Balancing on the edge of age: neuroendocrine, mental health and functional fitness correlates of fear of falling in older women

INTRODUCTION: Fear of Falling (FOF) is a common and natural behavior experienced by most of the elderly population during aging. It is thought to be caused by previous falls, dizziness, depression, and neuromotor impairments. However, the association between FOF and salivary biomarkers such as Cortisol (COR), Testosterone (TT), Dehydroepiandrosterone (DHEA), and alpha-amylase activities has not been consistently explored. OBJECTIVE: To explore the association between FOF and general health status, Functional Fitness (FF), and salivary-related stress biomarkers in institutionalized older women. MATERIALS AND METHOD: A total of 278 older women were assessed and grouped as having Higher (n = 176) or Lower FOF (n = 102), according to the Falls Efficacy Scale. Saliva samples were collected. RESULTS: The Higher FOF group had superior scores in the depressive state and comorbidity scale (p ≤ 0.05). Participants with Lower FOF showed better FF scores. Salivary levels of cortisol were higher, and DHEA levels were lower in the High FOF group (p ≤ 0.05). Spearman's Rank test showed that FOF was inversely correlated with DHEA, alpha-amylase, and FF, whereas COR was directly associated with the FOF scale. Regression analysis indicated that functional fitness indicators were significantly associated with variations in FOF. However, after adjusting for covariates, the influence of physical-functional fitness was reduced, while depressive symptoms and DHEA levels remained statistically significant in the model, suggesting their stronger association with FOF. The observed associations between FOF and biomarkers, especially DHEA, add important evidence to the growing body of literature exploring the multifactorial nature of FOF. These findings contribute to a deeper understanding of the biological components involved and may help inform fall-risk monitoring strategies in institutionalized older populations.