Perceived control over falling: a qualitative study of psychological aspects in older adults with fall concerns

Concern about falling (CaF) is common in later life and can both protect against and contribute to functional decline. However, how older adults with CaF construct perceived control over falling, and how this shapes fall-related awareness and behaviours, remains underexplored. This study aimed to explore how community-dwelling older adults with CaF interpret fall experiences and physical ageing, and how these interpretations shape perceived control over falling, activity engagement, and fall-prevention behaviours.

We conducted a qualitative study in urban community settings in Bangkok, Thailand. Purposive sampling was used to recruit community-dwelling older adults with CaF who varied in perceived control over falling. Semi-structured individual interviews examined fall experiences, perceptions of CaF, ageing, and everyday activities. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis to develop themes capturing how perceived control over falling is constructed and continually negotiated.

Twenty older adults participated. Five interrelated themes described how perceived control over falling is shaped: (1) falling experiences being attributed to internal or external controls, (2) initiating fear and its transformation into adaptive awareness, (3) fall control transcending physical ageing and health through acceptance and adaptation, (4) the interplay of life history, peers, and social expectations in shaping resilience, and (5) ongoing negotiation of perceived control, activity engagement, and fall-prevention behaviours. Older adults with higher perceived control tended to transform initial fear into "authentic" awareness, integrate falls into a coherent ageing narrative, and use proportionate safety strategies while maintaining valued activities. Those with lower perceived control more often reported persistent worry, external or fatalistic attributions, and over- or under-cautious behaviours that restricted participation and eroded confidence.

Perceived control over falling among older adults with CaF is a dynamic, multidimensional process that extends beyond physical risk factors. Fall-prevention interventions should therefore move beyond purely physical components to incorporate psychological, social, and life-course dimensions, supporting adaptive appraisals, resilience, independence, and sustained engagement in daily life.