Incident Falls Across Concordant and Discordant Profiles of Concerns About Falling and Functional Mobility in Older Adults: A Prospective Cohort Study.

BACKGROUND: Concerns about falling and impaired functional mobility are established fall-risk indicators, but prospective fall risk is less clear when subjective concerns and objective mobility are discordant. We compared incident falls across joint profiles of concerns about falling and Timed Up and Go (TUG) performance, with particular attention to older adults with fast TUG performance and concerns versus those with slow TUG performance and no concerns. METHODS: This one-year prospective cohort study included 2,445 community-dwelling adults aged 60-79 years in Zhejiang Province, China. TUG performance was classified as fast (<12 s) or slow (≥12 s), and concerns about falling were assessed using a single yes/no item. Crossing the two measures produced four psychophysical groups. Self-reported falls were recorded on daily calendars and ascertained monthly. Cox regression estimated adjusted hazard ratios (HRs) for time to first fall. Sensitivity analyses used the Falls Efficacy Scale-International (FES-I), excluded participants with a baseline fall history, and applied the guideline-aligned TUG >15 s threshold. RESULTS: During follow-up, 232 participants (9.5%) reported at least one fall; 2,420 (98.98%) completed follow-up. Single-item concerns (adjusted HR 1.60, 95% CI 1.23-2.09) and slow TUG performance (HR 1.46, 95% CI 1.10-1.92) were independently associated with incident falls. Using the slow-TUG/no-concern group as the direct reference, the fast-TUG/concern group did not differ significantly (HR 1.08, 95% CI 0.72-1.63), whereas the slow-TUG/concern group had a higher hazard (HR 1.96, 95% CI 1.29-2.97). The discordant groups also did not differ after excluding baseline fallers (HR 0.97, 95% CI 0.62-1.52) or after additionally applying the TUG >15 s threshold (HR 0.87, 95% CI 0.46-1.63). CONCLUSION: Concerns about falling and TUG performance provided complementary information about subsequent falls. The two discordant profiles were not significantly separated. These findings support considering concerns alongside mobility performance rather than relying on either measure alone.