Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)

Graduate Group


First Advisor

Pamela Z. Cacchione


Many older adults develop fear of falling (FOF), defined as the level of concern about falling, creating a psychological barrier to performing activities. The negative impact of FOF increases risk of curtailment of activities, future falls, and injury. Bronfenbrenner's Social Ecology Model framed the investigation. The specific aims and hypotheses for this study of high-risk, urban, community-dwelling older adults from one Program for All-Inclusive Care for the Elderly (PACE) program were to: 1) Describe the relationship between FOF and falls self-efficacy; 2) Examine the variables (participant characteristics, the neighborhood built environment, and self-rated health) and their corresponding explained variance associated with FOF and falls self-efficacy, separately; and 3) Examine the role of falls self-efficacy as a moderator between the set of variables (participant characteristics, the neighborhood built environment, and self-rated health) and participation in physical and social activities. The study included a convenience sample of 107 mostly Black (94%) members from one PACE program. In aim 1, the FOF Likert scale and Falls Self Efficacy Scale-International (FES-I) were significantly correlated with Pearson and Spearman correlations of 0.62 (p<0.0001). One-way ANOVA and Kruskal-Wallis were highly significant (F-value=22.25, R-squared=0.39, p<0.0001). Aim 2 findings included 10 significant items (age, falls, injury, gender, race, anxiety, mobility, traffic, safety, and crime environment items) associated with FES-I as dependent variable (F-value=9.21, R-squared=0.49, p<0.0001) compared to four (age, traffic, safety, and crime) with FOF scale as dependent variable (F-value=5.76, R-squared=0.18, p=0.0003) in the final models. In aim 3, there was a significant, negative Pearson correlation of -0.43 (p<0.001) and Spearman correlation of -0.42 (p<0.001) between concern about falling measured by the FES-I and participation in activities measured by the Functional Performance Inventory-Short Form (F-value=23.40, R-squared=0.18, p<0.0001). The greater the difficulty in participation in activities, the higher the concern about falling during activities measured by the FES-I. A weak interaction effect was seen with falls self-efficacy interacting with two traffic-related items measured by the Physical Activity Neighborhood Environment Scale (PANES) and participation in physical and social activities. Future FOF research should focus on mobility and concepts of safety, traffic, and crime perceived by high-risk, urban, community-dwelling older adults.