Is concerns about falling a risk factor for future falls? A systematic review of prospective studies

Toby Jack Ellmers (Imperial College London), Jodi Ventre (University of Manchester), Ellen Freiberger (Friedrich-Alexander-University Erlangen-Nürnberg), Klaus Hauer (AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg), David B Hogan (University of Calgary), Lisa McGarrigle (University of Manchester), Samuel Nyman (University of Winchester), Mae Ling Lim (Neuroscience Research Australia), Chris Todd (University of Manchester), Kim Delbaere (Neuroscience Research Australia), The World Falls Guidelines Working Group on Concerns About Falling

Background: Concerns (or, ‘fear’) about falling are common among older people. They have been reported to be associated with various negative outcomes, including activity restriction, depression, decreased quality-of-life and social isolation. Whilst prior conceptualisations have proposed an association between concerns about falling and future falls, the evidence base for such purported association is uncertain. We therefore conducted a systematic review to explore the association between concerns about falling and future prospective falls.

Methods: We searched 4 databases for articles that included concerns about falling as a baseline predictor for future falls over a 6-month period or longer. Following the removal of duplicates, we screened the abstract and titles of 10,554 articles; and the full text of 172 articles.

Results: We included and extracted data from 58 articles. A significant association between baseline concerns about falling and future falls was reported in 76% of the articles assessed (44/58); with higher concerns associated with a greater risk/odds of future falls. This significant association remained when controlling for confounding variables (n=16 articles).

Conclusion: These findings support previous conceptualisations and identify concerns about falling as an independent risk factor for future falls. As part of the World Falls Guidelines, we recommend that clinicians working with older people regularly screen for concerns about falling, using the short 7-item Falls Efficacy Scale-International (FES-I). Further analysis is currently ongoing to conduct meta-analyses based on specific outcomes (e.g., recurrent vs. single falls) and assessment tools (e.g., FES-I vs. single-item measures).