The Dynamic Interplay of Objective and Subjective Balance and Subsequent Task Performance: Implications for Fall Risk in Older Adults

Abstract

Introduction. Falls occur in daily life when an activity results in a loss of balance that is too great to recover from. Our purpose in this study was to examine how fall risk differentiates the dynamic interplay of objective and subjective balance on a given day and subsequent task performance on that day. Methods. For 30 consecutive days, following a baseline fall risk assessment, 41 older adults (56% female, Age M = 75.22, SD = 6.75) self-assessed balance and task performance using a smartphone. The Activity-specific Balance Confidence scale measured subjective balance. Postural sway and chair-stand performance were measured within a smartphone using accelerometry. Data were analyzed using multilevel random coefficient models. Results. Tests of heterogeneity in level one residuals showed day-to-day variability in balance confidence and postural sway to be greater in individuals with higher fall risk at baseline. Baseline fall risk differentiated how the interplay of balance confidence and postural sway on a given day related to chair-stand performance on that day. For those with higher fall risk, on days that balance confidence was higher, greater postural sway was followed by greater chair-stand performance. Discussion / Conclusion. Findings indicate that older adults, especially those with higher fall risk, may be unaware of subtle fluctuations in balance, which could lead to engaging in activities that exceed the capacity to maintain balance at that moment. Fall prevention efforts should address older adults’ understanding of and responses to fluctuations of physical function in daily life.

Overestimation of Balance Ability Among Older Adults at Risk for Falls

“…The average mean physical performance scores for “Unaware” adults were generally considered normal when compared to fall risk cutoff scores for each performance test used on the STEADI. This supports current evidence that older adults who are unaware of their elevated fall risk may engage in behaviors that exceed their physical abilities (Mejia et al, 2023). Additional research studies that focus on mechanisms of falling may provide useful information in understanding their fall risk.…”

“…A deeper understanding of an older adult's perception of their balance and whether it aligns or misaligns with their fall risk has implications for approaches to lowering future fall risk through appropriate intervention. For example, older adults who are unaware of their elevated fall risk may engage in behaviors that exceed their physical abilities or to not engage in fall prevention behaviors (Mejia et al, 2023).…”