Fear of falling affects between 29 to 92 per cent of older people living in the community who have fallen [71, 83] and between 12 to 65 per cent of those older people who have not fallen [71]. 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].
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, 82].
A fear of falling can be an issue for the health and well-being 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:
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'. The consequences that develop as a result of a fear of falling can include:
These consequences have a 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].
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:
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.
A diagram illustrating the downward spiral of fear is available here.
The 2007 review recommends the Falls Efficacy Scale - International (FES-I) as a valid and reliable tool to measure a person's concern about falling [83, 85]. 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. This tool helps to:
The Falls Efficacy Scale - International is available for use with permission from the Prevention of Falls Network Europe (ProFaNE).
Research is continuing into the fear of falling, through the Prevention of Falls Network Europe (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.
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.
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