PTOTOtherJournal of geriatric physical therapy (2001)2022

Differences in Balance Confidence, Fear of Falling, and Fall Risk Factors Among White and Black Community-Dwelling Older Adults.

Allison A Bay, Smrithi Ramachandran, Liang Ni and 2 others

PMID 35981334

WHAT IT FOUND

In 84 high-functioning older adults, Black participants had objectively worse fall risk markers but reported less fear of falling than White participants.

Race and gait speed predicted fear, but the sample was too small to explain why White adults fall more often.

Key findings

01Black participants had slower fast gait speeds and lower cognitive scores than White participants, yet White participants reported significantly greater subjective fear of falling.

02In the final statistical model for fear of falling, race, forward gait speed, and physical quality of life were significant predictors, with White race associated with greater fear.

03The study did not find the higher fall rates in White adults seen in larger national surveys, likely because this sample was small and matched for sociodemographic factors.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTs

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What it does not show

The sample was small (84 participants) and had low statistical power (0.632), limiting the reliability of the findings. Fear of falling was measured with a single, unvalidated item rather than a comprehensive scale like the FES-I. The participants were highly educated and high-functioning, which limits generalizability to more diverse or impaired populations. Fall rates were based on self-report, which is prone to error, and the study did not replicate the higher fall rates in White adults seen in larger national studies. As a secondary analysis, it could not account for all potential confounders, and the directionality of associations remains unclear.

Declared interests

The authors declared no conflicts of interest. The work was supported by non-US government and US government (non-PHS) research grants.

The easy way to misread this

Do not conclude that Black older adults are at lower risk for falls or that their fear of falling is misplaced. This small, highly educated sample did not reflect the higher fall incidence seen in larger national studies for White adults, and the objective risk factors (gait, cognition) were actually worse in the Black participants.

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