Categorizing fear of falling using the survey of activities and fear of falling in the elderly questionnaire in a cohort of hospitalized older adults: A cross-sectional design

Background: Fear of falling is commonly assessed using the Activities-specific Balance Confidence Scale which is an instrument to measure balance confidence, based on the assumption that fear of falling is due to the absence of balance confidence. The “Survey of Activities and Fear of Falling in the Elderly” measures the concept of fear of falling more directly on a scale of 0.0 and 3.0 points. However, there are no valid cut-off points that might help practitioners to interpret “Survey of Activities and Fear of Falling in the Elderly” scores. The aim of this study was to identify such cut-off points and distinguish between low, moderate and high fear of falling, in relation to balance confidence. Method: In this cross-sectional study different cut-off point schemes for classifying fear of falling scores as low, moderate or high were compared with F-values in ANOVA using the cut-off point scheme as an independent variable and the balance confidence scores as a dependent variable. The analysis was performed using data from a cohort of 98 hospitalized older adults. Results: Using the Activities-specific Balance Confidence Scale as a reference tool, values of 0.6 and 1.4 were identified as optimal cut-off points for low, moderate and high fear of falling. Conclusions: This study was the first to systematically classify fear of falling using the “Survey of Activities and Fear of Falling in the Elderly”. This classification can assist health practitioners to interpret fear of falling score and guide clinical decision making. Registration: The study is registered with the German Clinical Trials Register (DRKS00010773, date of registration 2016/05/07, date of recruitment 2016/11/07).