Lower muscle quality and lower-extremity function are associated with a higher fear of falling in older women: an age-matched cross-sectional study

Background The impact of muscle quality on the fear of falling, lower extremity functionality, and their complex interaction, particularly in older women, is uncertain.Objective This cross-sectional study aimed to investigate the association of muscle quality with fear of falling and lower extremity functionality in older women.Methods This study evaluated 168 age-matched older adults (women = 84, men = 84). Outcome measures included the Muscle Quality Index (MQI), Lower Extremity Functional Scale (LEFS), and Fall Efficiency Scale-International (FES-I). Correlation and linear regression analyses were used to examine the associations among muscle quality, lower extremity function, and fear of falling.Results Women scored lower than men on the MQI (44.56 ± 18.20 vs 55.88 ± 22.11 W) and LEFS (46.92 ± 12.86 vs 54.32 ± 14.01), and higher on the FES-I (29.19 ± 8.14 vs 24.25 ± 7.66; all p < .001). Among women, LEFS and FES-I were strongly correlated (rho = −0.730). Higher MQI was associated with lower FES-I (B = −0.187, β = −0.417) and higher LEFS (B = 0.325, β = 0.460), and higher LEFS was associated with lower FES-I (B = −0.442, β = −0.698) (all p < .001). All three associations persisted after adjustment.Conclusion Compared with age-matched men, older women had poorer muscle quality, poorer lower extremity function, and greater fear of falling. In women, both poorer muscle quality and lower extremity function were associated with greater fear of falling; the association was stronger for lower extremity function. These findings may indicate a need for a sex-specific and multidimensional rehabilitation model. Clinicians should prioritize interventions that strategically target both muscle quality and functional mobility to preemptively mitigate the unique physical and psychological risks that threaten aging women’s quality of life.Trial registration ClinicalTrials.gov NCT05758792