Fear of Falling and Related Factors in Older Adults in the City of Kashan in 2017

Document Type : Original Article


1 Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran

2 Student Research Committee, Kashan University of Medical Sciences, Kashan University of Medical Sciences, Kashan, IR Iran

3 Department of Epidemiology and Biostatistics, Kashan University of Medical Sciences, Kashan, IR Iran



Background: Fear of falling has been reported in various societies for different reasons and affects the quality of life of older adults.
The present study was conducted to determine the level of fear of falling and related factors in older adults in the city of Kashan in 2017.
Materials and Methods: In this cross‑sectional study, 414 older adults living in the city of Kashan, in 2017, were selected by cluster sampling.
Data were collected using a demographic questionnaire (including age, gender, number of children, having a caregiver, education, marital status,
occupation, smoking, alcohol use, use of anxiolytic medication, history of diseases, ability to carry out daily tasks, history of fall, injury due
to fall, osteoporosis, access to medical care, access to social supports, walking aids, living alone, income, housing, insurance, and insomnia),
and Falls Efficacy Scale‑International (FES‑I), and then were analyzed using Chi‑square and logistic regression. Results: Fear of falling was
low in 63.3% of the older adults, moderate in 22.7%, and intense in 4.3%. Fear of falling showed a significant relationship with age, having
a caregiver, education, history of taking anxiolytic and hypnotic medications, history of psychosomatic diseases, ability to perform daily
tasks, history of falling, injury caused by falling, use of walking aids, access to social support in case of emergency, and income. Multivariate
analysis showed that fear of falling in older adults had a direct relationship with age of over 70 years (odds ratio [OR] = 3.24), history of use
of anxiolytic and hypnotic medications (OR = 0.26), and illiteracy (OR = 0.37). Conclusion: The results showed that a high percentage of
participants suffered fear of falling, of whom one‑third had moderate‑to‑severe fear. Age, use of anxiolytic medications, and illiteracy were
effective in increasing the risk of fear of falling in older adults. Further studies and appropriate measures are required in this regard.


1. Chang HT, Chen HC, Chou P. Factors associated with fear of falling among community‑dwelling older adults in the Shih‑Pai study in Taiwan. PLoS One 2016;11:e0150612.
2. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009;(2):CD007146.
3. Tanjani P, Ainy E, Akbarpuor S, Soori H. Study of characteristics of falls among Iranian elders. Saf Promot Inj Prev 2015;2:313‑20.
4. Lach HW. Incidence and risk factors for developing fear of falling in older adults. Public Health Nurs 2005;22:45‑52.
5. Tomita Y, Arima K, Kanagae M, Okabe T, Mizukami S, Nishimura T, et al. Association of physical performance and pain with fear of falling among community‑dwelling japanese women aged 65 years and older. Medicine (Baltimore) 2015;94:e1449.
6. SchefferAC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: Measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing 2008;37:19‑24.
7. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701‑7.
8. Murphy SL, Dubin JA, Gill TM. The development of fear of falling among community‑living older women: Predisposing factors and subsequent fall events. J Gerontol A Biol Sci Med Sci 2003;58:M943‑7.
9. Jung D. Fear of falling in older adults: Comprehensive review. Asian Nurs Res (Korean Soc Nurs Sci) 2008;2:214‑22.
10. Kressig RW, Wolf SL, Sattin RW, O’Grady M, Greenspan A, Curns A, et al. Associations of demographic, functional, and behavioral characteristics with activity‑related fear of falling among older adults transitioning to frailty. J Am Geriatr Soc 2001;49:1456‑62.
11. Andresen EM, Wolinsky FD, Miller JP, Wilson MM, Malmstrom TK, Miller DK. Cross‑sectional and longitudinal risk factors for falls, fear of falling, and falls efficacy in a cohort of middle‑aged african americans. Gerontologist 2006;46:249‑57.
12. Najafi Ghezlcheh T, Ariapour S, Jafari Oori M. Epidemiology and relationship of fall and fear of falling in the elderly residing at Kamrani Nursing home, Tehran, Iran. Salmand Iran J Aging 2015;10:152‑61.
13. Zijlstra GA, van Haastregt JC, van Eijk JT, van Rossum E, Stalenhoef PA, Kempen GI, et al. Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community‑living older people. Age Ageing 2007;36:304‑9.
14. Gillespie SM, Friedman SM. Fear of falling in new long‑term care enrollees. J Am Med Dir Assoc 2007;8:307‑13.
15. Sharaf AY, Ibrahim HS. Physical and psychosocial correlates of fear of falling: Among older adults in assisted living facilities. J Gerontol Nurs 2008;34:27‑35.
16. Yeung F, Chou KL, Wong E. Characteristics associated with fear of falling in Hong Kong Chinese elderly residing in care and attention homes. Clin Gerontol 2006;29:83‑98.
17. Kato C, Ida K, Kawamura M, Nagaya M, Tokuda H, Tamakoshi A, et al. Relation of falls efficacy scale (FES) to quality of life among nursing home female residents with comparatively intact cognitive function in japan. Nagoya J Med Sci 2008;70:19‑27.
18. Ozcan A, Donat H, Gelecek N, Ozdirenc M, Karadibak D. The relationship between risk factors for falling and the quality of life in older adults. BMC Public Health 2005;5:90.
19. Chou KL, Yeung FK, Wong EC. Fear of falling and depressive symptoms in chinese elderly living in nursing homes: Fall efficacy and activity level as mediator or moderator? Aging Ment Health 2005;9:255‑61.
20. Chang NT, Chi LY, Yang NP, Chou P. The impact of falls and fear of falling on health‑related quality of life in taiwanese elderly. J Community Health Nurs 2010;27:84‑95.
21. Blanchard RA, Myers AM, Pearce NJ. Reliability, construct validity, and clinical feasibility of the activities‑specific fall caution scale for residential living seniors. Arch Phys Med Rehabil 2007;88:732‑9.
22. Yardley L, Beyer N, Hauer K, Kempen G, Piot‑Ziegler C, Todd C, et al. Development and initial validation of the falls efficacy scale‑international (FES‑I). Age Ageing 2005;34:614‑9.
23. Khajavi D, Farokhi A, Jaberimoghadam A, Kazemnejad A. Effect of a training intervention program on fallrelated psychological factors of community‑doweling men older adults. Salmand Iran J Aging 2014;9:22‑31.
24. Kim S, So WY. Prevalence and correlates of fear of falling in korean community‑dwelling elderly subjects. Exp Gerontol 2013;48:1323‑8.
25. Liu JY. Fear of falling in robust community‑dwelling older people: Results of a cross‑sectional study. J Clin Nurs 2015;24:393‑405.
26. Choi K, Ko Y. Characteristics associated with fear of falling and activity restriction in south korean older adults. JAging Health 2015;27:1066‑83.
27. Oliver D, Daly F, Martin FC, McMurdo ME. Risk factors and risk assessment tools for falls in hospital in‑patients: A systematic review. Age Ageing 2004;33:122‑30.
28. Chen YC, Chien SF, Chen LK. Risk factors associated with falls among chinese hospital inpatients in taiwan. Arch Gerontol Geriatr 2009;48:132‑6.
29. Vitorino LM, Teixeira CA, Boas EL, Pereira RL, Santos NO, Rozendo CA, et al. Fear of falling in older adults living at home: Associated factors. Rev Esc Enferm USP 2017;51:e03215.
30. Pohl P, Sandlund M, Ahlgren C, Bergvall‑Kåreborn B, Lundin‑Olsson L, Melander Wikman A, et al. Fall risk awareness and safety precautions taken by older community‑dwelling women and men – A qualitative study using focus group discussions. PLoS One 2015;10:e0119630.
31. Chen YM, Hwang SJ, Chen LK, Chen DY, Lan CF. Risk factors for falls among elderly men in a veterans home. J Chin Med Assoc 2008;71:180‑5.
32. Thiamwong L, Suwanno J. Fear of falling and related factors in a community‑based study of people 60 years and older in Thailand. Int J Gerontol 2017;11:80‑4.
33. White UE, Black AA, Wood JM, Delbaere K. Fear of falling in vision impairment. Optom Vis Sci 2015;92:730‑5.
34. Ambrose AF, Cruz L, Paul G. Falls and fractures: A systematic approach to screening and prevention. Maturitas 2015;82:85‑93.
35. Hita‑Contreras F, Martínez‑Amat A, Lomas‑Vega R, Álvarez P, Aránega A, Martínez‑López E, et al. Predictive value of stabilometry and fear of falling on falls in postmenopausal women. Climacteric 2013;16:584‑9.
36. Ayoubi F, Launay CP, Annweiler C, Beauchet O. Fear of falling and gait variability in older adults: A systematic review and meta‑analysis. J Am Med Dir Assoc 2015;16:14‑9.
37. Visschedijk JH, Caljouw MA, Bakkers E, van Balen R, Achterberg WP. Longitudinal follow‑up study on fear of falling during and after rehabilitation in skilled nursing facilities. BMC Geriatr 2015;15:161.
38. Knauth DR, Couto MT, Figueiredo Wdos S. The standpoint of professionals on the presence and demands of men on the healthcare services: Perspectives for the analysis of the implementation of the comprehensive healthcare policy for men. Cien Saude Colet 2012;17:2617‑26.
39. Cho H, Seol SJ, Yoon DH, Kim MJ, Choi BY, Kim T. Disparity in the fear of falling between urban and rural residents in relation with socio‑economic variables, health issues, and functional independency. Ann Rehabil Med 2013;37:848‑61.
40. Resnick B, Nahm ES, Zhu S, Brown C, An M, Park B, et al. The impact of osteoporosis, falls, fear of falling, and efficacy expectations on exercise among community‑dwelling older adults. Orthop Nurs 2014;33:277‑86.
41. Delbaere K, Close JC, Heim J, Sachdev PS, Brodaty H, Slavin MJ, et al. A multifactorial approach to understanding fall risk in older people. J Am Geriatr Soc 2010;58:1679‑85.
42. Lopes KT, Costa DF, Santos LF, Castro DP, Bastone AC. Prevalence of fear of falling among a population of older adults and its correlation with mobility, dynamic balance, risk and history of falls. Rev Bras Fisioter May/June 2009;13:223-9.
43. Bryant MS, Rintala DH, Hou JG, Protas EJ. Influence of fear of falling on gait and balance in parkinson’s disease. Disabil Rehabil 2014;36:744‑8.
44. Mane AB, Sanjana T, Patil PR, Sriniwas T. Prevalence and correlates of fear of falling among elderly population in urban area of Karnataka, India. J Midlife Health 2014;5:150‑5.
45. Mazumder R, Lambert WE, Nguyen T, Bourdette DN, Cameron MH. Fear of falling is associated with recurrent falls in people with multiple sclerosis: A Longitudinal Cohort Study. Int J MS Care 2015;17:164‑70.
46. Akosile CO, Anukam GO, Johnson OE, Fabunmi AA, Okoye EC, Iheukwumere N, et al. Fear of falling and quality of life of apparently‑healthy elderly individuals from a nigerian population. J Cross Cult Gerontol 2014;29:201‑9.