Increased Concern Is Protective for Falls in Chinese Older People: The Chopstix Fall Risk Study

Background. Chinese older people have approximately half the risk of falling as their white counterparts, but no studies to date have explained why such a disparity exists. Methods. A total of 692 Chinese and 764 white community-dwelling older people participated in a multicohort study conducted in Taiwan, Hong Kong, and Australia. Baseline measurements included sociodemographic, psychological, and physical measures; concern about falling (Falls Efficacy Scale-International scores); and physical activity levels. Falls were monitored prospectively for 12-24 months. Results. The standardized annual fall rates for the 3 Chinese cohorts were 0.26 +/- 0.47 in Taiwan, 0.21 +/- 0.57 in Hong Kong, and 0.36 +/- 0.80 in Australia, which were significantly lower than that of the white cohort at 0.70 +/- 1.15. The fall rates for the Taiwan and Hong Kong cohorts were also significantly lower than that of the Australian Chinese cohort. The difference in fall rates was not due to better physical ability in the Chinese cohorts. However, the Chinese cohorts did more planned activity and expressed more concern about falling. Negative binomial regression analysis revealed a significant Cohort x Falls Efficacy Scale-International score interaction. After adjusting for this interaction, Falls Efficacy Scale-International scores, other predictors, and confounders, the incidence rate ratios comparing the cohorts were no longer statistically significant. Conclusions. Low fall rates in Chinese cohorts appear to be due to increased concern about falling as manifest in high Falls Efficacy Scale-International scores. These findings suggest that the Chinese cohorts are more likely to adapt their behaviors to lessen fall risk and that such adaptations are partially lost in Chinese people who have migrated to a "Westernized" country.