficient to optimally reduce falls in older adults with a fear of falling, as the presence of this fear increased future fall risk independent of balance performance.

中文翻译：

---

对跌倒的恐惧、平衡能力和未来跌倒之间的相互作用：来自国家健康和老龄化趋势研究的数据

背景和目的： 

害怕跌倒在老年人中很常见，这大大增加了他们跌倒的风险。旨在降低害怕跌倒的老年人跌倒风险的干预措施通常旨在改善平衡。然而，这种方法的成功有限，并且平衡表现影响该人群跌倒风险的想法主要基于对一般老年人群的研究。本研究的目的是评估在全国具有代表性的老年人样本中，对跌倒的恐惧是否会改变平衡表现与未来跌倒之间的关系。

方法： 

我们分析了国家健康和老龄化趋势研究第一波和第二波中 5151 名社区居民医疗保险受益人（65 岁或以上）的数据。在这项前瞻性队列研究中，在第 1 波期间记录了平衡表现和对跌倒的恐惧，而在第 2 波（1 年随访）期间记录了跌倒报告。使用逻辑回归分析对跌倒的恐惧、平衡能力和跌倒风险之间的相互作用，以对跌倒的恐惧作为调节变量，同时控制常见的混杂变量。

结果： 

27% 的参与者报告在第 1 波中害怕跌倒，而 32.7% 的参与者报告在第 2 波中跌倒。无论是否害怕跌倒，平衡能力下降与未来跌倒可能性增加显着相关 (P = .008 ) 。此外，对跌倒的恐惧的存在并没有改变平衡与未来跌倒之间的关联（P = .749）。对跌倒的恐惧与未来跌倒可能性的增加相关，与平衡能力无关 ( P < .001)。

结论： 

这些发现表明，对跌倒的恐惧并没有改变平衡表现与未来跌倒风险之间的关系，因此表明平衡训练适合减少害怕跌倒的老年人的跌倒。然而，单独的平衡训练可能不足以最佳地减少有跌倒恐惧的老年人的跌倒，因为这种恐惧的存在会增加未来跌倒的风险，而与平衡表现无关。