Predictors of Avoidance Behavior in Fear of Falling Among Older Adults: A Latent Profile Analysis

Objectives: Fear of falling (FoF) is a common psychological phenomenon in later life and is often accompanied by avoidance behavior and activity restriction. Although FoF is associated with anxiety, depressive symptoms, reduced self-efficacy, and fear of loss of autonomy, older adults with FoF may differ substantially in the configuration of these characteristics. The present study aimed to identify data-derived profiles of older adults based on FoF, avoidance behavior, self-efficacy, and fear of loss of autonomy, and to examine profile-specific psychological predictors of FoF and avoidance behavior. Methods: The main analytical sample included 217 older adults aged 60–97 years (M = 76.45, SD = 10.14) with Mini-Mental State Examination scores of 20 or higher. Latent profile analysis was conducted using FoF, avoidance behavior, self-efficacy, and fear of loss of autonomy. Anxiety components, depressive symptoms, coping strategies, pain catastrophizing, and loneliness-related indicators were examined in class-specific regression models. The stability of the class solution was tested across different MMSE cut-off scores. Between-class comparisons were conducted for functional, fall-related, socio-demographic, and psychological indicators. Results: A three-class solution was selected and interpreted as adaptive, vulnerable, and maladaptive profiles. The profile structure remained relatively consistent across MMSE cut-off scores, including in the broader sample with MMSE ≥ 15. The classes did not differ significantly in postural balance or number of falls, suggesting that the profiles could not be fully explained by objective fall-risk indicators. Significant between-class differences were found for age, daily pain level, and state social defense. Class-specific regression models suggested that psychological variables associated with FoF and avoidance behavior differed across profiles. Pain appraisal and emotion-related coping were more relevant in the adaptive profile, phobic anxiety and anxious appraisal of future events in the vulnerable profile, and anxiety-related, depressive, interpersonal, and coping-related factors in the maladaptive profile. All reported associations remained significant after false discovery rate correction. Conclusions: FoF and avoidance behavior are related but not identical phenomena and vary across data-derived psychological profiles. A profile-oriented approach may provide a more differentiated understanding of activity restriction in older adults and help identify profile-specific targets for psychological support.