Cognition, Fear, and Falls: Psychological Predictors of Balance Impairment in Community-Dwelling Older Adults.

Batool Alkhamis¹Basant Hamdy Elrefaey¹Mohammad A. ALMohiza²Khalid A. Alahmari¹Mastour Saeed Alshahrani¹Hani Hassan Alnakhli¹Ghada Koura¹Debjani Mukherjee¹Saleh M. Kardm³Faisal M. Alyazedi⁴RAVI SHANKAR REDDY^1*

• ¹Program of Physical Therapy, Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia, Abha, Saudi Arabia
• ²Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
• ³Department of Surgery, College of Medicine, Najran University, Najran, Saudi Arabia
• ⁴Physical Therapy Department, Prince Sultan Military College of Health Sciences,, Dahran, Saudi Arabia

Objective: This study aimed to (1) assess the associations among cognitive function, fear of falling, and balance in community-dwelling older adults; (2) identify key predictors of balance performance; and (3) examine implications for fall prevention strategies.Methods: Eighty-four older adults (≥65 years) residing independently in the community were recruited during outpatient visits. Cognitive function was assessed using the Saint Louis University Mental Status (SLUMS), fear of falling was measured with the Falls Efficacy Scale-International (FES-I), and balance performance was evaluated using the Berg Balance Scale (BBS). Physical activity, demographic factors, and fall history were also recorded.Results: Bivariate correlations showed that higher cognitive function was associated with better balance (r = 0.45, p = 0.014), while greater fear of falling was linked to poorer balance (r = -0.52, p = 0.003). A hierarchical regression model revealed that cognitive function (β = 0.32, p = 0.002) and fear of falling (β = -0.44, p < 0.001) were significant predictors of balance performance, even after controlling for age, gender, physical activity, and fall history. Exploratory logistic regression showed that fear of falling (OR = 1.12, p = 0.002) and balance performance (OR = 0.91, p = 0.008) were significant predictors of fall history.Conclusion: Cognitive function and fear of falling are independent and meaningful predictors of balance performance in older adults. These findings support the integration of cognitive and psychological assessments into exercise-based fall prevention strategies.