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Article

Falls of Older Adults: Which Is Worse, Falling or Fear of Falling?

by
Ahuva Even-Zohar
1,*,
Shulamith Kreitler
2 and
Hanna Gendel Guterman
1
1
School of Social Work, Faculty of Social Sciences, Ariel University, Ariel 40700, Israel
2
School of Psychological Science, Faculty of Social Science, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel
*
Author to whom correspondence should be addressed.
J. Ageing Longev. 2025, 5(2), 20; https://doi.org/10.3390/jal5020020
Submission received: 23 March 2025 / Revised: 3 June 2025 / Accepted: 9 June 2025 / Published: 16 June 2025
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Abstract

:
Falls among older adults create major damage to their quality of life. The present study explores which has a greater impact on this quality and feeling of safety in daily life—falling itself or the fear of falling. A stratified sample of 403 Israelis aged 55–80 years was recruited through a panel survey company, and self-reported questionnaires were completed. The questions included history of the number of past falls, as well as meaning and quality of life, along with the feeling of safety. Fear of falling was directly measured using a new scale as an additional measure to the feeling of safety. The research analysis was based on a theoretical model, tested by path analysis. The main findings show that fear of falling has a greater negative impact on the feeling of safety and quality of life than actually falling and is significantly influenced by subjective psychological feelings. The implications for clinical practice should be to raise awareness among the staff who care for older adults of the psychological fear of falling among the adults in their care and build both diagnosis and treatment programs for treating and reducing the fear of falling. Such programs have to be built by organizations, either in institutions or in meetings organized for community-dwelling older adults.

1. Introduction

Falling among older adults has become a common occurrence around the world that is becoming more prevalent. At present, it is expected that a third of the older adults in Israel will fall at least one time during their life [1]. According to the World Health Organization (WHO), a fall is defined as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level, with or without injury” [2].
The results of such occurrences can be severe, especially for older adults. First, major damage to their quality of life can result, and older adults have the highest risk of death or serious injury arising from falls, with the risk increasing with age [3]. Second, the state health system is negatively impacted by the growing expenses of health and nursing care [4,5]. The problem of falling among older adults has already been addressed by health organizations in order to reduce this occurrence. In both existing and new programs dealing with this problem, the focus is on either physical health or environmental/surrounding factors. Yet research has found that it is not just the act of falling itself but also the fear of falling (FOF) that contributes to negative consequences. There is existing research on the negative effects of fear regarding the feeling of safety, but some present a narrow approach [6,7,8]. In a meta-analysis, it was found that demographic factors associated with the fear of falling include physical function, chronic diseases, and mental health problems [9]. Recent research projects have taken a broader approach by examining more factors, including dependence on daily activities, medications, activity restrictions, vision, and self-assessment of health and depressive symptoms and quality of life (QOL) [10,11]. However, in most studies, fear is actually measured by the feeling of safety in performing daily activities. The present study aimed to broaden the existing research by directly measuring the fear of falling.
Fear of falling was largely researched in the 20th and 21st centuries. Jung et al. [12] present the evolution of the definition for fear of falling: it was first described as “ptophobia,” meaning a phobic reaction to standing or walking [13], then classified as “Post fall syndrome” [6]. Tinetti and Powell [7] described FOF as an ongoing concern about falling of such magnitude that an avoidance of performing many daily activities develops. Furthermore, Tideiksaar [14] and Liu et al. [15] found that there is an unhealthy avoidance of activities due to FOF.
Fear of falling, whether or not related to a previous fall, can have a major impact on older adults and has been found to be predictive of future falling, with no relation to previous falling events [12,15,16,17]. Among individuals who have fallen, a high percentage (40–73%) expressed a fear of falling. Even among older adults who have never fallen, up to half have a fear of falling [18,19]. Young and Williams [20] explained that the fear of falling mediation mechanism influences actual falling by changes in the allocation of attention and associated alterations in motor control.
Fear of falling has been connected with negative developments: reduced movement of daily living [21]; reduced physical activity [22,23]; lower perceived physical health status with poorer health conditions showing a greater effect on ease of falling than do sensory and cognitive elements [24,25]; and lower quality of life [22,25,26,27].
Most research has been performed using safety scales as a proxy to assess the fear of falling. Examining these scales reveals that they measure the feeling of safety when conducting daily tasks [17,28,29]. Research that included fall events as a variable in the association with the feeling of safety, i.e., self-efficacy towards completing basic activities of daily tasks without fear of falling, found that it is an independent predictor, different from quality of life, and dependent on many other factors, proved by the fact that non-fallers are also afraid of their safety or of falling [18]. The feeling of safety among people without mobility restrictions or increased fall risks either had the lowest score of safety, or it increased directly with the number of falls experienced [30]. Soh et al. [28] found that fear of falling might not be enough to empower older people to deal with an actual fall or to gain feelings of safety and recovery post-fall.
Fear of falling is linked to activity restriction and poorer physical and cognitive functions and may be a key contributor to a reduced QOL [30,31]. The objectives of the systematic review completed by Schoene et al. [30] found a strong relation between lower levels of FOF and higher perceived QOL, and the relationship appears to be more significant than other predictors such as age and gender. It was also discovered in a multivariate analysis that FOF stayed as an independent forecaster of QOL. The assessment of the quality of life in old age is a subjective, multi-dimensional assessment of older adults’ personal well-being consisting of two components: [1] a cognitive component in which a person judges their personal life comprehensively; [2] an emotional component in which a person reports positive emotions [30,32]. QOL is a measure that relates to the main areas of life and reveals the extent to which they affect each other such as autonomy, role and activity, marital status, relationships, emotional comfort, financial security, and health status [33].
Healthy aging has been described as developing and maintaining the functional ability that enables well-being in older age [34]. There is a wide diversity of health among individuals of similar ages in the group of older adults. Therefore, age itself cannot objectively describe the health status of each individual [35]. Additionally, it was found that falls are correlated to health status, with poorer health conditions showing a greater effect on ease of falling than sensory and cognitive elements [36]. In addition, ‘level of function’ is defined as the ability of an individual to execute tasks and social interactions in daily undertakings. There are two levels in general: Basic Activities of Daily Living (BADL) that include essential tasks such as dressing oneself, bathing, toileting, and eating; Instrumental Activities of Daily Living (IADL) that include shopping alone and traveling alone [37]. The measure of what is called “the feeling of safety” includes the feelings evoked by both types of activities. Regarding the issue of fear of falling, it can be assumed that performing the IADL actions will induce greater fear than BADL actions [38].
The meaning of life (MOL) has been found to have an effect on a range of life conditions, including being a significant resource for overcoming difficulties in life, as a mitigating factor of trauma outcomes, as a helper in dealing with adverse events, and helping to overcome fear of death [39,40]. MOL is sometimes wrongly regarded as equal to QOL, because QOL is influenced by the life history of the individual and its after-effects [41]. The results showed that MOL was positively correlated with the total QOL score, which included scores of emotional state, functional state, and physical state [42]. According to Kreitler [42], the concept of the meaning of life could be assumed to help in dealing with the consequences of falls. The meaning of life can be described in terms of several components, including mental state, functional state, and physical state, and therefore, regarding older adults, the MOL is of considerable importance [43].
In summary, the above literature supports the importance of researching falls among older adults. However, it is focused on the falling aspect with little attention given to correlated factors. For example, the fall survey conducted in 2019 [1] in Israel explored the occurrence of falling and the fear of falling among older adults. The survey data show that about 1000 adults fall every day in Israel. One in four people aged 65 and over in Israel report that they have fallen at least once in the past year, with the incidence of falls increasing with age. About 50% of people aged 65 and over report a fear of falling, with a significantly higher fear of falling among those who have fallen at least once [1].
In view of the above, the aim of this study was first to add knowledge to the subject of falling by directly measuring the fear of falling as an additional element of safety feeling, as well as the history/number of falls. Thus, the theoretical model is an addition to the existing theory. This addition enables us to examine the most fundamental question: Is the fall itself or the fear of falling (again) more detrimental to the feeling of safety and QOL of older adults? It enables us to see a more holistic “picture”. Although direct and indirect relations concerning falls and FOF have been reported [11], the current research measured FOF directly and separately from safety feelings. In addition, this study can explore the connections between falls and other factors among older adults, such as MOL. Thus, the results can serve to guide in building therapy programs to reduce the psychological effects of falling. Accordingly, we formulated six hypotheses.
The first hypothesis addresses the connection that was found between fear of falling, the actual number of falls experienced, and the connection with an individual’s health status [12,15,16,17].
a. Fear of falling increases with the number of falls.
b. Fear of falling decreases with good health.
The second hypothesis is based on the association between an individual’s feeling of safety, the actual number of falls experienced, and their fear of falling [6,7,8].
a. There is a negative correlation between the feeling of safety and the number of falls.
b. There is a negative correlation between the feeling of safety and fear of falling.
The third hypothesis is based on the connection that was found between fear of falling and an individual’s quality of life [22].
There is a negative correlation between fear of falling and quality of life.
The fourth hypothesis addresses the connection that was found between the meaning of life and quality of life [42] and examines the meaning of life in relation to the fear of falling.
a. More positive meaning of life leads to increased quality of life.
b. More positive meaning of life leads to reduced fear of falling.
The fifth hypothesis addresses the association that was found between an individual’s health and their feeling of safety [6,7,8].
There is a positive correlation between good health and the feeling of safety.
The sixth hypothesis addresses the effect of the fear of falling that was found on both an individual’s safety feeling and actual falls [6,7,8,15,16,17].
Fear of falling decreases the feeling of safety more than the number of falls.
A theoretical model of the relationships between the meaning of life and quality of life and their effect on falling, fear of falling, and health of older adults, and the hypotheses developed from these relationships are displayed in Figure 1. This theoretical model is created for the current study and is based on the research variables in accordance with previous studies, as reviewed above.

2. Materials and Methods

2.1. Ethical Approval and Procedure

After receiving approval (AU-SOC-AEZ-20210426; 26 April 2021) from the Ethics Committee of the university at which the study was conducted, the research was based on a survey conducted among Israeli adults and older adults. The panel survey company recruited individuals who met the study criteria: men and women aged 55 and over. The company then explained the purpose of the fall research and provided the questionnaires. Anonymity and confidentiality were promised and respected throughout the process because of the sensitivity of the issues, and participants were asked to sign an informed consent form. The respondents were chosen by using stratified sampling according to age and gender, with confirmation that half of the sample had experienced at least one fall in the five preceding years. The selection method was a simple random sampling within each stratum. The stratified system was used in order to produce a statistically valid size of subgroups for comparisons.

2.2. The Sample

The sample included 403 respondents living in their own homes in Israel, half males (202) and half females (201). The range of age was between 55 and 86 years. Only 37% were less than 65 years of age. Regarding level of education, 47% had a high school degree and 53% had an academic degree; for the level of economic condition within the age group, 23% were below average, 55% average, and 22% above average. In addition, 48% had severe effects from falling in the past, 38% had at least one fall in the last year, and 28% had two falls in the last three years. Table 1 describes the characteristics of the two groups: those who had fallen and those who had not. Although sampling methods were based on probabilities and thousands of panel members were selected, no significant differences were found except for gender, which showed relatively more females who had fallen.

2.3. Measurements

The survey instrument consisted of seven questionnaires, with some of them having been tested in previous studies: (1) feeling of safety—the scale of the feeling of safety was based on the Activities-specific Balance Confidence (ABC) scale [44] and the Falls Efficacy Scale (FES) [6]. Most research has been performed using the FES or ABC scale to assess the fear of falling. Examining these scales reveals that they measure the feeling of safety when conducting daily tasks [28]. Therefore, in this research, these scales were used but were named “safety feeling” in order to differentiate them from the feeling of fear, which was measured directly (see below). In the current study, (2) scale of quality of life was based on The Short Depression-Happiness Scale (SDHS) [45]; (3) health status included questions based on Physical Functioning the SF-36 Health Survey [46]; (4) the scale of Meaning of Life was based on the meaning of life scale [42]; (5) questionnaire on the number of falls was compiled for the current study related to the history of past falls, numbers, and results; (6) questionnaire on the fear of falling was compiled for the current study related to the fear of falling; (7) a socio-demographic questionnaire.

2.4. Statistical Analysis

The analyses included six statistical tools: confirmatory analysis; reliability tests; two-sided correlation test; t-tests of independent difference mean (SPSS 29); path analysis using Structural Equation Modeling (SEM) based on the maximum likelihood approach (Amos 29); and mediation test under process 4.1.

3. Results

3.1. Reliability of the Questionnaires

Table 2 presents the number of items in each questionnaire and their reliability.
In order to construct validated scales, a Confirmatory Factor Analysis (CFA) was performed based on three scales with fifteen items. The scales were health status, quality of life, and fear of falling. The results show acceptable fit for all measurements (χ2 value (207) = 127.1 (55), p < 0.05 (χ2/df = 2.311); Comparative Fit Index (CFI) = 0.98; Normed Fit Index (NFI) = 0.96; and Root Mean Square Error of Approximation (RMSEA) = 0.057. The construct standardized regression estimates for all items were above 0.50, reflecting the acceptable fit of the measures. Meaning of life and safety feeling were not included due to containing an excessive number of items.

3.2. Pearson Correlation

To test the hypotheses, a Pearson correlation test between the study’s variables was conducted, and the results are summarized in Table 3.
The results of the correlation test (Table 3) show that the number of falls increases FOF, whereas good health decreases FOF. Thus, the two parts of the first hypothesis were accepted. Regarding the difference in the two levels of safety feeling, BADL is correlated −0.544 ** to fear, while IADL is correlated −0.568 ** to fear. Hence, no significant difference was found regarding these two levels of functions.

3.3. Comparing Those Who Have and Have Not Fallen

To test differences between those who fell and those who did not fall with regard to fear of falling, safety feeling, and good health, a t-test was conducted (Table 4).
Table 4 reveals that even people who have never fallen have a FOF and other symptoms associated with FOF, but with lower intensity than people who have fallen.
The results of the correlation test (Table 3) also reveal a significant negative correlation between safety feelings and the number of falls, as well as a significant negative correlation between safety and FOF. Thus, the two parts of the second hypothesis were accepted. As hypothesized (the third hypothesis), a negative correlation was found between FOF and QOL. MOL was found to increase QOL but did not decrease FOF. Part one of the fourth hypothesis was accepted, and part two of the fourth hypothesis was rejected. Good health is highly positively correlated to the feeling of safety. The fifth hypothesis was accepted.

3.4. The Relationships Between Fear of Falling and the Other Variables

To test the sixth hypothesis, Fisher’s Z transformation of the correlation coefficient test was conducted. The negative correlation between FOF and safety feeling was higher (−0.580) than the negative correlation between number of falls and safety feeling (−0.217) (Z = 4.09, p < 0.001), leading to acceptance of the sixth hypothesis.
In order to explore all the connections between fear of falling and the other factors in the research, as well as the inter-correlation between them, a theoretical model was built. To test the research model hypotheses, path analysis was carried out using Structural Equation Modeling (SEM) based on the maximum likelihood approach (Amos 29). In this model, the number of falls was used to represent falling history. The overall fit statistics (goodness of fit measures) exhibit an acceptable level of fit (χ2 value (6) = 15.654, χ2/Df < 2.60, p = 0.016; CFI = 0.979; NFI = 0.968; RMSEA = 0.063), supporting the validity of the path model. The model explains 42% of the variance of the feeling of safety and 10% of quality of life, 26% of fear, and 17% of health status. Because the correlation between age and FOF and safety feeling was low, and after testing the model with and without age, it was not included in the path analysis.
In a path analysis using age of falling as representative of fall history, the results were similar, with a better overall statistic (χ2 value (6) = 10.140, χ2/Df < 1.690; p = 0.119; CFI = 0.990; NFI = 0.977; RMSEA = 0.041). Table 4 displays the results of the relations in the model, and Figure 2 displays the results graphically. (The numerical values in the figure present the b-coefficients that indicate the relations between the variables.)
Table 5 and Figure 2 demonstrate that FOF itself is affected by the number of falls and health status. Hence, the two parts of the first hypothesis were accepted. The major variables of directly predicting safety are health and fear of falling; therefore, the second part of the second hypothesis and the fifth hypothesis were accepted. There is an indirect negative relation between the feeling of safety and the number of falls. The first part of the second hypothesis was accepted. Although a portion of the FOF reduces QOL, indirectly, QOL is reduced. The third hypothesis has two directions and was accepted. The meaning of life contributes positively to the quality of life, while fear of falling is increased by the meaning of life. Only the first part of the fourth hypothesis was accepted.
Regarding the sixth hypothesis, the results indicate first that the feeling of safety is directly affected by FOF but not directly by the number of falls (Figure 2). Second, the total effect of FOF on safety feeling is −0.455, whereas the total effect of the number of falls is −0.140. (Table 5).

3.5. Fear of Falling as a Mediator Between the Number of Falls and Safety Feeling

In addition, a test of mediation was conducted (Figure 3). The mediator between the number of falls and the feeling of safety was FOF. The b-coefficient between the number of falls (the independent variable) and fear of falling (the mediator) was b = −0.333 (p < 0.001), and between fear of falling and safety feeling (the dependent variable) was b = −0.373 (p < 0.001). The relation between the number of falls and safety feeling was significant at 0.135 (p < 0.001). After adding the mediator variable to the regression equation, b was reduced to 0.010, with no significance (p = 0.681). To test the significance of this mediation, the Sobel test was applied. The decrease in the b-coefficient was significant (Z = 6.84, p < 0.001). Thus, FOF indicated a mediating effect on the relation between the number of falls and the feeling of safety.

4. Discussion

The main aim of this research was to explore the consequences of falling and the fear of falling among older adults. Indeed, the results of our study show that falls in the past (number of falls) are associated with an increased fear of falling and may further increase the fear of falling. In the first part of the first hypothesis, but even among those who have not fallen in the past, there is a fear of falling, albeit with a lesser intensity. This is in agreement with a previous study [47] that found that the fear of falling also exists in the absence of falling. That is, the fear of falling is a major issue for older people who are watching other people in their age group falling and suffering from its consequences. These findings are in line with previous research findings [18,19]. This outcome emphasizes that the occurrence of falling is associated with both the physical health and psychological state of older people.
Regarding the feeling of safety when performing daily activities, it was found that there are two main factors that affect it. First is bad health, which is destructive and greatly diminishes the feeling of safety. Indeed, it was found that good health was correlated to the feeling of safety. Health status was found to impact the subjective well-being levels of an older person, confirming the fifth hypothesis, which supports findings from previous studies that risk factors for falling included healthy, cognitively and sensory impaired, and health impaired [36]. Second is the fear of falling, which is a new, direct measurement in the current study, that decreases the feeling of safety, as postulated in the first part of the second hypothesis.
The generally accepted association of falls with the disability-adjusted life years (DALYs) [48]. Two persons with the same condition may not accurately reflect the impact of fall-related disabilities for older people. A new addition to fall research findings is the acceptance of the sixth hypothesis. The history of falls (number of falls) has a weaker relation with the feelings of safety, and, moreover, it is not a direct effect but manifests through the mediation of FOF. This finding indicates that the feeling of safety is not an “objective” one that is represented only by the physical condition of the older adults, but rather, is significantly influenced by “subjective” feelings such as fear.
The other research aim was to explore the function of the psychological factors, MOL and QOL, on the unfortunate outcomes of falling. The relationship between QOL and safety was found to be entangled. From one direction, as postulated with the third hypothesis, FOF reduces the feeling of a positive QOL, which affects the activities of older adults or reduces social connections. This finding can be interpreted based on the research of Bowling et al. [32] that identifies the main independent predictors of self-rated global quality of life as social comparisons and expectations; personality and psychological characteristics; health and functional status; and personal and neighborhood social capital factors. From another direction that was not considered, QOL had an indirect positive outcome on the feeling of safety through its positive connection to improving health status. Older adults who believe that they have a good life in spite of becoming older and experiencing bad events in the past are able to better cope with bad experiences [41].
Meaning of life was found to increase quality of life, as postulated in the first part of the fourth hypothesis, in agreement with earlier research findings [41,42] that two persons with the same objective QOL measures, including health, economic, and social life, will differ in their subjective evaluation of their quality of life if they also differ in their level of MOL. This results from QOL, including both a cognitive and an emotional aspect [33].
Concerning the role of MOL, it was found to have a small significant effect on FOF but no significant effect on safety feeling. Its influence comes indirectly through QOL; MOL is rather a constant personality trait that is not affected by life events, even falling, as found in previous research [31].
The current study has several limitations. First, the sample includes participants in only one country and probably cannot be extrapolated to populations in other countries with different cultures. Second, the sample was formed using a Web panel with participants who might be more active than the regular general older adult population. Such a sample may limit the generalizability of the findings. It is recommended for future studies to strive to collect data from a wide range of older populations in terms of other cultures. Third, no significant differences were found in comparing age groups in the sample. As life expectancy increases, people of higher ages should be included in the sample, enabling comparisons between the older and younger age groups. Some other factors should be added in future research with a focus on health before falling without chronic sickness or the effect of dietary pattern on the risk of falling [38].

5. Conclusions

The theoretical contribution of this study is the use of path analysis that uncovers how the fear of falling develops and the important finding that FOF has the role of a mediator with a greater negative impact on the feeling of safety and, therefore, on QOL than actual falling. To our knowledge, few studies have been conducted using a Structural Equation Modeling approach regarding falls and fear of falling, along with other factors such as QOL and MOL, all of which were used in the current study. This Structural Equation Modeling is an important theoretical contribution to this research topic. Although direct and indirect relations concerning falls and FOF have been reported [11], the current research measured FOF directly and separately from the feeling of safety. Regarding the factors in the model, a theoretical contribution is the combination of QOL and MOL topics that were integrated in the model, exposing their different connections to the outcomes of falling.
The empirical contribution arises from the fact that most of the current programs for improving the life of older adults focus on physical aspects, such as modifying the environment in order to decrease the number of falls [49,50]. For example, there is a positive role for physical interventions in reducing FOF among frail and pre-frail older adults [51]. But clearly, that approach is not sufficient. The implications for clinical practice should be to focus on building programs for the treatment of the fear of falling. It is necessary to raise awareness of the problem of the fear of falling among the staff who care for older adults, such as physicians, psychiatrists, psychologists, social workers, and physical therapists, to build a program of diagnosis and treatment plans in order to help patients overcome this type of anxiety. Programs should be built to reduce the fear of falling, first through acknowledgment by older adults that their peers experience the same feelings and that there is no reason to be ashamed of or hide these feelings. The program must include psychological elements aimed at reducing this fear. Thus, areas of treatment should include psychological elements, such as legitimizing these feelings of fear of falling, as well as providing tools to deal with the fear. For example, it is recommended to develop both group therapy and individual therapy skills. Another recommended tool is practicing Tai Chi, which involves both physical and psychological elements [27]. Education for older adults themselves should include workshops and programs to raise awareness and to provide practical tools to deal with the fear of falling. Such appropriate programs should include exploring the level of fear of each adult who has fallen and the sources of this fear. Detailed information should be distributed among older adults that explains that falling is not the end to quality of life and includes the benefits of overcoming the fear of falling. For example, strengthening self-confidence through the use of aids such as items in a fall prevention kit given to the older adults, which has been found to contribute to strengthening confidence and reducing the risk of falls [37]. In addition, it is useful to combine various techniques related to the mind, such as breathing exercises, to reduce anxiety. Such care programs should be both in the community through clubs and day centers, health insurance funds, welfare departments, and institutional settings for older adults.

Author Contributions

A.E.-Z.: Conceptualization, data curation, resources, writing—original draft preparation. S.K.: Conceptualization. H.G.G.: Conceptualization, methodology, formal analysis, investigation, data curation, writing—original draft preparation. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Ariel University (protocol code AU-SOC-AEZ-20210426, 26 April 2021).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Israel Ministry of Health. Israel National Elderly Falls Survey 2019; Israel Ministry of Health, National Center for Disease Control: Jerusalem, Israel, 2021. Available online: https://www.gov.il/BlobFolder/reports/israel-national-elderly-falls-survey-2019/he/files_publications_units_ICDC_israel-national-elderly-falls-survey-2019.pdf (accessed on 16 February 2022).
  2. World Health Organization. Falls; World Health Organization: Geneva, Switzerland, 2021. Available online: https://www.who.int/news-room/fact-sheets/detail/falls (accessed on 2 February 2022).
  3. Xie, Q.; Pei, J.; Gou, L.; Zhang, Y.; Zhong, J.; Su, Y.; Wang, X.; Ma, L.; Dou, X. Risk Factors for Fear of Falling in Stroke Patients: A Systematic Review and Meta-Analysis. BMJ Open 2022, 12, e056340. [Google Scholar] [CrossRef]
  4. Haddad, Y.K.; Bergen, G.; Florence, C.S. Estimating the Economic Burden Related to Older Adult Falls by State. J. Public Health Manag. Pract. 2019, 25, E17–E24. [Google Scholar] [CrossRef]
  5. Williams, S.A.; Daigle, S.G.; Weiss, R.; Wang, Y.; Arora, T.; Curtis, J.R. Economic Burden of Osteoporosis-Related Fractures in the US Medicare Population. Ann. Pharmacother. 2021, 55, 821–829. [Google Scholar] [CrossRef]
  6. Murphy, J.; Isaacs, B. The Post-Fall Syndrome. Gerontology 1982, 28, 265–270. [Google Scholar] [CrossRef] [PubMed]
  7. Tinetti, M.E.; Powell, L. 4 Fear of Falling and Low Self-Efficacy: A Cause of Dependence in Elderly Persons. J. Gerontol. 1993, 48, 35–38. [Google Scholar] [CrossRef] [PubMed]
  8. Ellmers, T.J.; Wilson, M.R.; Norris, M.; Young, W.R. Protective or Harmful? A Qualitative Exploration of Older People’s Perceptions of Worries about Falling. Age Ageing 2022, 51, afac067. [Google Scholar] [CrossRef]
  9. Xiong, W.; Wang, D.; Ren, W.; Liu, X.; Wen, R.; Luo, Y. The Global Prevalence of and Risk Factors for Fear of Falling among Older Adults: A Systematic Review and Meta-Analysis. BMC Geriatr. 2024, 24, 321. [Google Scholar] [CrossRef]
  10. Fernandes, S.; Sales, W.; Tavares, D.; Pereira, D.; Nóbrega, P.; Holanda, C.; Maciel, A. Relationship between Pain, Fear of Falling and Physical Performance in Older People Residents in Long-Stay Institutions: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2022, 19, 12014. [Google Scholar] [CrossRef]
  11. Dos Santos, E.P.R.; Ohara, D.G.; Patrizzi, L.J.; De Walsh, I.A.P.; Silva, C.D.F.R.; Da Silva Neto, J.R.; Oliveira, N.G.N.; Matos, A.P.; Iosimuta, N.C.R.; Pinto, A.C.P.N.; et al. Investigating Factors Associated with Fear of Falling in Community-Dwelling Older Adults through Structural Equation Modeling Analysis: A Cross-Sectional Study. J. Clin. Med. 2023, 12, 545. [Google Scholar] [CrossRef] [PubMed]
  12. Jung, D.-Y.; Shin, K.-R.; Kang, Y.-H.; Kang, J.-S.; Kim, K.-H. A Study on the Falls, Fear of Falling, Depression, and Perceived Health Status among the Older Adults. Korean J. Adult Nurs. 2008, 20, 91–101. [Google Scholar]
  13. Bhala, R.P.; O’Donnell, J.; Thoppil, E. Ptophobia: Phobic Fear of Falling and Its Clinical Management. Phys. Ther. 1982, 62, 187–190. [Google Scholar] [CrossRef] [PubMed]
  14. Tideiksaar, R. Falls in Older People: Prevention and Management, 4th ed.; Health Professions Press: Baltimore, MD, USA, 2010; ISBN 1-932529-44-6. [Google Scholar]
  15. Liu, M.; Hou, T.; Li, Y.; Sun, X.; Szanton, S.L.; Clemson, L.; Davidson, P.M. Fear of Falling Is as Important as Multiple Previous Falls in Terms of Limiting Daily Activities: A Longitudinal Study. BMC Geriatr. 2021, 21, 350. [Google Scholar] [CrossRef] [PubMed]
  16. Weber, M.; Schnorr, T.; Morat, M.; Morat, T.; Donath, L. Effects of Mind–Body Interventions Involving Meditative Movements on Quality of Life, Depressive Symptoms, Fear of Falling and Sleep Quality in Older Adults: A Systematic Review with Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 6556. [Google Scholar] [CrossRef]
  17. Akosile, C.O.; Igwemmadu, C.K.; Okoye, E.C.; Odole, A.C.; Mgbeojedo, U.G.; Fabunmi, A.A.; Onwuakagba, I.U. Physical Activity Level, Fear of Falling and Quality of Life: A Comparison between Community-Dwelling and Assisted-Living Older Adults. BMC Geriatr. 2021, 21, 12. [Google Scholar] [CrossRef] [PubMed]
  18. Friedman, S.M.; Munoz, B.; West, S.K.; Rubin, G.S.; Fried, L.P. 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. [Google Scholar] [CrossRef]
  19. 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. Ser. A Biol. Sci. Med. Sci. 2003, 58, M943–M947. [Google Scholar] [CrossRef]
  20. 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. [Google Scholar] [CrossRef]
  21. Martin, F.C.; Hart, D.; Spector, T.; Doyle, D.V.; Harari, D. Fear of Falling Limiting Activity in Young-Old Women is Associated with Reduced Functional Mobility Rather than Psychological Factors. Age Ageing 2005, 34, 281–287. [Google Scholar] [CrossRef]
  22. Li, F.; Fisher, K.J.; Harmer, P.; McAuley, E.; Wilson, N.L. Fear of Falling in Elderly Persons: Association with Falls, Functional Ability, and Quality of Life. J. Gerontol. Ser. B Psychol. Sci. Soc. Sci. 2003, 58, P283–P290. [Google Scholar] [CrossRef]
  23. Turunen, K.M.; Kokko, K.; Kekäläinen, T.; Alén, M.; Hänninen, T.; Pynnönen, K.; Laukkanen, P.; Tirkkonen, A.; Törmäkangas, T.; Sipilä, S. Associations of Neuroticism with Falls in Older Adults: Do Psychological Factors Mediate the Association? Aging Ment. Health 2022, 26, 77–85. [Google Scholar] [CrossRef]
  24. Brouwer, B.; Musselman, K.; Culham, E. Physical Function and Health Status among Seniors with and without a Fear of Falling. Gerontology 2004, 50, 135–141. [Google Scholar] [CrossRef]
  25. Clemson, L.; Cumming, R.G.; Heard, R. The Development of an Assessment to Evaluate Behavioral Factors Associated with Falling. Am. J. Occup. Ther. 2003, 57, 380–388. [Google Scholar] [CrossRef] [PubMed]
  26. Orihuela-Espejo, A.; Álvarez-Salvago, F.; Martínez-Amat, A.; Boquete-Pumar, C.; De Diego-Moreno, M.; García-Sillero, M.; Aibar-Almazán, A.; Jiménez-García, J.D. Associations between Muscle Strength, Physical Performance and Cognitive Impairment with Fear of Falling among Older Adults Aged ≥ 60 Years: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2022, 19, 10504. [Google Scholar] [CrossRef]
  27. Salkeld, G.; Cameron, I.D.; Cumming, R.G.; Easter, S.; Seymour, J.; Kurrle, S.E.; Quine, S. Quality of Life Related to Fear of Falling and Hip Fracture in Older Women: A Time Trade off Study. BMJ 2000, 320, 341–346. [Google Scholar] [CrossRef] [PubMed]
  28. Soh, S.L.-H.; Tan, C.-W.; Thomas, J.I.; Tan, G.; Xu, T.; Ng, Y.L.; Lane, J. Falls Efficacy: Extending the Understanding of Self-Efficacy in Older Adults towards Managing Falls. J. Frailty Sarcopenia Falls 2021, 6, 131–138. [Google Scholar] [CrossRef]
  29. Ramsey, K.A.; Zhou, W.; Rojer, A.G.M.; Reijnierse, E.M.; Maier, A.B. Associations of Objectively Measured Physical Activity and Sedentary Behaviour with Fall-Related Outcomes in Older Adults: A Systematic Review. Ann. Phys. Rehabil. Med. 2022, 65, 101571. [Google Scholar] [CrossRef] [PubMed]
  30. Schoene, D.; Heller, C.; Aung, Y.N.; Sieber, C.C.; Kemmler, W.; Freiberger, E. A Systematic Review on the Influence of Fear of Falling on Quality of Life in Older People: Is There a Role for Falls? Clin. Interv. Aging 2019, 14, 701–719. [Google Scholar] [CrossRef]
  31. Halama, P.; Dědová, M. Meaning in Life and Hope as Predictors of Positive Mental Health: Do They Explain Residual Variance Not Predicted by Personality Traits? Stud. Psychol. 2007, 49, 191–200. [Google Scholar]
  32. Bowling, A.; Banister, D.; Sutton, S.; Evans, O.; Windsor, J. A Multidimensional Model of the Quality of Life in Older Age. Aging Ment. Health 2002, 6, 355–371. [Google Scholar] [CrossRef]
  33. Van Leeuwen, K.M.; Van Loon, M.S.; Van Nes, F.A.; Bosmans, J.E.; De Vet, H.C.W.; Ket, J.C.F.; Widdershoven, G.A.M.; Ostelo, R.W.J.G. What Does Quality of Life Mean to Older Adults? A Thematic Synthesis. PLoS ONE 2019, 14, e0213263. [Google Scholar] [CrossRef]
  34. World Health Organization. World Report on Ageing and Health; World Health Organization: Geneva, Switzerland, 2015. Available online: https://apps.who.int/iris/handle/10665/186463 (accessed on 12 March 2022).
  35. World Health Organization. Decade of Healthy Ageing: Baseline Report; World Health Organization: Geneva, Switzerland, 2021. Available online: https://www.who.int/publications/i/item/9789240017900 (accessed on 28 April 2023).
  36. Rietdyk, S.; Ambike, S.; Amireault, S.; Haddad, J.M.; Lin, G.; Newton, D.; Richards, E.A. Co-Occurrences of Fall-Related Factors in Adults Aged 60 to 85 Years in the United States National Health and Nutrition Examination Survey. PLoS ONE 2022, 17, e0277406. [Google Scholar] [CrossRef] [PubMed]
  37. Reuben, D.B.; Wieland, D.L.; Rubenstein, L.Z. Functional Status Assessment of Older Persons: Concepts and Implications. Facts Res. Gerontol. 1993, 7, 231–240. [Google Scholar]
  38. Laborde, C.; Ankri, J.; Cambois, E. Environmental Barriers Matter from the Early Stages of Functional Decline among Older Adults in France. PLoS ONE 2022, 17, e0270258. [Google Scholar] [CrossRef]
  39. Lethborg, C.; Aranda, S.; Cox, S.; Kissane, D. To What Extent Does Meaning Mediate Adaptation to Cancer? The Relationship between Physical Suffering, Meaning in Life, and Connection to Others in Adjustment to Cancer. Palliat. Support. Care 2007, 5, 377–388. [Google Scholar] [CrossRef]
  40. Routledge, C.; Ostafin, B.; Juhl, J.; Sedikides, C.; Cathey, C.; Liao, J. Adjusting to Death: The Effects of Mortality Salience and Self-Esteem on Psychological Well-Being, Growth Motivation, and Maladaptive Behavior. J. Personal. Soc. Psychol. 2010, 99, 897–916. [Google Scholar] [CrossRef]
  41. Hajibabaei, M.; Kajbaf, M.B.; Esmaeili, M.; Harirchian, M.H.; Montazeri, A. Impact of an Existential-Spiritual Intervention Compared with a Cognitive-Behavioral Therapy on Quality of Life and Meaning in Life among Women with Multiple Sclerosis. Iran. J. Psychiatry 2020, 15, 322–330. [Google Scholar] [CrossRef]
  42. Kreitler, S. Meanings of Meaningfulness of Life. In Logotherapy and Existential Analysis: Proceedings of the Viktor Frankl Institute Vienna; Batthyány, A., Ed.; Springer International Publishing: Cham, Switzerland, 2016; Volume 1, pp. 95–106. ISBN 978-3-319-29423-0. [Google Scholar]
  43. Araujo, L.; Ribeiro, O.; Paúl, C. Hedonic and Eudaimonic Well-Being in Old Age through Positive Psychology Studies: A Scoping Review. An. Psicol. 2017, 33, 568. [Google Scholar] [CrossRef]
  44. Powell, L.E.; Myers, A.M. The Activities-Specific Balance Confidence (ABC) Scale. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 1995, 50A, M28–M34. [Google Scholar] [CrossRef]
  45. Joseph, S.; Linley, P.A.; Harwood, J.; Lewis, C.A.; McCollam, P. Rapid Assessment of Well-being: The Short Depression-Happiness Scale (SDHS). Psychol. Psychother. 2004, 77, 463–478. [Google Scholar] [CrossRef]
  46. Ware, J.E.; Gandek, B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J. Clin. Epidemiol. 1998, 51, 903–912. [Google Scholar] [CrossRef]
  47. Bahat Öztürk, G.; KiliÇ, C.; Bozkurt, M.E.; Karan, M.A. Prevalence and Associates of Fear of Falling among Community-Dwelling Older Adults. J. Nutr. Health Aging 2021, 25, 433–439. [Google Scholar] [CrossRef] [PubMed]
  48. Wyper, G.M.A.; Fletcher, E.; Grant, I.; McCartney, G.; Fischbacher, C.; Harding, O.; Jones, H.; De Haro Moro, M.T.; Speybroeck, N.; Devleesschauwer, B.; et al. Measuring Disability-Adjusted Life Years (DALYs) Due to COVID-19 in Scotland, 2020. Arch. Public Health 2022, 80, 105. [Google Scholar] [CrossRef] [PubMed]
  49. Gandhi, S.; Long, L.; Gandhi, V.; Bashir, M. Empowering Older Adults in Underserved Communities—An Innovative Approach to Increase Public Health Capacity for Fall Prevention. J. Ageing Longev. 2023, 3, 450–464. [Google Scholar] [CrossRef]
  50. Xu, T.; Lim, Y.V.; Wee, L.S.X.; Tan, Y.J.S.; Xue, A.L. The Usability of Hip Protectors: A Mixed-Method Study from the Perspectives of Singapore Nursing Home Care Staff. J. Ageing Longev. 2024, 4, 359–372. [Google Scholar] [CrossRef]
  51. Savvakis, I.; Adamakidou, T.; Kleisiaris, C. Physical-Activity Interventions to Reduce Fear of Falling in Frail and Pre-Frail Older Adults: A Systematic Review of Randomized Controlled Trials. Eur. Geriatr. Med. 2024, 15, 333–344. [Google Scholar] [CrossRef]
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Figure 1. Theoretical model.
Figure 1. Theoretical model.
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Figure 2. Results of the path analysis.
Figure 2. Results of the path analysis.
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Figure 3. Fear of falling as a mediator between the number of falls and the feeling of safety.
Figure 3. Fear of falling as a mediator between the number of falls and the feeling of safety.
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Table 1. Sociodemographic traits of the samples of those who had fallen and those who had not.
Table 1. Sociodemographic traits of the samples of those who had fallen and those who had not.
Had Fallen
(203)		Had not Fallen
(200)		Total
403
Average%Average%%
Gender
Male
Female		 43.3
56.7		 57.0
43.0		50.1
49.9
Age (years)67.4
±8.14		 68.3
±7.71		 67.9
±8.00
Education
Below academic
Academic		46.8
53.2		 47.5
52.5		 47.3
52.9
Income
Below average
Similarly to average
Higher than average		 23.6
51.2
25.1		 18.5
58.5
23.0		22.1
55.3
24.0
Table 2. The scale’s internal consistency.
Table 2. The scale’s internal consistency.
ScaleNumber
of Items		Cronbach’s
Alpha
Safety feeling220.96
Quality of life60.91
Health status30.80
Meaning of life400.94
Number of falls80.49
Fear of falling60.80
Table 3. Pearson correlation (two-sided) between the scales.
Table 3. Pearson correlation (two-sided) between the scales.
123456
Number of falls (1)1
Fear of falling (2)0.355 ** 1
Meaning of life (3)0.0480.078 1
Quality of life (4)0.070−0.254 **0.199 ** 1
Safety feeling (5)−0.217 **−0.580 **0.0730.236 ** 1
Health status (6)−0.174 **−0.428 **0.179 **0.404 **0.531 ** 1
BADL0.191 **−0.545 **
IADL0.225 **−0.568
** p < 0.01. Numbers 1–6 in the first row are variable names as they appear in the first column on the left.
Table 4. Mean difference between those who fell and those who did not fall.
Table 4. Mean difference between those who fell and those who did not fall.
Those Who FellThose Who Did Not Fall
Mean (Sd)Mean (Sd)Tp
FOF2.790 (0.898)2.130 (0.764)7.953<0.001
Safety feeling4.385 (0.656)4.612 (0.476)−3.960<0.001
Good health3.812 (0.877)4.122 (0.711)−3.816<0.001
Table 5. Direct and indirect significant relationships between variables.
Table 5. Direct and indirect significant relationships between variables.
Relationships Standardized EffectRegression Weights
(Direct)
TotalDirectIndirectEstimateC.R.p
Number of fallsvs.safety−0.1400.000−0.140
MOLvs.safety0.0380.0000.038
Health statusvs.safety0.5170.3500.1660.1938.516<0.001
FOFvs.safety−0.455−0.428−0.027−0.281−10.39<0.001
QOLvs.safety0.1720.0000.172
FOFvs.QOL−0.162−0.158−0.003−0.113−3.016<0.01
MOLvs.QOL0.2010.211−0.0100.2374.456<0.001
Number of fallsvs.FOF0.3143080.0060.2717.191<0.001
MOLvs.FOF0.0620.128−0.0660.2012.927<0.01
Health statusvs.FOF−0.373−0.366−0.077−0.307−8.011<0.001
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MDPI and ACS Style

Even-Zohar, A.; Kreitler, S.; Gendel Guterman, H. Falls of Older Adults: Which Is Worse, Falling or Fear of Falling? J. Ageing Longev. 2025, 5, 20. https://doi.org/10.3390/jal5020020

AMA Style

Even-Zohar A, Kreitler S, Gendel Guterman H. Falls of Older Adults: Which Is Worse, Falling or Fear of Falling? Journal of Ageing and Longevity. 2025; 5(2):20. https://doi.org/10.3390/jal5020020

Chicago/Turabian Style

Even-Zohar, Ahuva, Shulamith Kreitler, and Hanna Gendel Guterman. 2025. "Falls of Older Adults: Which Is Worse, Falling or Fear of Falling?" Journal of Ageing and Longevity 5, no. 2: 20. https://doi.org/10.3390/jal5020020

APA Style

Even-Zohar, A., Kreitler, S., & Gendel Guterman, H. (2025). Falls of Older Adults: Which Is Worse, Falling or Fear of Falling? Journal of Ageing and Longevity, 5(2), 20. https://doi.org/10.3390/jal5020020

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