Balance impairment as a central correlate of falls, short sleep, and physical health in community-dwelling adults

BACKGROUND: Falls are a leading cause of disability in older adults and often co-occur with sleep disturbance, balance impairment, concern about falling and reduced health-related quality of life. However, these domains are usually studied separately. This exploratory cross-sectional analysis assessed the interrelationships among sleep quality and duration, concern about falling, clinical balance and functional performance, and health-related quality of life in community-dwelling adults aged ≥45 years using seven prespecified binary outcomes: falls, high concern about falling, balance impairment, short sleep duration, poor physical health-related quality of life, current smoking, and weak grip strength. METHODS: A community-based cross-sectional study was conducted among adults aged ≥45 years (N=52; mean age 61.10±12.55 years). Trained physiotherapists collected sociodemographic and clinical data, medications, morbidities, smoking, and administered standardized measures: grip strength, 30-s Sit-to-Stand (STS), Timed Up & Go (TUG), Berg Balance Scale (BBS), Falls Efficacy Scale-International (FES-I), SF-12 Physical and Mental, Pittsburgh Sleep Quality Index (PSQI), sleep duration, and the International Physical Activity Questionnaire (IPAQ). Seven prespecified binary outcomes were modelled using logistic regression adjusted for age and sex. RESULTS: Falls were common (46.2%), as were BBS impairment (36.5%), weak grip strength (73.1%), short sleep (63.5%), and poor sleep quality (86.5%). Current smoking was reported by 26.9% of participants. Fallers were more often ≥65 years, smokers, and on ≥5 medications, and showed worse STS, BBS, SF-12 Physical/Mental, and FES (all p≤.041). Falls were strongly associated with age (rho=.58), smoking (rho=.71), BBS impairment (rho=.66), and higher FES concern (rho=.60) (all p<.001). In logistic regression models adjusted for age and sex, BBS impairment predicted falls (OR=5.88, 95% CI 1.06-6.67, p=.043) and high FES concern (OR=1.68, 95% CI 1.40-3.28, p=.004). Short sleep duration strongly associated with BBS impairment (OR=4.71, 95% CI 2.82-6.02, p=.008), having ≥1 fall was associated with current smoking (OR=2.86, 95% CI 1.02-3.74, p=.048) and high FES concern was linked to poorer SF-12 Physical status (OR=0.18, 95% CI 0.05-0.74, p=.017). CONCLUSION: In this cohort, balance impairment, fall concern, short sleep and lower physical health-related quality of life were observed to cluster. BBS was identified as a key independent correlate of both falls and concern about falling, while short sleep duration was strongly associated with balance impairment, and concern about falling independently predicted lower SF-12 physical scores. Given these results, multidimensional assessment including balance testing, concern-about-falling assessment, sleep and health-related quality of life screening is supported, and confirmation in larger longitudinal cohorts is required.