can lead an individual to avoid activities he or she can perform, is strongly associated with falling and fall risk. Although White older adults fall more often, Black older adults have more fall risk factors. The purpose of this study was to investigate factors that explain fear of falling and differences between White and Black community-dwelling older adults in fear of falling, balance confidence, and fall risk factors. Methods: Using a cross-sectional, retrospective design, 84 community-dwelling older adults (mean age [SD] = 69.0 [5.2], range: 55-80; White, n = 37, 44%; Black, n = 47, 56%, M/F = 20/64) were assessed. Assessments were conducted in a laboratory for human studies. Fall history and risk factors, and subjective fear of falling, were collected. The Montreal Cognitive Assessment (MoCA), Activities-Specific Balance Confidence (ABC) score, preferred, backward, and fast Gait Speed, Short Form-12 Physical and Mental Component Scores, fear of falling rating scale, and demographics questionnaires were administered. Analyses included a proportional odds logistic regression model to examine which factors predicted ABC score and which factors were associated with subjective fear of falling, 1-way analysis of variance for continuous variables, the Fisher exact test for categorical variables, and the Mann-Whitney-Wilcoxon test for ordinal variables. Results: Black participants had significantly fewer years of education (P = .007), lower MoCA scores (P = .002), and slower fast gait speed (P = .032) than White participants. Black participants reported less subjective fear of falling (P = .043). In the final ABC model (Akaike information criterion 208.26), lower ABC scores were predicted by White race, slower preferred and fast gait speeds, and worse Short Form-12 Mental Composite Scores. Discussion: Despite Black participants demonstrating typical characteristics of higher fall risk including lower cognitive scores, slower gait speed, and lower ABC scores, Black participants reported fewer falls. Understanding racial differences is an important factor in fear of falling and balance confidence. Conclusion:Reasons for racial differences should be examined further in fear of falling and balance confidence to facilitate the development of patient-centered falls prevention physical therapy programs.

Background Falling among older adults is common and can cause chronic health complications. This study investigated differences between White and Black community-dwelling older adults in fall history, fear of falling, and indicators of fall risk.Methods All assessments and analyses were conducted in a clinical laboratory at Emory University in the Department of General Medicine and Geriatrics on 84 diverse community-dwelling older adults (White, n=37; Black, n=47). Statistical analyses included one-way ANOVA for continuous variables, the Fisher exact test for categorical variables, the Mann-Whitney-Wilcoxon test for ordinal variables, and an ordinal logistic regression model to examine which factors predicted fear of falling. Measures included fall history, fear of falling, and fall risk indicators. The Montreal Cognitive Assessment, Activities-Specific Balance Confidence Score, Gait Speed, Short Form 12 Physical Component Score and Mental Component Score, fear of falling and quality of life rating scales and demographics questionnaires were administered.Results Falls history was not significantly different between groups. Black participants had significantly fewer years of education (p=.007), lower MoCA scores (p=0.002), and slower fast gait speed (p=0.032) than White participants. However, Black participants reported significantly less fear of falling (p=0.043). Race (Black/White) (p=<0.001), sex (p=0.028), preferred gait speed (p=0.036), and a dichotomous variable of use of assistive device for walking (p=0.023) were significant predictors of fear of falling in the logistical model.Conclusions These factors may explain the observed differences in fear of falling observed between white and black groups in this study. This work offers an explanation of possible factors related to the well-documented yet poorly understood fact that while Black older adults have more risk factors for falling, White older adults tend to fall more frequently and are more afraid of falling.