Subjective Cognitive Decline and Fear of Falling Among Community-Dwelling Racially Diverse Older Adults in Low-Income Settings.

BACKGROUND

Subjective cognitive decline (SCD) and fear of falling share similar mental health consequences (e.g. increased depression and anxiety), but limited research evaluates their relationships in racially diverse older adults living in low-income settings.

OBJECTIVES

We examined associations of older adults' SCD and SCD-related functional difficulties with fear of falling and the moderating effects of depressive and anxiety symptoms.

METHODS

A cross-sectional study, part of a larger clustered randomized controlled trial, was conducted. The sample consisted of racially diverse adults aged 60+ with the ability to stand without assistance, living in residential units and apartments in Central Florida (N=91; 89% female, Mage=73.26, SD ±6.99, 96.7% non-White). The short Fall-Efficacy Scale International assessed fear of falling. SCD was evaluated using a single question regarding confusion or memory loss, followed by a follow-up question that captured SCD-related functional difficulties on a Likert scale. The Patient Health Questionnaire assessed depressive symptoms. The Geriatric Anxiety Inventory-Short Form assessed anxiety. A Poisson regression analysis examined associations among SCD, SCD-related functional difficulties, fear of falling, and interactions with depressive and anxiety symptoms.

RESULTS

Depressive symptoms were independently associated with fear of falling, while SCD, SCD-related functional difficulties, and anxiety symptoms were not. Older adults with SCD-related functional difficulties who reported higher anxiety also reported greater fear of falling, whereas those with lower anxiety reported fewer fall-related concerns The interaction of SCD-related functional difficulties with depressive symptoms was not significantly related to fear of falling, but its interaction with anxiety symptoms was. Simple slope analysis showed the association between SCD-related functional difficulties and fear of falling was accentuated with higher anxiety symptoms and attenuated with lower anxiety.

DISCUSSION: Among racially diverse older adults, SCD was not independently associated with fear of falling; however, accounting for co-occurring affective symptoms provided a more comprehensive understanding. Although depressive symptoms were associated with fear of falling, it was anxiety that contributed to concerns about falling when older adults experienced functional difficulties due to SCD. Future studies should use larger, more representative samples to evaluate whether older adults' fear of falling and affective well-being changes over time, particularly among those experiencing SCD.