Original Study| Volume 21, ISSUE 5, P615-620, May 2020

Download started.


Predictors of Incident Fear of Falling in Community-Dwelling Older Adults

  • Giulia Rivasi
    Address correspondence to Giulia Rivasi, MD, Geriatric Intensive Care Medicine, Hypertension Centre, Syncope Unit, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Viale Pieraccini 6, 50139, Florence, Italy.
    Syncope Unit and Referral Centre for Hypertension in the Elderly, Department of Geriatrics and Geriatric Intensive Care Unit, Careggi Hospital and University of Florence, Italy
    Search for articles by this author
  • Rose Anne Kenny
    Discipline of Medical Gerontology and Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
    Search for articles by this author
  • Andrea Ungar
    Syncope Unit and Referral Centre for Hypertension in the Elderly, Department of Geriatrics and Geriatric Intensive Care Unit, Careggi Hospital and University of Florence, Italy
    Search for articles by this author
  • Roman Romero-Ortuno
    Discipline of Medical Gerontology and Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
    Search for articles by this author
Published:October 11, 2019DOI:



      Fear of falling (FoF) is common in older people and may lead to physical decline, disability, poor quality of life, and falls. Several risk factors for FoF have been identified in cross-sectional studies, but evidence on predictors of its incidence is scarce. We investigated the latter in community-dwelling older people undergoing a comprehensive geriatric assessment at baseline and after a 2-year follow-up.


      Longitudinal study.

      Setting and Participants

      Convenience sample of community-dwelling people aged ≥60 years evaluated in an Irish university hospital.


      Participants were evaluated at baseline (August 2007–May 2009) and after a 2-year follow-up. FoF was measured using the Modified Falls Efficacy Scale. Predictors of incident FoF at 2 years were investigated.


      At baseline, there were 563 participants (69% female, mean age 73 years). Among individuals that were not fearful at baseline, 105 (18.7%) developed FoF (incident FoF) after a median follow-up of 2.1 years. Individuals reporting incident FoF were older at baseline (P < .001), had worse performance in balance and physical function tests, and more frequently needed a walking aid (P < .001). Anxiety (P = .012) and depressive symptoms (P < .001) were more prevalent, as well as self-reported previous falls (P < .001). In multivariate analysis, older age, walking aid use, and a higher burden of depressive symptoms at baseline were predictors of incident FoF.

      Conclusions and Implications

      Almost a fifth of older adults using a walking aid and reporting depressive symptoms at baseline developed FoF after 2 years. These identifiable prodromal factors could help design FoF prevention strategies.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kumar A.
        • Delbaere K.
        • Zijlstra G.A.
        • et al.
        Exercise for reducing fear of falling in older people living in the community: Cochrane systematic review and meta-analysis.
        Age Ageing. 2016; 45: 345-352
        • Howland J.
        • Peterson E.W.
        • Levin W.C.
        • et al.
        Fear of falling among the community-dwelling elderly.
        J Aging Health. 1993; 5: 229-243
        • Tinetti M.E.
        • Speechley M.
        • Ginter S.F.
        Risk factors for falls among elderly persons living in the community.
        N Engl J Med. 1988; 319: 1701-1707
        • Scheffer A.C.
        • Schuurmans M.J.
        • van Dijk N.
        • et al.
        Fear of falling: Measurement strategy, prevalence, risk factors and consequences among older persons.
        Age Ageing. 2008; 37: 19-24
        • Niino N.
        • Tsuzuku S.
        • Ando F.
        • Shimokata H.
        Frequencies and circumstances of falls in the National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA).
        J Epidemiol. 2000; 10: S90-S94
        • Denkinger M.D.
        • Lukas A.
        • Nikolaus T.
        • Hauer K.
        Factors associated with fear of falling and associated activity restriction in community-dwelling older adults: A systematic review.
        Am J Geriatr Psychiatry. 2015; 23: 72-86
        • Liu J.Y.
        Fear of falling in robust community-dwelling older people: Results of a cross-sectional study.
        J Clin Nurs. 2015; 24: 393-405
        • Bruce D.G.
        • Devine A.
        • Prince R.L.
        Recreational physical activity levels in healthy older women: The importance of fear of falling.
        J Am Geriatr Soc. 2002; 50: 84-89
        • Murphy S.L.
        • Williams C.S.
        • Gill T.M.
        Characteristics associated with fear of falling and activity restriction in community-living older persons.
        J Am Geriatr Soc. 2002; 50: 516-520
        • Cumming R.G.
        • Salkeld G.
        • Thomas M.
        • Szonyi G.
        Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M299-M305
        • Franzoni S.
        • Rozzini R.
        • Boffelli S.
        • et al.
        Fear of falling in nursing home patients.
        Gerontology. 1994; 40: 38-44
        • Tinetti M.E.
        • Mendes de Leon C.F.
        • Doucette J.T.
        • Baker D.I.
        Fear of falling and fall-related efficacy in relationship to functioning among community-living elders.
        J Gerontol. 1994; 49: M140-M147
        • Friedman S.M.
        • Munoz B.
        • West S.K.
        • et al.
        Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention.
        J Am Geriatr Soc. 2002; 50: 1329-1335
        • Deshpande N.
        • Metter E.J.
        • Lauretani F.
        • et al.
        Activity restriction induced by fear of falling and objective and subjective measures of physical function: A prospective cohort study.
        J Am Geriatr Soc. 2008; 56: 615-620
        • Arfken C.L.
        • Lach H.W.
        • Birge S.J.
        • Miller J.P.
        The prevalence and correlates of fear of falling in elderly persons living in the community.
        Am J Public Health. 1994; 84: 565-570
        • Iglesias C.P.
        • Manca A.
        • Torgerson D.J.
        The health-related quality of life and cost implications of falls in elderly women.
        Osteoporos Int. 2009; 20: 869-878
        • Suzuki M.
        • Ohyama N.
        • Yamada K.
        • Kanamori M.
        The relationship between fear of falling, activities of daily living and quality of life among elderly individuals.
        Nurs Health Sci. 2002; 4: 155-161
        • Lachman M.E.
        • Howland J.
        • Tennstedt S.
        • et al.
        Fear of falling and activity restriction: The survey of activities and fear of falling in the elderly (SAFE).
        J Gerontol B Psychol Sci Soc Sci. 1998; 53: P43-P50
        • van Haastregt J.C.
        • Zijlstra G.A.
        • van Rossum E.
        • et al.
        Feelings of anxiety and symptoms of depression in community-living older persons who avoid activity for fear of falling.
        Am J Geriatr Psychiatry. 2008; 16: 186-193
        • Hoang O.T.
        • Jullamate P.
        • Piphatvanitcha N.
        • Rosenberg E.
        Factors related to fear of falling among community-dwelling older adults.
        J Clin Nurs. 2017; 26: 68-76
        • Lee J.
        • Choi M.
        • Kim C.O.
        Falls, a fear of falling and related factors in older adults with complex chronic disease.
        J Clin Nurs. 2017; 26: 4964-4972
        • Burker E.J.
        • Wong H.
        • Sloane P.D.
        • et al.
        Predictors of fear of falling in dizzy and nondizzy elderly.
        Psychol Aging. 1995; 10: 104-110
        • Vellas B.J.
        • Wayne S.J.
        • Romero L.J.
        • et al.
        Fear of falling and restriction of mobility in elderly fallers.
        Age Ageing. 1997; 26: 189-193
        • Kressig R.W.
        • Wolf S.L.
        • Sattin R.W.
        • et al.
        Associations of demographic, functional, and behavioral characteristics with activity-related fear of falling among older adults transitioning to frailty.
        J Am Geriatr Soc. 2001; 49: 1456-1462
        • Romero-Ortuno R.
        • Cogan L.
        • Foran T.
        • et al.
        Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people.
        J Am Geriatr Soc. 2011; 59: 655-665
        • Ní Mhaoláin A.M.
        • Fan C.W.
        • Romero-Ortuno R.
        • et al.
        Frailty, depression, and anxiety in later life.
        Int Psychogeriatr. 2012; 24: 1265-1274
        • Hill K.D.
        • Schwarz J.A.
        • Kalogeropoulos A.J.
        • Gibson S.J.
        Fear of falling revisited.
        Arch Phys Med Rehabil. 1996; 77: 1025-1029
        • Tinetti M.E.
        • Richman D.
        • Powell L.
        Falls efficacy as a measure of fear of falling.
        J Gerontol. 1990; 45: 239-243
        • Bandura A.
        Reflections on self-efficacy.
        in: Rachman S. Advances in Behavior Research and Therapy, vol. 1. Pergamon, Oxford1978: 237-269
        • Akosile C.O.
        • Anukam G.O.
        • Johnson O.E.
        • et al.
        Fear of falling and quality of life of apparently-healthy elderly individuals from a Nigerian population.
        J Cross Cult Gerontol. 2014; 29: 201-209
        • Moore G.
        • Hartley P.
        • Romero-Ortuno R.
        Health and social factors associated with a delayed discharge amongst inpatients in acute geriatric wards: A retrospective observational study.
        Geriatr Gerontol Int. 2018; 18: 530-537
        • Austin N.
        • Devine A.
        • Dick I.
        • et al.
        Fear of falling in older women: A longitudinal study of incidence, persistence, and predictors.
        J Am Geriatr Soc. 2007; 55: 1598-1603
        • Murphy S.L.
        • Dubin J.A.
        • Gill T.M.
        The development of fear of falling among community-living older women: Predisposing factors and subsequent fall events.
        J Gerontol A Biol Sci Med Sci. 2003; 58: M943-M947
        • Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society
        Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons.
        J Am Geriatr Soc. 2011; 59: 148-157
        • Sharaf A.Y.
        • Ibrahim H.S.
        Physical and psychosocial correlates of fear of falling: Among older adults in assisted living facilities.
        J Gerontol Nurs. 2008; 34: 27-35
        • Li W.
        • Cheng R.
        Research on the influence factors of the fall efficiency of the hospitalized geriatric patients with cerebrovascular diseases.
        Pak J Pharm Sci. 2016; 29: 2343-2348
        • Maki B.E.
        • Holliday P.J.
        • Topper A.K.
        Fear of falling and postural performance in the elderly.
        J Gerontol. 1991; 46: M123-M131
        • Adkin A.L.
        • Frank J.S.
        • Carpenter M.G.
        • Peysar G.W.
        Fear of falling modifies anticipatory postural control.
        Exp Brain Res. 2002; 143: 160-170
        • Gagnon N.
        • Flint A.J.
        • Naglie G.
        • Devins G.M.
        Affective correlates of fear of falling in elderly persons.
        Am J Geriatr Psychiatry. 2005; 13: 7-14
        • Hughes C.C.
        • Kneebone I.I.
        • Jones F.
        • Brady B.
        A theoretical and empirical review of psychological factors associated with falls-related psychological concerns in community-dwelling older people.
        Int Psychogeriatr. 2015; 27: 1071-1087
        • Donoghue O.A.
        • Cronin H.
        • Savva G.M.
        • et al.
        Effects of fear of falling and activity restriction on normal and dual task walking in community dwelling older adults.
        Gait Posture. 2013; 38: 120-124
        • Young W.R.
        • Mark Williams A.
        How fear of falling can increase fall-risk in older adults: Applying psychological theory to practical observations.
        Gait Posture. 2015; 41: 7-12
        • Binda S.M.
        • Culham E.G.
        • Brouwer B.
        Balance, muscle strength, and fear of falling in older adults.
        Exp Aging Res. 2003; 29: 205-219
        • Whipple M.O.
        • Hamel A.V.
        • Talley K.M.C.
        Fear of falling among community-dwelling older adults: A scoping review to identify effective evidence-based interventions.
        Geriatr Nurs. 2018; 39: 170-177
        • Iaboni A.
        • Flint A.J.
        The complex interplay of depression and falls in older adults: A clinical review.
        Am J Geriatr Psychiatry. 2013; 21: 484-492
        • Brouwer B.J.
        • Walker C.
        • Rydahl S.J.
        • Culham E.G.
        Reducing fear of falling in seniors through education and activity programs: A randomized trial.
        J Am Geriatr Soc. 2003; 51: 829-834
        • Zijlstra G.A.
        • van Haastregt J.C.
        • Ambergen T.
        • et al.
        Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: Results of a randomized controlled trial.
        J Am Geriatr Soc. 2009; 57: 2020-2028
        • Sattin R.W.
        • Easley K.A.
        • Wolf S.L.
        • et al.
        Reduction in fear of falling through intense tai chi exercise training in older, transitionally frail adults.
        J Am Geriatr Soc. 2005; 53: 1168-1178
        • Blake H.
        • Hawley H.
        Effects of tai chi exercise on physical and psychological health of older people.
        Curr Aging Sci. 2012; 5: 19-27