According to a new study, an older person who is concerned about having a fall is at a significantly higher risk of having a fall in the future. Researchers say that identifying and addressing this risk factor in older adults can help them stay mobile and independent for longer.
In 2015, the estimated cost to the US healthcare system of fatal and non-fatal falls was around US$50 billion. In our aging global population, reducing the number of falls among older adults is a high priority. That is why newly published international research into a particular fall risk factor is important.
Researchers from Australia, the UK, Germany and Canada undertook a systematic review and meta-analysis of studies examining the association between older adults’ fear, or concerns, about falling and the incidence of future falls, and found a link.
“Concerns about falling are highly prevalent in older adults, affecting nearly one in two people by age 86,” said the study’s senior author, Professor Kim Delbaere, from the Falls, Balance and Injury Research Center, which is part of Neuroscience Research Australia (NeuRA). “They have been linked to reduced quality of life and independence, poor rehabilitation outcomes and increased risk of frailty, disability and admission to care homes.”
The researchers analyzed 53 studies comprising 75,076 participants. The studies explored the association between baseline concerns about falling – or related factors, such as balance confidence – and future falls over a follow-up period of at least six months. They were conducted in both community dwellings and institutions, and the participants were aged 60 and older. The Falls Efficacy Scale-International (FES-I) and the short version of the scale, Short FES-I, were used to measure “concerns about falling.” Both scales have been shown to have good reliability and validity. The studies also used single-item measures of concern (e.g., asking participants, “Are you afraid of falling?”). These measurements were compared with the rate of falls that occurred during the follow-up period.
The data showed that for every one-point increase in concern about falling according to the FES-I, there was a 3% higher risk of future falls. For every one-point increase in concern under the Short FES-I, there was an 8% higher risk of future falls. On the single-item measure of concern, high concern about falling increased the risk of future falls by 60% compared to low concern. Confidence in one’s ability to balance was found not to significantly predict future falls.
“Our analysis found that older adults with high concerns about falling were significantly more likely to experience a fall,” Delbaere said. “While we already knew having prior falls was a risk factor for developing concerns about falling, this research found falling can be both a cause and a consequence of falls.
“Importantly, this increased risk was observed even after accounting for key physical risk factors such as age, previous falls and balance impairments. This means that concerns about falling are not just a reflection of physical frailty but an independent factor influencing future falls.”
The systematic review had several limitations. There was wide variability across the studies examined, particularly in confounding variables, study inclusion and exclusion criteria, and consistency regarding the assessment of falls. The exclusion of people with significant cognitive or neurological impairments limited the generalizability of the findings. In some studies, high levels of participants left before the study had ended. Nonetheless, the researchers say their findings still fill a gap in evidence and have clinical use.
“The first step in prevention is starting the conversation,” said Delbaere. “Many older adults don’t talk about their concerns unless asked, yet these concerns are real and can increase their risk of falling. By routinely discussing concerns about falling, healthcare professionals, families, and caregivers can help older adults take early action to stay active and independent.
“By identifying concerns about falling and other risk factors early and providing the right interventions, we can help older adults stay active, independent and confident in their mobility, ultimately improving their quality of life.”
In addition to NeuRA, the other institutions involved in the study were Imperial College London, the University of Manchester and the University of Winchester in the UK, Heidelberg University in Germany, and the University of Calgary, Canada.
The study was published in the journal Age and Ageing.
