Could worrying about experiencing a fall trigger one?

When it comes to preventing falls later in life, there are plenty of well-known strategies — from staying active to making homes safer with handrails and better lighting.

However, a new international study led by Neuroscience Research Australia (NeuRA) has found that one powerful predictor of future falls is less visible: the fear of falling itself.

The systematic review and meta-analysis were led by Professor Kim Delbaere, Senior Research Scientist and Director of Innovation and Translation at NeuRA’s Falls, Balance and Injury Research Centre. Working alongside the World Falls Guidelines group, the research confirms that worrying about falling independently increases a person’s risk of actually falling.

The findings are based on an analysis of 53 studies involving more than 75,000 participants worldwide. The results showed that older adults with high levels of concern about falling were significantly more likely to experience a fall — even when other key risk factors such as age, previous falls, and balance impairments were taken into account.

“Many older Australians develop concerns about falling, and this concern itself increases their risk of future falls,” Prof Delbaere said.

“Our analysis found that older adults with high concerns about falling were significantly more likely to experience a fall. While we already knew having had prior falls was a risk factor for developing concerns about falling, this research found falling can be both a cause and consequence of falls.

“Importantly, this increased risk was observed even after accounting for key physical risk factors such as age, previous falls and balance impairments. This means that concerns about falling are not just a reflection of physical frailty but an independent factor influencing future falls.

“Concerns about falling are highly prevalent in older adults, affecting nearly 1 in 2 people by age 85. They have been linked to reduced quality of life and independence, poor rehabilitation outcomes and increased risk of frailty, disability and admission to care homes.”

Now that fear of falling is known to increase the risk, it’s crucial to take it into account when planning prevention measures.

“The first step in prevention is starting the conversation. Many older adults don’t talk about their concerns unless asked, yet these concerns are real and can increase their risk of falling,” Prof Delbaere said.

“By routinely discussing concerns about falling, healthcare professionals, families and caregivers can help older adults take early action to stay active and independent.

“After identifying concerns about falling, it is important to support people with targeted, multidisciplinary interventions such as exercise, cognitive behavioural therapy and occupational therapy, to help reduce their risk of falls.

“By identifying concerns about falling and other risk factors early and providing the right interventions, we can help older adults stay active, independent and confident in their mobility, ultimately improving their quality of life.

“Falls are not an inevitable part of ageing – they are preventable. With strong evidence showing up to 30% of falls are preventable, it’s time for Australia to invest in a coordinated national strategy and make falls prevention a public health priority, not an afterthought.”