Comparison of three established measures of fear of falling in community-dwelling older adults: Psychometric testing

Background: Several approaches have emerged for measuring self-reported fear of falling. A comparison of measurement scales' psychometric properties is needed for researchers to choose the proper scale for their study. Objectives: To compare the psychometric properties of the Falling Efficacy Scale (FES), the Activities-Specific Balance Confidence Scale (ABC) and the Geriatric Fear of Falling Measurement (GFFM). Design: Secondary analysis using baseline and 8-week data from a randomized, controlled trial on fall and fear of falling prevention. Settings: Rural area northeast of Taiwan with assessments conducted in participants' homes. Participants: Population-based sample of 168 community-dwelling older adults aged 60 and older. Methods: During a home visit, a nurse administered the Tinetti Mobility Scale, and asked about the FES, ABC, GFFM, WHOQOL, falls, chronic illnesses and medicines taken. Results: Baseline internal consistency measured using Cronbach's alpha was 0.98 for the FES, 0.96 for the ABC and 0.88 for the GFFM. Baseline concurrent validity between the FES, ABC and GFFM measured using a correlation coefficient was 0.88 (FES vs. ABC), -0.55 (FES vs. GFFM), and -0.57 (ABC vs. GFFM), respectively, p < .001. All three instruments scores were significantly correlated at baseline with physical performance tests and WHOQOL. The GFFM demonstrated responsiveness to change at 8 weeks. Conclusions: The FES, ABC and GFFM demonstrated strong internal consistency reliability. The GFFM had stronger associations with physical and psychosocial functioning and may be more appropriate for studies focused on improving all aspects of fear of falling. Both FES and ABC instruments demonstrated ceiling effects, which may explain the lack of responsiveness to change in relatively non-frail older community-dwelling adults. Instruments sensitive to measuring lower levels of fear of falling are needed to capture the full range of this phenomenon in this population.