Balance confidence predicts incident injurious falls in older adults: a longitudinal study

Abstract Purpose Falls affect one-third of older adults each year, often resulting in low balance confidence, which is associated with reduced mobility and quality of life. This study examined the association between MFES scores and incident injurious falls and evaluated whether MFES scores mediate the relationship between previous and subsequent falls in older adults. Methods Data for participants (n = 952, age ≥ 65 yr) from the Geelong Osteoporosis Study were linked with the Victorian Emergency Minimum Dataset (VEMD). The outcome was the time to first emergency presentation for an injurious fall. Balance confidence was measured using the Modified Falls Efficacy Scale (MFES). Competing risk regression evaluated the MFES score as a predictor of incident injurious falls. Receiver operating characteristic (ROC) analysis determined the optimal MFES cut point for predicting incident injurious falls based on the maximum Youden’s index, while mediation analysis assessed MFES score’s role between prior and subsequent falls. Results The median follow-up time was 11.5 years (IQR: 5.9–19.0), with a total of 11,368 person-years. Over the follow-up period, 219 participants (23.0%) experienced at least one incident injurious fall, with an incidence rate of 19.3 per 1000 person-years (95% CI: 16.9–22.0). Low MFES score was a significant predictor of incident injurious falls (aSHR = 1.019, 95% CI: 1.005–1.033). Although an MFES cutoff of 55 was identified, the AUC (0.508) indicated no meaningful discriminative ability. Low MFES score explains 14.9% of the relationship between prior self-reported and subsequent injurious falls. Conclusion A low MFES score is associated with incident injurious falls and partially mediates the relationship between previous and subsequent falls. Although an optimal MFES cut point of 55 was identified, its very low specificity and lack of meaningful discriminative ability limit its reliability for prediction. These findings support recommendations, consistent with the World Falls Guidelines, to incorporate assessments of balance confidence—captured through validated measures such as the MFES—into multifactorial fall risk management.