Fear of falling - Stay On Your Feet
Why is the fear of falling a risk factor?
 | An older person's fear of falling can be defined as 'an ongoing concern about falling that ultimately limits the undertaking of daily activities' 71,. Fear of falling affects between 29 to 92% of older people living in the community who have fallen 71,, 83, and between 12 to 65% of those older people who have not fallen 71,. |
The term 'falls self-efficacy' is often used in falls prevention research to discuss an older person's fear of falling. Falls self-efficacy can be defined as 'a person's belief in their ability to undertake certain activities of daily living without falling or losing balance' 71,81.
A fear of falling can be an issue for the health and wellbeing of older people while also being a protective factor. A fear of falling becomes a serious public health concern when older people do not perform daily activities they have the ability to perform 71,82,83,84. This restriction of activity may lead to a loss of lower limb strength, a further reduction in mobility and physical function and social isolation 83. However, a person's fear of falling can be protective when this fear stops people from undertaking activities with a high risk of falling and potential for injury 71,84.
Older people can develop a fear of falling due to:
- a previous fall 71
- feeling unsteady 84
- poor health 71
- a belief that they are unable to do normal activities (low falls self-efficacy)
- functional decline, or a reduced ability to perform tasks associated with every day living eg. dressing themselves 71
- frailty 71
- poor vision 84
- no emotional support from family or friends 84
- inactive lifestyle 84.
There are considerable negative physical and emotional consequences that can result from a fear of falling. These are often referred to as a 'debilitating downward spiral' 83 or a 'cycle of fear of falling'. A diagram illustrating the downward spiral of fear is available. The consequences that develop as a result of a fear of falling can include:
- loss of confidence 71,83,84
- reducing both physical and social activities 71,83,84
- depression 71,83
- hesitancy and tentativeness 84
- loss of mobility and independence 83
- increased risk of falls 83,84
- increased frailty 83
- risk of nursing home admission 84.
These consequences have a strong negative impact on an older person's quality of life and can also contribute to an increase in health care costs as people access more health care services 84.
What works
When working with older people in the community, it is important that falls prevention projects/programs do not make people afraid of falling by focusing on negative risk factors and the consequences of falls. Falls prevention projects/programs will be more effective if positive healthy active ageing messages such as 'stay active' and 'improve your strength and balance' are used. Projects/programs should adopt the term 'concern about falling' rather than 'fear of falling' as this term is less emotional and may be easier to discuss 85.
It is possible to address the concerns of falling by intervening with any of the factors within the spiral 83, but improving functional ability must be addressed at the same time. A 2007 systematic review of the fear of falling research assessed which interventions effectively reduce the fear of falling in older people living in the community 83. This review found that the fear of falling can be significantly reduced by:
- a home-based multifactorial falls prevention program 83
- home-based exercise 83
- a community-based Tai Chi group 83.
These interventions help to manage both the fear of falling and reduce this risk of falls occurring in the community 83. In addition, the review also suggested that future falls prevention projects/programs could teach older people to perform activities safely 83 to reduce their concerns and increase their confidence in safely performing physical and social activities.
Other options include participation in balance and mobility training exercise program or the use of hip protectors.
Who can help older people with reducing the fear of falling?
- Doctor + psychologist + physical activity providers?
Screening tools
- The Falls Efficacy Scale - International (FES-I) is a valid and reliable tool to measure a person's fear of falling, and is available for use with permission from the Prevention of Falls Network Earth (ProFaNE). This 16 item tool measures the intensity of concern a person has about performing easy and more demanding physical and social activities. The tool has been developed for use in a variety of languages and the instructions offer suggestions if the questions are being translated.
- You can also measure physical activity, social participation and activities of daily living. For more information on measuring these factors, see: Phase 4 - Materials - Impact Evaluation Tools.
Research on fear of falling
Research is continuing into the fear of falling, through the Prevention of Falls Network Earth (ProFaNE). You can stay up-to-date with this research by registering to access the latest falls prevention information and resources for free. To register, visit the ProFaNE website.
Resources related to fear of falling
- A Meta-analysis of fear of falling treatment programs for the elderly, Western Journal of Nursing Research article. February 2009 vol.31 no.1, pp 6-16.