Fear of falling (FOF) is an internal psychological phenomenon of geriatric individuals, and was initially defined as low perceived self-efficacy or confidence in avoiding falls while performing relatively non-hazardous daily activities.1 The concept of FOF has since expanded to include reductions in balance self-efficacy, fearful anticipation of falling, and/or a deleterious avoidance of activity.2 FOF is common among older adults, and it may be sequelae in older adults after falling, while may also occur among those older adults without fall history. Its prevalence in older adults is estimated to range from 20% to 85% depending on the characteristics of older people.3 It has been established that the FOF is positively associated with a range of adverse health outcomes for older persons, such as the loss of independence, activity restriction, risk of falls, decreased social activity, and lower quality of life.4

The aetiology of FOF is unclear but involves physical, cognitive, and psychological components, which do not necessarily overlap and are associated with the loss of postural control, functional impairment, mobility disability, and a history of falls.2,5 A substantial body of research has identified the risk factors for FOF, which mainly include sociodemographic, physical, psychological, and environmental factors. Among them, older age, female sex, low educational level, poor health status, cognitive impairment, and chronic diseases such as diabetes mellitus, arthritis and depression are independent risk factors for FOF.3,5, 6, 7, 8 Given the prevalence of FOF among community-dwelling older adults and the significant impact of FOF on physical function and the risk of future falls, knowledge of the risk factors for FOF may be useful in developing multidimensional strategies to decrease FOF and prevent adverse health outcomes from FOF.

Considering the great variation in the reported prevalence of FOF in older adults,9,6 age is likely to have a specifical impact on FOF. First, the aging process usually accompanies by loss of muscle mass and strength and decline in physical functioning due to many physiological, psychological and sociological changes; second, the cognitive function of older adults take on a gradually decline trend with brain aging process; and the declines in vision, hearing, and proprioceptive senses with ageing process may be related to the development of FOF in older adults.10,11 Whereas the uneven decline on homeostasis, morphological, physiological, and psychological changes during aging process, the factors influencing FOF may vary in older adults of different ages. For example, a longitudinal observational study found that a slower time on a single-up and go test (TUG) and a lower dual-task cost (DTC) value were associated with the occurrence of falls among older group (aged ≥75 years) but not among younger group (aged 60∼74 years).12 Therefore, further insight into the impact of age on FOF would be helpful to better target older persons in need of interventions and to better design such interventions. Public health care practitioners and policymakers should consider aging-related factors in practical FOF intervention and prevention strategies. However, there are few studies that focus on determining factors for FOF among community-dwelling older adults of different ages. Hence, the purpose of this study was to investigate the determinants of FOF for older adults in different age groups.

Hypotheses to be tested included:

There will be a higher prevalence of FoF among the old older people (>75 years of age) compared to young older people (<75 years of age).

The decline in cognitive ability, muscle strength, gait and balance, and physical activity that occurs associated with aging will be associated with FOF.