Evaluating Factors That Influence How Older People in the UK and KSA Report Fear of Falling: A Cross-Sectional Study

Abstract

Background Falls are a major health problem for those 60 years and older, and fear of falling (FoF) is a critical psychological aspect of this issue. A widely used subjective scale that measures a person's level of concern towards falling is the Falls Efficacy Scale International (FES-I). The FES-I is commonly used in research, but several studies highlighted potential issues and biases associated with its use. This cross-sectional study aimed to investigate some of these issues by providing participants with four versions of the FES-I: the FES-I (or standard. FES-I), two modified instruction FES-Is (worst and best FES-I), and the Iconographic (ICON) FES-I. Methods A sample of community-dwelling older adults from two countries, the UK (n = 76) and the KSA (n = 100), participated in this cross-sectional study. Four different versions of the FES-I were used to assess changes in FoF. Additionally, the Hospital Anxiety and Depression Scale (HADS), the Medical Outcomes Study Social Support Survey (MOS-SSS), a sociodemographic survey, a 6-month Fall History question, Timed up and Go test (TUG), and two bespoke Likert scales, were used to assess the potential factors that could influence FES-I scores and were treated as independent variables. Descriptive statistics, T-tests, analysis of variance (ANOVA), correlation and regression analysis were performed to examine the significance of the difference and the relationship between FES-I scores and independent variables. Results The standard FES-I and the ICON FES-I scores significantly differed from the worst and best FES-I (P<0.05). Perceived health status, anxiety and depression scores significantly correlated with standard FES-I when accounting for TUG and fall history. Mobility, fall history, and psychological factors collectively predicted the FES-I reporting tendencies (degree of deviation between the different versions of the FES-I). Conclusions The results confirmed that the participants’ FES-I scores changed when clarity was added to the instructions and that other variables influenced FES-I scores. Although the FES-I is a valid and reliable scale, it needs refinement because its ambiguity dilutes what can be obtained through its use. More studies should examine how the FES-I is affected by interpersonal factors and focus on understanding it more comprehensively.