If fear of falling is not falls efficacy, then what is fear of falling?
A Cochrane review done by Lenouvel et al (2023) evaluated the use of cognitive behavioural therapy (CBT) with and without exercise to reduce the fear of falling in older people living in the community.
This paper nicely expresses that fear of falling is “a lasting concern about falling that leads to an individual avoiding activities that he/she remains capable of performing.” Lenouvel et al. (2023) nicely expressed that this fear is a state of apprehension towards danger, the fall. There are potentially several associations with other psychological concepts. Perhaps the low resiliency and confidence towards mitigating the threat (falls efficacy)? Or perhaps, expressed as concern about falling even though concerns are considered less intense and emotional than fear. Some posit that fear is innate, whereas concern describes a solution-orientated cognitive response. Anxiety has been thrown into the mix, in consideration that the thoughts are focused on some, probably poorly specified, future bad outcome (Adamczewska and Nyman, 2018). Ultimately, fear is a basic and adaptive emotion which could be considered a protective response toward a current, identifiable threat (Barlow, 2002)
There are different approaches to measuring fear of falling. Single-item instruments involve direct questioning with yes/no questionnaires, such as “Are you afraid of falling?” or with Likert scales, such as, “How afraid are you that you will fall and hurt yourself in the next year?”
If the intention is to understand the individual’s concerns, the FES-I scale is recommended. If clinicians aim to address fear through falls efficacy, then measures such as the Activities Specific Balance and Confidence Scale (ABC), or the Fall Efficacy Scale could be used. If activity avoidance behaviour is targeted, then clinicians could consider instruments such as FES-IABQ. Consideration of evaluating fear through physiological responses could look at measures such as functional magnetic resonance imaging, and testing for neurochemical correlates such as cortisol.
For more information about the different measurement instruments for fear of falling or falls efficacy, please click here.
Essentially, fear of falling could be addressed using cognitive behavioural therapy with and without exercises. It is arguable that falls efficacy needs a different strategy. Addressing falls efficacy using cognitive behavioural therapy without exercise is arguably not seen as the most effective strategy. Falls efficacy, underpinned by the Bandura’s self-efficacy concept, should employ enactive strategies given that enactive performance is the most substantial factor influencing self-efficacy compared to other strategies, such as social modelling, social persuasion and physiological/emotional responses.
Future research should compare the effects of different strategies targeting fear of falling and falls efficacy.
Reference
1. Barlow, D. H. (2002). Anxiety and its disorders. New York, NY: Guilford Press.
2. Lenouvel E, Ullrich P, Siemens W, Dallmeier D, Denkinger M, Kienle G, Zijlstra GAR, Hauer K, Klöppel S. Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community. Cochrane Database Syst Rev. 2023 Nov 15;11(11):CD014666.
3. Adamczewska N, Nyman SR. A New Approach to Fear of Falls From Connections With the Posttraumatic Stress Disorder Literature. Gerontol Geriatr Med. 2018 Aug 27;4:2333721418796238.
4. Steimer T. The biology of fear- and anxiety-related behaviors. Dialogues Clin Neurosci. 2002 Sep;4(3):231-49.
