Toward a Methodological Framework for Assessing Self-Awareness of Fall Risk in Older Adults

Falls are a significant public health concern among older adults, often resulting in injury, hospitalization, and reduced independence. Although physical, sensory, and cognitive impairments are well-established risk factors, growing attention is being paid to the role of self-awareness in fall prevention. However, literature often conflates self-awareness of fall risk-the ability to accurately reflect on one's functional abilities-with perceived fall risk, the subjective sense of vulnerability to falling. This conceptual overlap has led to inaccuracy in clinical interpretation. This paper proposes a practical methodological framework to guide clinicians in identifying impairments in self-awareness of fall risk. Two complementary approaches are outlined. The first is an indirect method, based on identifying mismatches between individuals' self-reported confidence and their actual performance on standardized balance or mobility tests. Such discrepancies may suggest reduced self-awareness and serve as a useful screening tool in time-limited settings. The second, direct method uses structured assessments to evaluate awareness of functional abilities in everyday life. This paper offers recommendations for selecting an appropriate approach and introduces a decision-making framework to support multidisciplinary evaluation. Future research is needed to validate these approaches and determine their predictive value for fall-related outcomes.