Does concern about falling predict future falls in older adults? A systematic review and meta-analysis

Area of Science:

• Gerontology
• Public Health
• Clinical Medicine

Background:

• The 2022 World Falls Guidelines suggest assessing fear of falling in fall risk evaluations.
• Limited evidence currently supports this recommendation.
• This review critically examines concerns about falling as an independent predictor of future falls using established causality criteria.

Purpose of the Study:

• To evaluate the evidence supporting concerns about falling as an independent predictor of future falls in older adults.
• To synthesize findings from existing research on the association between fear of falling and subsequent fall events.
• To inform clinical practice and guidelines regarding fall risk assessment.

Main Methods:

• A systematic review and meta-analysis were performed.
• Searched major databases (MEDLINE, CINAHL Plus, Web of Science, PsycINFO) for studies with a minimum 6-month follow-up.
• Assessed risk of bias and certainty of evidence using adapted Newcastle Ottawa Scale and GRADE, respectively.

Main Results:

• Included 53 studies with 75,076 participants.
• Meta-analysis revealed a significant independent association between baseline concerns about falling and future falls, particularly when using the Falls Efficacy Scale-International.
• Single-item measures of concern also showed significant associations, while balance confidence did not predict future falls.

Conclusions:

• Baseline concern about falling is a validated predictor of future falls in older adults.
• Supports the routine inclusion of concern assessment in multifactorial fall risk evaluations.
• Regular assessment and targeted interventions for fear of falling can mitigate fall risk.