Consensus definition of fall-related psychological harm: findings from an international e-Delphi study

Falls can cause substantial psychological consequences in older adults beyond physical injury, yet no definition of fall-related psychological harm (FPH) exists. This gap limits consistent identification and intervention development. This e-Delphi study aimed to establish an international consensus definition of FPH.

A five-round modified e-Delphi study engaging an international panel of clinicians and researchers was conducted. Round 1 (n = 30; 15 countries, five continents) explored the need for a definition and its potential components; content and thematic analysis identified key concepts that informed item development for subsequent rounds. Round 2 expanded participation to 99 experts (24 countries, six continents). Rounds 2-5 involved iterative rating and refinement of definition elements and wording. Consensus was set a priori as ≥70% agreement.

In Round 1, 93% (28/30) agreed that a formal definition of FPH is needed. The definition reached consensus in Round 4 (n = 48, 77.4%), and minor wording refinements in Round 5 confirmed stability of agreement (n = 49, 86.0%). Two applicability criteria (an actual fall [n = 62, 98%] or a near-fall [n = 52, 83%]), and two examples (concerns about falling [n = 88, 89%] and activity restriction/avoidance [n = 81, 82%]) reached consensus. The consensus definition for FPH was: 'Fall-related psychological harm refers to emotional (e.g., increased concern about falling), behavioural (e.g., activity restriction/avoidance), and/or broader mental health consequences that immediately arise and/or develop over time following a fall or near-fall'.

This international Delphi study established a definition of fall-related psychological harm, supporting standardised assessment and future work to develop targeted interventions.