Concern About Falling Is Associated With Gait Speed, Independently From Physical and Cognitive Function

Background Higher levels of concern about falling in older people have been associated with slower walking speed and an increased risk of falls. However, it is unclear whether this relationship is independent or confounded by other fall risk factors, such as physical and cognitive function. Objective The aim of this study was to examine the effects of concern about falling on gait speed, adjusted for physiological fall risk and cognitive function. Design This was an observational, cross-sectional study. Methods A total of 204 community-dwelling older people aged 70 years or older were recruited from 2 sites (Germany, n=94; Australia, n=110). Walking speed was measured over 6 m under 4 conditions: preferred speed, fast speed, speed while carrying a tray (functional dual task), and speed while answering a question (cognitive dual task). The Falls Efficacy Scale-International was used to assess concern about falling, the Physiological Profile Assessment was used to assess physiological fall risk, and the Digit Symbol Substitution Test and Trail Making Test were used to assess attention and executive function. Results Higher levels of concern about falling were associated with slower gait speed. Following adjustment for age, history of falls, and female sex, and further adjustment for physical and cognitive function, the association between concern about falling and walking speed remained significant, with a considerable effect size (standardized beta=0.180.08; P=.037). Limitations The use of walking speed as a sole measure of gait was a limitation of this study. Conclusions Gait speed, especially under dual-task conditions, was affected by concern about falling. Concern about falling was the strongest predictor of gait speed under all 4 conditions and should be included in routine geriatric assessments.