- Subjective balance was the strongest direct predictor of fall risk; objective balance, depression, anxiety, and heart disease also had direct effects.
- Hearing, cognitive function, and hypertension were not direct predictors; their effects on falls were fully or partially mediated by balance.
- Clinical fall prevention should prioritise subjective and objective balance assessment, manage mental health, and address sensory and cognitive function to support postural control.
Innov Aging. 2026 Jul 1;10(10):igag076. doi: 10.1093/geroni/igag076. eCollection 2026.
ABSTRACT
BACKGROUND AND OBJECTIVES: Falls in older adults are a major public health concern, but the mechanistic pathways linking sensory, cognitive, and vascular deficits to falls are poorly understood. We hypothesized that balance acts as a critical mediator, channeling these upstream deficits into functional fall risk.
METHODS: Using cross-sectional data from 4805 community-dwelling adults (≥ 65 years) in the National Health and Aging Trends Study (NHATS) Round 13, we examined predictors of a composite fall-risk score (self-reported past falls and worry about falling). Survey-weighted multiple regression identified direct predictors, while mediation analyses tested the indirect effects of hearing, cognition, and vascular conditions through subjective (self-reported problems) and objective (performance-based) balance measures.
RESULTS: Subjective balance was the strongest direct predictor of fall risk (β = 0.53, p < .001), with additional direct effects from objective balance, depression, anxiety, and heart disease. Notably, hearing ability, cognitive function, and hypertension were not direct predictors of fall risk; their influence was fully or partially mediated by balance, establishing postural control as the primary pathway through which these upstream factors contribute to falls.
DISCUSSION AND IMPLICATIONS: These findings identify a dual-pathway fall risk model driven by subjective and objective balance. While psychological factors and heart disease directly influence fall risk, upstream sensory, cognitive, and hypertensive deficits operate through balance as a convergent mediating pathway. Clinical fall prevention must prioritize subjective and objective balance measures, while managing mental health as a direct threat and addressing sensory and cognitive function as foundational to postural control.
PMID:42732430 | PMC:PMC13570676 | DOI:10.1093/geroni/igag076
Share Evidence Blueprint
Save to Google Notes
Search Google Scholar
Save as PDF
⭐ My Revision List
