Association between anxiety symptoms and risk of falls in older adults residing in a high-altitude Peruvian Andean district: a secondary analysis of the Aunqui-Andes study
DOI:
https://doi.org/10.21142/mecp.2026.1.2.e019Keywords:
Geriatric assessment, GAD-2, Postural balance, Altitude, PeruAbstract
Objectives: This study aimed to evaluate the association between anxiety symptoms and risk of falls in older adults residing in the district of Totos, Ayacucho, Peru, in 2022. Methods: We conducted a secondary analysis of an analytical cross-sectional study. A total of 272 community-dwelling older adults aged ≥60 years were included. Participants with severe cognitive impairment (Pfeiffer score ≥8), dependence for ambulation, or incomplete data were excluded. Anxiety symptoms were assessed using the GAD-2 scale (score≥3). Risk of falls was evaluated using the functional reach test (≤20.32 cm indicating increased risk). Crude (cPR) and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) were estimated using Poisson regression with robust variance. The adjusted model included sex, age, employment status, use of prescription eyeglasses, polypharmacy, frailty, and history of falls in the past year. Results: The prevalence of anxiety symptoms was 58.1% and the prevalence of risk of falls was 57.4%. In the crude analysis, older adults with anxiety symptoms had a higher prevalence of risk of falls (cPR = 1.32; 95% CI: 1.06 – 1.66; p = 0.014). After adjustment, the association was no longer statistically significant (aPR = 1.08; 95% CI: 0.86 – 1.36; p = 0.491). Conclusions: In older adults residing in a high-Andean rural district, anxiety symptoms were not significantly associated with risk of falls after adjustment for relevant covariates. These findings suggest that fall risk in high-altitude settings may be driven primarily by physical and functional factors, highlighting the importance of comprehensive geriatric assessment in rural Andean populations.
Downloads
References
1. World Health Organization. Falls [Internet]. Geneva: WHO; 2021 [cited 2026 Apr 8]. Available from: https://www.who.int/ news-room/fact-sheets/detail/falls
2. Salari N, Darvishi N, Ahmadipanah M, Shohaimi S, Mohammadi M. Global prevalence of falls in the older adults: a comprehensive systematic review and meta-analysis. J Orthop Surg. 2022;17:334. doi: 10.1186/s13018-022-03222-1.
3. Xu Q, Ou X, Li J. The risk of falls among the aging population: A systematic review and meta-analysis. Front Public Health. 2022;10:902599. doi: 10.3389/fpubh.2022.902599.
4. Li Y, Hou L, Zhao H, Xie R, Yi Y, Ding X. Risk factors for falls among community-dwelling older adults: A systematic review and meta-analysis. Front Med. 2023;9:1019094. doi: 10.3389/fmed.2022.101909.
5. Urrunaga-Pastor D, Salazar-Talla L, Alcantara-Diaz AL, Camacho-Caballero K, Cuba-Ruiz S, Runzer-Colmenares FM, et al. Association between frailty and activities of daily living disability in older adults residing in a high-altitude Peruvian Andean community: the Aunqui-Andes study. BMC Geriatr. 2024;24(1):792. doi: 10.1186/s12877-024-05381-8.
6. Luo Y, Miyawaki CE, Valimaki MA, Tang S, Sun H, Liu M. Symptoms of anxiety and depression predicting fall-related outcomes among older Americans: a longitudinal study. BMC Geriatr. 2022;22(1):749. doi: 10.1186/s12877-022-03406-8.
7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). 5th ed. Washington (DC): American Psychiatric Association; 2013.
8. Prina AM, Ferri CP, Guerra M, Brayne C, Prince M. Prevalence of anxiety and its correlates among older adults in Latin America, India and China: cross-cultural study. Br J Psychiatry. 2011;199(6):485-91. doi: 10.1192/bjp.bp.110.083915.
9. Shafiee A, Mohammadi I, Rajai S, Jafarabady K, Abdollahi A. Global prevalence of anxiety symptoms and its associated factors in older adults: A systematic review and metaanalysis. J Gen Fam Med. 2025;26(2):116-27. doi: 10.1002/ jgf2.750.
10. Porensky EK, Dew MA, Karp JF, Skidmore E, Rollman BL, Shear MK, et al. The Burden of Late-Life Generalized Anxiety Disorder: Effects on Disability, Health-Related Quality of Life, and Healthcare Utilization. Am J Geriatr Psychiatry. 2009;17(6):473-82. doi: 10.1097/JGP.0b013e31819b87b2.
11. Hohls JK, König H-H, Raynik YI, Hajek A. A systematic review of the association of anxiety with health care utilization and costs in people aged 65 years and older. J Affect Disord. 2018;232:163-76. doi: 10.1016/j.jad.2018.02.011.
12. Yardley L. Fear of falling: links between imbalance and anxiety. Rev Clin Gerontol. 2003;13(3):195-201. doi: 10.1017/ S0959259803001023.
13. Debenham MIB, Smuin JN, Grantham TDA, Ainslie PN, Dalton BH. Hypoxia and standing balance. Eur J Appl Physiol. 2021;121(4):993-1008. doi: 10.1007/s00421-020-04581-5.
14. Urrunaga-Pastor D, Runzer-Colmenares FM, Arones TM, Meza-Cordero R, Taipe-Guizado S, Guralnik JM, et al. Factors associated with poor physical performance in older adults of 11 Peruvian high Andean communities. F1000Research. 2019;8:59. doi: 10.12688/f1000research.17513.2.
15. Urrunaga-Pastor D, Moncada-Mapelli E, Runzer-Colmenares FM, Bailon-Valdez Z, Samper-Ternent R, Rodriguez-Mañas L, et al. Factors associated with poor balance ability in older adults of nine high-altitude communities. Arch Gerontol Geriatr. 2018;77:108-14. doi: 10.1016/j.archger.2018.04.013.
16. Meucci RD, Runzer-Colmenares FM, Parodi JF, de Mola CL. Falls Among the Elderly in Peruvian Andean Communities and the Rural far South of Brazil: Prevalence and Associated Factors. J Community Health. 2020;45(2):363-9. doi: 10.1007/ s10900-019-00751-5.
17. Scott V, Votova K, Scanlan A, Close J. Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings. Age Ageing. 2007;36(2):130-9. doi: 10.1093/ ageing/afl165.
18. Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B. Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection. Ann Intern Med. 2007;146(5):317- 25. doi: 10.7326/0003-4819-146-5-200703060-00004.
19. Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65(9):989-95. doi: 10.1016/j.jclinepi.2012.02.018.
20. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in Older Adults: Evidence for a Phenotype. J Gerontol Ser A. 2001;56(3):M146-57. doi: 10.1093/ gerona/56.3.M146.
21. Petty DR, House A, Knapp P, Raynor T, Zermansky A. Prevalence, duration and indications for prescribing of antidepressants in primary care. Age Ageing. 2006;35(5):523-6. doi: 10.1093/ ageing/afl023.
22. Lewinsohn PM, Seeley JR, Roberts RE, Allen NB. Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among communityresiding older adults. Psychol Aging. 1997;12(2):277-87. doi: 10.1037/0882-7974.12.2.277.
23. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412-23. doi: 10.1093/ageing/afq034.
24. Washburn RA, Smith KW, Jette AM, Janney CA. The physical activity scale for the elderly (PASE): Development and evaluation. J Clin Epidemiol. 1993;46(2):153-62. doi: 10.1016/0895-4356(93)90053-4.
25. Theou O, Brothers TD, Mitnitski A, Rockwood K. Operationalization of Frailty Using Eight Commonly Used Scales and Comparison of Their Ability to Predict All-Cause Mortality. J Am Geriatr Soc. 2013;61(9):1537-51. doi: 10.1111/ jgs.12420.
26. Martínez de la Iglesiaa J, DueñasHerrerob R, Carmen Onís Vilchesa M, Aguado Tabernéa C, Albert Colomerc C, Luque Luquec R. Adaptación y validación al castellano del cuestionario de Pfeiffer (SPMSQ) para detectar la existencia de deterioro cognitivo en personas mayores e 65 años. Med Clínica. 2001;117(4):129-34. doi: 10.1016/S0025-7753(01)72040-4.
27. Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): Recent Evidence and Development of a Shorter Version. In: Clinical Gerontology: a guide to assessment and intervention. New York: Routledge; 1986.
28. Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: A reliability study. Int Disabil Stud. 1988;10(2):61-3. doi: 10.3109/09638288809164103.
29. Hallford DJ, Nicholson G, Sanders K, McCabe MP. The Association Between Anxiety and Falls: A Meta-Analysis. J Gerontol Ser B. 2017;72(5):729-41. doi: 10.1093/geronb/gbv160.
30. Payette M-C, Bélanger C, Léveillé V, Grenier S. Fall-Related Psychological Concerns and Anxiety among CommunityDwelling Older Adults: Systematic Review and MetaAnalysis. PLOS ONE. 2016;11(4):e0152848. doi: 10.1371/journal. pone.0152848.
31. Liu JY. Fear of falling in robust community-dwelling older people: results of a cross-sectional study. J Clin Nurs. 2015;24(3-4):393-405. doi: 10.1111/jocn.12613.
32. Kious BM, Kondo DG, Renshaw PF. Living High and Feeling Low: Altitude, Suicide, and Depression. Harv Rev Psychiatry. 2018;26(2):43-56. doi: 10.1097/HRP.0000000000000158.
33. Young WR, Mark Williams A. How fear of falling can increase fall-risk in older adults: Applying psychological theory to practical observations. Gait Posture. 2015;41(1):7-12. doi: 10.1016/j.gaitpost.2014.09.006.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Medical Education & Clinical Practice

This work is licensed under a Creative Commons Attribution 4.0 International License.


