Validation of the Iconographical Falls Efficacy Scale in Cognitively Impaired Older People

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This study evaluated psychometric properties of the Iconographical Falls Efficacy Scale (Icon-FES) to measure fear of falling in cognitively impaired older people. Icon-FES uses pictures as visual cues to prompt responses.


A total of 50 community-dwelling older people with moderate cognitive impairment were assessed on Icon-FES, Falls Efficacy Scale-International, and various physical and cognitive measures.


Overall structure and measurement properties of Icon-FES, as evaluated with item response theory, were good. Internal consistency was high (Cronbach’s alpha = 0.97). Distribution was near normal, indicating absence of floor and ceiling effects. Icon-FES construct validity was supported by its relation with Falls Efficacy Scale-International (r = .68, p < .001) and its ability to discriminate between groups relating to fall risk factors (gender, balance, falls). Scores were not affected by different levels of cognitive functioning, as assessed with the Mini-Mental State Examination and Trail Making Test.


Icon-FES is the first measure of fear of falling that compensates for reduced abstract abilities by using pictures to match the verbal descriptions. This study supports its feasibility, reliability, and validity to assess fear of falling in people with moderate cognitive impairment or dementia living in the community. Compared with Falls Efficacy Scale-International, Icon-FES was better at identifying participants with higher fall risk and did not show a floor effect likely due to a greater range of physically challenging activities.

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