THE MEANING OF FEAR OF FALLING AMONG ELDERLY PEOPLE
Carmen-Lucia Curcio, Ph.D. (C)*, Hélène Corriveau, Ph.D., Marie
Background
Fear of falling has been reported in a high percentage of
community-dwelling elderly who both do and don’t have a
history of falling1. Even though fear of falling is a significant
health problem among the elderly2, little reported research
was published that investigated this issue in participants’
viewpoints and the meanings and perceptions of the elders’
experiences of the fear of falling3,4,5 .
There is great variation in the reported prevalence of fear of
falling in older people6, and is know to be multifactorial with
health, physical, psychological, functional and social
influences (fig. 1).
Fig. 1 Multidimensional Influences of Fear of Falling
HEALTH
Health status / Medical conditions
Chronic diseases
SOCIAL
ENVIRONMENTAL
Social interaction
Social support
Physical environment
PSYCHOLOGICAL
Depression
PHYSICAL
Anxiety
Self-efficacy
Objective
The purpose of this study is to explore the underlying
theoretical framework of fear of falling among Andes-
Mountains elderly people.
Methods
A grounded theory approach was used. Theoretical
sampling was used to saturate the emergent concepts.
Individual open, semi-structured and in-depth interviews
were conducted with 36 community-based participants
aged 62-96. Interviews were audio taped as agreed by the
participants. The interviews were approximately one hour
in length and occurred in the participant’s residence. All
of the interviews were audio taped and transcribed by the
investigator.
REFERENCES
1. Friedman, S., Munoz, B., West, S., Rubin, G., Fried, l. (2002). Falls and fear of falling: which comes first? A
longitudinal prediction model suggests strategies for primary and secondary prevention. Journal of the
American Geriatrics Society, 50 (13), 29-35.
2. Lach H. (2002). Fear of falling: An emerging health problem. Generations; 26,33 – 37.
3. Lee, F., Mackenzie, L., James, C. (2008). Perceptions of older people living in the community about their
fear of falling. Disability & Rehabilitation, 1- 9
4. Huang, T. (2005). Managing fear of falling: Taiwanese elders’ perspective. International journal of nursing
studies, 42, 743-50.
5. Tischler L, Hobson S. (2005). Fear of falling: A qualitative study among community-dwelling older adults.
Phys Occup Ther Geriatr; 23,37 – 53.
6. Jorstad, E., Hauer, K., Becker, C., Lamb, S.E. (2005). Measuring of psychological outcomes of falling: a
systematic review. JAGS, 53, 501-510.
Beaulieu, Ph.D.
Analysis Emotional support : Elderly of Colombian Andes Mountain place
Data was analyzed following the grounded theory principles: more emphasis on emotional support from their children than on other
open coding and memos for conceptual labeling, axial coding forms of support. The families are characterized by norms that
and memos for category building, and selective coding for emphasize interdependence among the various family members,
model building. especially those in the immediate kinship group. Older parents live
Results with children in traditional Colombian Andes Mountain families, and the
cultural norms dictate that the children have an obligation to care for
All participants, fallers and non fallers, were independent in them.
activities of daily living and remained active in the community.
The majority of participants also performed some form of Places/contexts: The fear of falling is most strong in public contexts
exercise or physical activity.
or places than the private places or at home. Elderly participants
Eight broad themes emerged from data analysis. The reduced and changed their pattern of interacting with the outside
theoretical model of fear of falling is depicted in Fig. 2.
world to avoid exposing themselves to dangerous environments.
Fig. 2 Theoretical Model of Fear of
Falling
FEAR OF FALLING Fears associated: There are others concerns like fear of being
Definition
robbed, fear of traffic .
Representation
Autonomy lost WHY? Consequences: Fear of falling may be a reasonable response to
Origin/causes
WHERE? Mort certain situations, leading elderly persons to be cautious, and can
Old age /ageing
places/contexts
Loss Vulnerability contribute to fall prevention through careful choices about physical
Private
FUNCTIONING
Public
Frailty
Falls
activity. The other side, fear of falling has a negatives consequences
ADL-IADL
HOW? Diseases like restriction of physical and social activity.
Disability Impact/ Strategies
WHO?
Impairment To avoid
Emotional support
Precaution
Overprotection Instrumental support
Counselling
Fears associated
Consequences  Discussion
Balance Activity Restriction
Gait Traffic
Robbery
Mobility Fear of falling is known to be a multifactorial with, at a minimum, physical,
psychological, functional and social dimensions and influences. Many of the
The definition of fear of falling is vague. The participants are
results obtained from this study correspond to results that have been
incapables to make a definition, but its is described as an
experience often linked with fear of incapacitation, fear of
previously discussed in the literature: causes3,5 losing independence
and autonomy3-5 , the strategies for managing the fear of falling,
disability, fear of dependence and lack of autonomy.
specially, precaution strategy3-5 and the positives3,4 and negatives
consequences2-5 .
Origin/causes: The participants identified many contributors to
the fear of falling, including the age, aging process, poor
The result of the present study also suggest that the fear of falling is
balance, lost of capacity, a previous fall and diseases. The
an attitude: a person's perspective toward a specified target.
participants identified that they discovered they had the fear of
falling as they aged.
Losing Autonomy: Becoming an invalid or burden, losing Conclusions
independence, being confined to a wheelchair or unable to walk The factors contributed to fear of falling are numerous. Many factors
are the most important concerns. This theme was apparent in other than health conditions, mobility impairment, physical
many of the participants’ responses who clearly identified that, functioning, depression, self-confidence and self-efficacy, must be
if they were to fall again, they truly worried that they would be considered. Aspects such as the context, the place, the time, and the
unable to care for themselves and would have to rely on others. cultural representations probably determine fear of falling. Knowledge
Fear of loss of independence and lack of autonomy was a larger about the concept and development of a fear of
concern than the actual fall itself. falling and its consequences will allow better fall and fear of falling
prevention
* The first author is member of Research group Gerontology and geriatrics. Caldas university. Manizales.
Three strategies were reported by elderly participants in and intervention programs to be established.
Colombia
managing their fear of falling: precaution strategy (paying and she was supported by a grant from Universidad de Caldas, Colombia, Le programme-réseau de Formation
interdisciplinaire en recherche Santé et Vieillissement (FORMSAV) and Québec Network for Research on Aging.
attention to environmental safety and modifying behaviour), to
avoid activities (activity restriction as a consequence) and using
instrumental support or the use of aids to decrease the
likelihood of a fall (use of ambulatory aids).