RC Grant Findings: Validation of Fall-Related Psychological Measures Among Independent-Living Older Adults

Falls are a major public health problem that can lead to a host of physical and psychological issues including fear of falling, low falls efficacy, and poor balance confidence. Although the physical consequences of falls are easy to identify and measure, assessing fall-related psychological issues is a challenge. Consequently, a recent review of the measurement of psychological outcomes of falling (Jorstad, Hauer, Becker, & Lamb, 2005) highlighted the need to compare measurement properties of several fall-related psychological instruments.

Purpose

The purpose of this investigation was to examine the construct validity of the Falls Efficacy Scale-International (FES-I), Activities-specific Balance Confidence (ABC), modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), and Consequences of Falling (CoF) scales for use in an independent-living older adult population.

Methods

Participants were 133 independent-living older adults between the ages of 51 and 95 years (M age = 74.4 yr, SD = 9.4) who volunteered to participate in a community-based falls risk screening. Measures included a demographic questionnaire, comprehensive falls risk screening instrument, FES-I, ABC, mSAFFE, and CoF scales, Physical Activity Scale for the Elderly (PASE), Expanded Timed Get-Up-and-Go Test (ETGUG), and the SF-36.

Analysis/Results

The FES-I, ABC, mSAFFE, and CoF exhibited significant moderate to large correlations with each other (r = .40 to r = -.68); small to moderate correlations with SF-36 (r = -.19 to r = .51), ETGUG (r = .28 to r = -.45), and PASE scores (r = -.17 to r = .34); and adequate internal consistency reliability (á = .84 to á = .94). The ABC yielded the largest correlations with the PASE, ETGUG, and one of the SF-36 subscales, and was the only instrument that discriminated between fallers and non-fallers, t (1, 131) = -2.76, p = .007, and significantly predicted total falls risk, R2 = .26, â =-.42, p < .01.

Conclusions

Collectively, results from this study provide additional psychometric evidence to support the use of the FES-I, ABC, mSAFFE, and CoF scales among independent-living older adults and suggest that the ABC may be the most suitable fall-related psychological measure to predict total falls risk among this population. Findings from this research can aid researchers and healthcare professionals in identifying those older adults in the community who experience fall-related psychological difficulties and in designing interventions to improve fall-related self-efficacy to ultimately prevent future falls and enhance HRQL.