Self-Reported Unsteadiness Predicts Fear of Falling, Activity Restriction, Falls, and Disability

Objective: To determine if self-reported unsteadiness during walking is associated with fear of falling (FOF), fear-related activity restriction, falls, and disability over 2 years in community-dwelling adults. Design: Data were obtained from the first 2 waves of The Irish Longitudinal Study on Ageing, a population-based study. Setting: Participants completed a home-based interview and a center-based health assessment at baseline and a home-based interview at 2 years follow-up. Participants: Community-dwelling adults aged >= 65 years, with Mini-Mental State Examination score >= 18 at baseline, and fully observed variables were included in the analyses (N = 1621). Measurements: Outcome variables were FOF, fear-related activity restriction, recurrent falls, and disability. Results: Unsteadiness was independently associated with an increased risk of all outcomes at follow-up after adjusting for sociodemographic variables, and physical, mental, and cognitive health (Incidence Rate Ratio [IRR] range 1.49-2.29; P < .05). All associations were attenuated after adjusting for usual gait speed but remained consistent in direction. The association was strongest for fear-related activity restriction [IRR = 1.82 (1.21-2.73); P < .01]. There was also evidence of an association between unsteadiness and an increased risk of activity restriction in adults who did not report FOF at baseline [IRR = 1.99 (1.10-3.61); P < .05]. Conclusions: Self-reported unsteadiness is independently associated with an increased risk of FOF, fear-related activity restriction, recurrent falls, and disability at follow-up. Self-reported balance/steadiness should be included in routine assessment of older adults especially those at risk of falls. As unsteadiness is modifiable, older adults should be targeted for balance-related training or medication review to minimize future risk of these outcomes. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.