Ability versus hazard: risk-taking and falls in older people.

BACKGROUND Among older people, undue risk taking could lead to falls, irrespective of physical ability. We investigated the interaction between risk-taking behavior and physical ability and its contribution to falls. METHODS Participants (N = 294, age ≥ 70) were asked to walk as quickly as possible to a visible destination by choosing one of six paths. Each contained a raised plank that had to be walked along without falling. The shortest path had the narrowest and tallest plank and the longest had the widest and lowest. Behavioral risk was defined as the probability of falling off the chosen plank. This was estimated from a ground path walking task because, for safety, participants were stopped before crossing the plank. Self-reported everyday risk-taking behavior, fear of falling, physical functioning, and 1-year prospective fall rates were measured. RESULTS Older participants and those with poor physical ability chose easier planks to cross. Participants with good physical ability consistently took a slight behavioral risk, whereas those with poor physical ability took either very-high behavioral risks or chose the overly safe path with no risk. Unexpectedly, participants reporting cautious behavior on the everyday risk-taking behavior scale took greater behavioral risks. Independent of physical performance, behavioral risk was significantly associated with falls during the subsequent year. CONCLUSIONS Assessing behavioral choice in relation to physical ability can identify risk-taking but neither the difficulty of a chosen action nor self-reports of risk-taking behavior are sufficient. Risk-taking behavior is an independent risk factor for falls and management of undue risk-taking might complement existing fall prevention strategies.