Abstract and Introduction
Abstract
Concerns (or 'fears') about falling (CaF) are common in older adults. As part of the 'World Falls Guidelines Working Group on Concerns about Falling', we recommended that clinicians working in falls prevention services should regularly assess CaF. Here, we expand upon these recommendations and argue that CaF can be both 'adaptive' and 'maladaptive' with respect to falls risk. On the one hand, high CaF can lead to overly cautious or hypervigilant behaviours that increase the risk of falling, and may also cause undue activity restriction ('maladaptive CaF'). But concerns can also encourage individuals to make appropriate modifications to their behaviour to maximise safety ('adaptive CaF'). We discuss this paradox and argue that high CaF—irrespective of whether 'adaptive' or 'maladaptive'—should be considered an indication that 'something is not right', and that is represents an opportunity for clinical engagement. We also highlight how CaF can be maladaptive in terms of inappropriately high confidence about one's balance. We present different routes for clinical intervention based on the types of concerns disclosed.
Introduction
Concerns (or 'fears') about falling (CaF) are common in older adults, with prevalence ranging from 21 to 85%1.[1] Reported risk factors for CaF include having experienced a fall, generalised anxiety, balance impairments and poor general health.[1] CaF have been reported to be associated with various negative outcomes, including depression, decreased quality-of-life and social isolation.[1] CaF-related avoidance of activities[1] can lead to physical deconditioning, resulting in reduced strength and impaired balance,[2] which may serve to increase the risk of future falls. Based on this, we as the 'World Falls Guidelines Concerns about Falls and Falling Working Group' recommended in the recent World Falls Guidelines that clinicians working in falls prevention services should regularly assess CaF.[3]
Age Ageing. 2023;52(4):afad057 © 2023 Oxford University Press
Copyright 2007 British Geriatrics Society. Published by Oxford University Press. All rights reserved.
