Study: Key Identifying Factors Could Determine Strategies to Prevent Fear of Falling

May 21, 2020

Fear of falling (FoF) is common in older adults and may lead to physical decline, disability, reduced quality of life, and falls. A study in the May issue of JAMDA details how identifiable factors—such as use of a walking aid and/or depressive symptoms—could help determine specific preventive strategies for addressing FoF in this population.

In Predictors of Incident Fear of Falling in Community-Dwelling Older Adults, the authors studied a sample of community-dwelling people age 60 and older. They found that older age, walking aid use, and a higher burden of depressive symptoms at baseline were predictors of incident FoF. At baseline, individuals with FoF also had worse performance in balance and physical function tests, had a higher comorbidity burden, were taking a higher mean number of antihypertensives, and were more frequently taking tricyclic antidepressants and sleeping medications.

The authors observed that by identifying people at greatest risk of FoF, they could recognize those who could benefit the most from interventions to increase falls-related self-sufficiency. For instance, they said, “On the basis of our results, we hypothesize that the walking aid could be a marker of balance that identifies those subjects who feel unsteady and are more likely to become fearful before they explicitly acknowledge FoF. Therefore, the walking aid could be considered as a prodromal sign that precedes the development of FoF.” At the same time, they suggested, “Depressive symptoms may represent the consequences of social isolation and loss of independence due to activity restriction.” The authors indicated that detecting and treating depression may help prevent FoF.

A past fall and FoF are often connected; the authors suggested that a possible explanation for this is that falls and FOF are “not directly related but share common underlying risk factors, such as age, gait and balance impairments, and vision problems.”

The authors concluded, “These predictors can be easily assessed during a routine clinical evaluation.” This will enable the identification of patients who are at risk of developing future FoF. Additionally, they said that modifiable risk factors, such as depressive symptoms, “may represent a target for preventive strategies.”

This study was conducted by researchers at Hypertension Centre, Syncope Unit and Referral Centre for Hypertension in the Elderly Department of Geriatrics and Geriatric Intensive Care Unit, University of Florence, Italy; and Discipline of Medical Gerontology and Falls and Syncope Unit, Mercer’s Institute for Successful Ageing, St. James Hospital, Dublin, Ireland. 

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JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

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AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.