PREDICTIVE MODELS FOR FEAR OF FALLING AMONG INNER CITY MINORITY COMMUNITY-DWELLING OLDER ADULTS: COMPARISON BETWEEN TWO INSTRUMENTS. Ahmed Y. Barhameen; Roberta A. Newton* Physical Therapy, Temple University, Philadelphia, PA PURPOSE: In primarily minority community-dwelling older adults, the current study aimed to: 1) Examine, the associations between participant demographics, selected balance and functional mobility measures with FOF, and 2) Identify and compare the predictors of FOF measured by these tools: One Question FOF (1QFOF), and Activity-specific Balance Confidence Scale (ABC). BACKGROUNDS/SIGNIFICANCE: Fear of falling (FOF) can have detrimental effects on physical function and quality of life in the elderly population. The relationship between an elder's FOF and actual balance ability and functional mobility is not known nor has this relationship been examined in older adults from different cultural backgrounds. Many tools, based on different constructs, have been developed to measure this phenomenon. Understanding the multi-dimensional nature of FOF may help practitioners use the most appropriate assessment tool and to develop better intervention strategies to reduce FOF in those who have fallen and those elders who have not fallen. SUBJECTS: The sample consisted of 102 community dwelling older adults. The average age was 75.46 ± 8 years (range, 60-91). Ninety two percent of the subjects were minorities by race (80% African-American, 8% Asian and 4% other racial categories). METHODS AND MATERIALS: This study was a descriptive, correlational and exploratory study that was achieved by secondary data analysis. FOF was measured by two commonly used tools, 1QFOF and the ABC Scale. Subjects received a sociodemographic and health status questionnaire, and were assessed by the Berg Balance Scale (BBS), Multi-directional Reach Test (MDRT), the Timed Up & Go Test (TUG), and Gait Stability Ratio (GSR). ANALYSES: Univariate and multivariate analysis were used to examine the associations between select demographics, balance ability variables (BBS and MDRT) and functional mobility variables (TUG and GSR) and both FOF tools. ROC (Receiver Operating Characteristic) curve was used to determine the cut score for the ABC scale. RESULTS: The majority of subjects in this study (85%) had no history of falls in the three months prior to data collection. The average BBS score was 48 ± 7 (range: 7 - 56, max. = 56). For the MDRT, subjects scored an average of 7.4 inches ± 3.1 in forward direction, 3.7 ± 2.3 inches in backward direction, and approximately 6.0 inches in both right and left directions (± 2.9, 2.3 inches, respectively). In terms of functional mobility, subjects scored an average of 15.9 ±7.8 seconds (range, 6.6 - 54.4 sec) to complete the TUG test. The average GSR score was 2.1 ± 0.6 steps per meter (range, 1.3 - 5.1steps/meter). These values are similar to published values. The univariate analysis revealed that almost all of the balance and mobility measures were significantly associated with the ABC tool. Conversely, few of the balance and mobility measures were associated with the 1QFOF. The multivariate analysis revealed eight predictors of FOF as measured by the ABC tool (total BBT score, 3 tasks of the BBS and 4 demographic factors); and three predictors when 1QFOF was used (2 tasks of the BBS and 1 component of the MDRT). The only item that existed in both models was item #10 of the BBS (turn to look behind over left & right shoulder). A score of 79 was the best cut-off point for the ABC to predict fear versus no fear (area under ROC curve = 0.69, specificity = 72.72; specificity = 66.67). CONCLUSIONS: Race did not appear to be an important factor that affects FOF, balance ability or functional mobility among community-dwelling older adults. Although the 1QFOF and the ABC Scale purport to evaluate FOF, the pattern of association between predictors for the ABC and between the predictors for the 1QFOF is different. This study strengthens the hypothesis that the ABC scale and the 1QFOF measure different domains of the FOF construct. FUNDING SOURCE: In part from Temple University Research Fund KEYWORDS: elderly, fear of falling, predictive model Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.