Are you afraid of falling (basophobia)? After a fall, and even more so if it happened simply while walking down the street or stairs, you can often be afraid of falling again.
This situation is so common that numerous clinical studies have been focusing on it for decades.
Here’s an article summarizing what we know about the fear of falling, its consequences, how to assess it and, above all, how to reduce it, notably through physical exercise and physiotherapy.
Last update: February 10, 2025
Links of interest with the subject : none. Complete declaration of interest in legal notice
Written by Nelly Darbois, physiotherapist and scientific editor
Summary
How to assess the fear of falling and why?
These are the situations in which it may be relevant to assess the fear of falling, and how to do it. It is usually assessed by physiotherapists or doctors.
Why evaluate the fear of falling
Fear of falling often arises after an elderly person over the age of 65 has had a fall. Sometimes, however, this apprehension can arise even in the absence of a fall, for example after a loss of walking ability or balance.
Physiotherapists, doctors and geriatricians sometimes wish to assess the fear of falling. In physiotherapy, this can be useful for :
- Identify situations in which the fear of falling arises in order to work on these situations in rehabilitation;
- evaluate the potential effectiveness of rehabilitation sessions on fear of falling, by comparing fear of falling before and after several sessions.
How to assess the fear of falling
There are many scales and tests available, often in English, sometimes translated into French. The person afraid of falling has to answer certain questions, either on a form or by a health professional.
Among the various scales used to assess the fear of falling are the following:
- FES-I (Falls Efficacy Scale International);
- FES (Falls Efficacy Scale);
- FFABQ (Fear of Falling Avoidance Behavioral Questionnaire);
- the Icon 30;
- ABC-scale ;
- short FE ;
- SAFE (Survey of Activities and Fear of Falling in the Elderly).
Studies have been carried out to find out which scales are more reliable and easier to produce.
The FES-I has been the most extensively studied, with the best results. It takes between 5 and 10 minutes to pass. It has been translated into French.
(Peyronnet et al., 2016)
Here it is:
Feedback on assessing fear of falling
I only use the FES-I. I use it on one person:
- who spontaneously tells me she’s afraid of falling;
- who has one or more risk factors for falls (such as age over 65);
- who can walk without assistance (but possibly with a technical walking aid) for at least a few metres;
- who agrees to undergo several rehabilitation sessions, in particular to reduce his risk of falling or his fear of falling.
Very often, people have trouble understanding what’s at stake in the questionnaire: if I don’t remind them enough (at least for each item, if not more), they think I’m asking them if they manage to do these activities, and not if they’re afraid of falling during them.
For example, for item 5 “going shopping”, they will answer 1 “not at all”, thinking “no difficulty at all” and not “not at all worried [about falling]”.
So I remind them with each item that we’re assessing their fear of falling, not their ability to do things.
It’s also important to remember that we’re looking to assess their fear of falling now, not a few months or years ago (which people may tend to do).
I use it mainly to assess situations in which the fear of falling arises. Most of the time, people are not afraid of falling at home.
But as soon as they cross the threshold of their front door, fear sets in.
They’ll say they’re not worried about indoor activities like cleaning, washing up or getting up from a chair, but they will be worried or very worried about going shopping, or going up and down slopes.
Re-education sessions can therefore be targeted more specifically at these situations: walking on unstable or sloping ground, which is most often found around the person’s home.
They can also be used to gradually plan the resumption of anxiety-provoking activities such as shopping.
Who is most afraid of falling?
People over 65 are the most likely to be afraid of falling.
Fear of falling can occur in people who have already fallen, even after the first fall. But it can also occur in the absence of a fall.
For example, when we followed elderly people who lived at home and had never fallen for almost two years, we realized :
- that 12% to 23% of people followed over 2 years would develop a fear of falling even if they had not fallen once during that period;
- that 21% to 39% of people monitored over the 2-year period who fell during this period developed a fear of falling.
The most identified risk factors for developing a fear of falling :
- advanced age;
- being a woman;
- have already fallen at least once.
Some other risk factors have been studied, but we are less sure of their relevance:
- be prone to dizziness;
- assess themselves in poor health;
- be depressed or anxious;
- need technical assistance to walk ;
- have balance problems.
(Scheffer 2008; Rivasi 2019)
When we look at people with specific pathologies such as multiple sclerosis, spinal cord injury sequelae (paraplegics or quadriplegics), muscular dystrophy or post-polio syndromes, it is the people who engage in the least physical activity who develop the most fear of falling (Matsuda 2019).
Fear of falling is also relatively common after a hip fracture. It occurs in 64% of hip fracture surgery patients at 1 month after surgery, and decreases to 50% 3 months after surgery. (Kornfield 2017)
In people undergoing total knee replacement surgery, fear of falling is more common before than after the procedure. (Chen 2019)
Fear of falling is also more common in people with rheumatoid arthritis than in people of the same age without the condition (Akyol 2018) or other chronic diseases, such as Parkinson’s.
What are the situations in which the fear of falling is most common?
To my knowledge, there are no studies identifying the situations in which people are most afraid of falling. My clinical experience has shown that, in general, people who are still able to walk are most afraid of falling:
- fear of falling while walking in the street;
- fear of falling down the stairs.
When I ask people to fill in the FES-I, they generally say they’re not at all worried or only slightly worried about things like cleaning or getting dressed.
On the other hand, when it comes to walking in crowds or simply strolling around the neighborhood, they’re immediately more worried.
For people who are no longer able to walk, transfers are the main moments when they mention the fear of falling. For example, when it comes to sitting up on the edge of the bed with someone’s help, or even moving from bed to chair.
What are the consequences of fear of falling?
Is being afraid of falling really a problem? For example, are people who are afraid of falling more likely to fall, or do they do less?
And does this have an impact on their quality of life and well-being? It seems logical. And a number of studies that look at people’s physical and mental health over time also point to this.
People who are afraid of falling are at greater risk:
- have a poorer quality of life (regardless of the tests used to assess their quality of life);
- moving less, being less physically active, becoming physically unconditioned;
- go out less and have fewer social interactions;
- poorer balance when standing and walking.
The fear of falling has a real and strong effect on quality of life, stronger than the influence of age or gender, for example.
(Schoene et al. 2019)
How do you know if someone who is afraid of falling will actually fall?
People who are afraid of falling are not necessarily going to fall in the coming months.
Certain indicators can be used to identify people who are more at risk than others. These indicators can be used in a positive way: if a person doesn’t have one or more of these risk factors, then this can potentially boost their self-confidence.
In most studies, these indicators don’t tell us whether people who are afraid of falling will actually fall more: age, gender, level of education, balance and functional abilities or body mass index.
One indicator, however, predicts the risk of falling: cognitive impairment (memory or attention problems, for example).
These disorders are often assessed by the MMS or the MoCA, the latter being more relevant for people with few disorders. It is particularly visuo-spatial abilities that determine the risk of falling.
(Langeard et al., 2019)
How to stop being afraid of falling? Treatments
Various things can be done to reduce the fear of falling and its consequences.
In general, physiotherapy sessions are prescribed so that a physiotherapist can help you put things into place. In this case, physiotherapy is prescribed at home, or sometimes in the office.
Psychomotricians and adapted physical activity instructors are also sometimes called upon to intervene in hospitals, retirement homes and EHPADs in France.
Is physical exercise useful against the fear of falling?
Several studies have evaluated the effectiveness ofphysical exercise against the fear of falling, particularly in people over 65. Over 2,800 people were included in these studies.
The physical exercise proposed was planned, structured and repeated over time (at least once a week, more often 2 or 3 or even 5 times a week). It was supervised by healthcare professionals, either face-to-face or remotely.
It can be carried out in a group or alone, with or without the presence of an instructor. When it is carried out without an instructor, DVDs or brochures are provided.
What is the effect of these exercises? A small to moderate reduction in the fear of falling for those who benefit (compared with a similar group of people who don’t).
This fear of falling is reduced after the intervention. If the intervention to guide or supervise physical activity is stopped, it seems that the fear of falling is no longer reduced.
Implementing a physical exercise program can also reduce the risk and number of falls, although the evidence for this is weaker.
Physical exercise can include :
- balance exercises;
- muscle-strengthening exercises;
- endurance exercises;
- more varied practices such as dance.
(Kendrick, 2014)
In France, physical exercise for the elderly is most often provided or supervised by :
- physiotherapists or adapted physical activity teachers for group sessions, for example organized by municipalities, senior residences or retirement homes;
- home physiotherapists for individual sessions at home or in the office. (See Find a home physiotherapist.)
Cognitive-behavioral programs to combat the fear of falling
Although fewer in number, there are also studies evaluating the effect of interventions other than exercise on the fear of falling.
These interventions use what are often referred to as cognitive-behavioral therapies.
To give you a better idea of what they’re all about, here’s a detailed description of one of these home-based programs against the fear of falling, which does not focus on physical activity.
In France, these programs are still in their infancy. However, some physiotherapists can be trained in these methods and supervise this type of treatment, in groups or individually.
Description of a cognitive-behavioral program against the fear of falling
Location: in Holland, in people’s homes.
Beneficiaries: 141 people over 70 who were afraid of falling, lived at home, could not attend group sessions and could walk at least a few metres.
Speakers: 8 nurses with experience in geriatrics and working in homecare services, who have completed a 2-day training program.
Objectives :
- instill a realistic vision of the risk of falling ;
- increase self-efficacy and sense of control ;
- modify behavior.
Strategies in place
- identify and restructure misconceptions about falls and fall risks;
- set realisticpersonal goals to increase activity levels and safe behaviors ;
- promote the adoption of old and new activities of daily living that have been avoided because of concerns about falls.
Schedule: 7 sessions
- 3 in-home visits lasting 1 hour to 1 hour 15 minutes (with another family member present if possible);
- 4 telephone calls of 35 minutes each.
Topics covered during sessions :
- concerns about falls;
- thoughts about falling;
- exercise;
- assertiveness;
- overcoming personal obstacles ;
- safety behaviours ;
- managing concerns about falls.
Course of the sessions :
- Summary of previous session (except for the first session)
- Discussion on one of the 7 themes
- Establishment of a personalized action plan in line with the theme (e.g. how to implement physical exercise, how to improve home safety, etc.). For the 5th session, the aim was to guide people to achieve something they had previously been afraid to do because of the fear of falling, such as crossing a road.
Tasks to be carried out outside sessions :
- Read brochures
- Notes on their beliefs about falls
- Setting up a personal action plan
- Watch a video on how their peers deal with their fear of falling
(Dorresteijn, 2016)
Effect of cognitive-behavioral programs against fear of falling
What was the effect of the program described above in Holland? The people who took part in the program, 12 months later, had, compared with similar people who did not take part :
- less fear of falling (fear of falling being assessed by the FES-I test described above);
- fell less at home (but not outdoors, where falls were just as frequent);
- more activities.
There are other studies of the same type: some fifteen, carried out on more than 3,100 people living at home.
They show that programs based on cognitive-behavioral therapy and motivational interviewing reduce the fear of falling in the months following intervention, often up to 12 months after the end of the intervention.
(Chua et al., 2019)
How do you reassure someone who is afraid of falling?
Of course, it’s not enough to tell someone “no, you’re not at risk of falling” to make them feel reassured. Especially as people who are afraid of falling are often actually at risk of falling.
The programs described above show that it is nonetheless possible to reduce the fear of falling, provided you take the time and know how to go about it.
The following general advice can be given:
- take the time tolisten to the person’s fears about falling, reinforcing positive thoughts about what is for some people a phobia;
- highlight what the person is able to do, particularly if these are protective indicators of the risk of falling (for example, if he or she is able to maintain unipodal balance for more than 10 seconds, or if he or she gets up from a chair, walks 3 meters and then sits down again in less than 20 seconds, or if he or she has a walking speed greater than 0.6 m.s-1);
- give her tips on things she can do to objectively reduce her risk of falling (adapting her environment, using a walking aid that physiotherapists can prescribe, taking supervised or unsupervised physical exercise , etc.);
- identify situations where she’s afraid of falling, and take them one by one to see what can be done to make her less apprehensive (e.g., being accompanied, using a walking aid, etc.).
People who are afraid of falling are also often the people who judge their abilities as poor (Trevisan 2019).
Hence the importance of seeking to objectively improve physical and functional capacities through physical exercise, but also to make people aware of the capacities they have.
The essentials about fear of falling
- Fear of falling is common among people over 65
- People who are afraid of falling tend to have a lower quality of life, notably because they go out less and have fewer social interactions.
- Physical exercise and cognitive-behavioural therapy programs can reduce the fear of falling, as well as associated problems such as the frequency of falls.
- The FES-I is a scale that evaluates the intensity of the fear of falling and, above all, can help to identify the situations that worry you the most so that you can work more specifically on them.
Any questions or comments? See you in comments!
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📘 Sources 📘
Studies were identified via the Medline database, with the following query: fear of falling [ti]. Last update: February 2020.
On the effect of supervised exercise on fear of falling: Kendrick D, Kumar A, Carpenter H, Zijlstra G, Skelton DA, Cook JR, Stevens Z, Belcher CM, Haworth D, Gawler SJ, Gage H, Masud T, Bowling A, Pearl M, Morris RW, Iliffe S, Delbaere K. Exercise for reducing fear of falling in older people living in the community. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD009848. DOI: 10.1002/14651858.CD009848.pub2
On the effect of cognitive therapies on fear of falling: Chua et al. Effectiveness of cognitive behaviour therapy-based multicomponent interventions on fear of falling among community-dwelling older adults: A systematic review and meta-analysis. JAN. 2019 For more details on the content of cognitive behavioral therapies for fear of falling: Dorresteijn TA, Zijlstra GA, Ambergen AW, Delbaere K, Vlaeyen JW, Kempen GI. Effectiveness of a home-based cognitive behavioral program to manage concerns about falls in community-dwelling, frail older people: results of a randomized controlled trial [published correction appears in BMC Geriatr. 2016;16:108]. BMC Geriatr. 2016;16:2. Published 2016 Jan 6.
On the feelings of elderly people at home who are afraid of falling: Piot-Ziegler Chantal, Cuttelod Thérèse, Santiago Delefosse Marie, ” Définir ” la peur de tomber ” chez les personnes âgées à domicile. Étude qualitative”, Bulletin de psychologie, 2007/6 (Numéro 492), pp. 515-525. DOI : 10.3917/bupsy.492.0515.
On scales for assessing fear of falling in the elderly : Peyronnet P, Darbois N, Pinsault P. Les échelles d’évaluation de la peur de la chute chez les personnes âgées-Revue systématique de littérature. Grenoble-Alpes University, 2016
On the frequency, consequences and determinants of the fear of falling in the elderly : Alice C. Scheffer, Marieke J. Schuurmans, Nynke van Dijk, Truus van der Hooft, Sophia E. de Rooij, Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons, Age and Ageing, Volume 37, Issue 1, January 2008, Pages 19-24
On the predictive factors of falls in people afraid of falling (and more specifically on the best prediction of cognitive and non-motor indicators): Langeard, A., Desjardins-Crépeau, L., Lemay, M. et al. Aging Clin Exp Res (2019). Cognitive performances better identify fallers than mobility assessment among older adults with fear of falling
On risk factorsfor developing fear of falling: Rivasi et al., 2019. Predictors of Incident Fear of Falling in Community-Dwelling Older Adults. JAMDA 2019
On the impact of fear of falling on physical activity: Matsuda et al. Relationship Between Fear of Falling and Physical Activity in People Aging With a Disability. PM&R 2019
Fear of falling and posttraumatic stress disorder after hip fracture surgery: Kornfield SL, Lenze EJ, Rawson KS. Predictors of Posttraumatic Stress Symptoms and Association with Fear of Falling After Hip Fracture. J Am Geriatr Soc. 2017;65(6):1251-1257.
On the relationship between fear of falling and balance: António M. Monteiro, Pedro Forte, Joana Carvalho, Tiago M. Barbosa & Jorge E. Morais (2019) Relationship between fear of falling and balance factors in healthy elderly women: A confirmatory analysis, Journal of Women & Aging
On fear of falling before and after total knee replacement: Chen SK, Voaklander D, Perry D, Jones CA. Falls and fear of falling in older adults with total joint arthroplasty: a scoping review. BMC Musculoskelet Disord. 2019;20(1):599. Published 2019 Dec 12. doi:10.1186/s12891-019-2954-9
On factors associated with fear of falling: Denkinger, Factors Associated with Fear of Falling and Associated Activity Restriction in Community-Dwelling Older Adults: A Systematic Review. The American Journal of Geriatric Psychiatry. 2015
On the theoretical way to explain the link between fear of falling and actually falling more: Young et al. How fear of falling can increase fall-risk in older adults: Applying psychological theory to practical observations. Gait & Posture. 2015
On the link between quality of life and fear of falling: Schoene D, Heller C, Aung YN, Sieber CC, Kemmler W, Freiberger E. A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls?. Clin Interv Aging. 2019;14:701-719. Published 2019 Apr 24.
On the links between fear of falling and actual falls, depending on one’s judgment of one’s abilities: Trevisan et al. Judgment Capacity, Fear of Falling, and the Risk of Falls in Community-Dwelling Older Adults: The Progetto Veneto Anziani Longitudinal Study. Rejuvenation Research. 2019
On the fear of falling in rheumatoid arthritis: Akyol Y, Ulus Y, Tander B, et al. Falls, fear of falling, and associated factors in ambulatory patients with rheumatoid arthritis: A comparative study with healthy controls. Turk J Phys Med Rehabil. 2018;64(3):213-221. Published 2018 Jul 17. doi:10.5606/tftrd.2018.1687
Written by Nelly Darbois
I enjoy writing articles that answer your questions, drawing on my experience as a physiotherapist and scientific writer, as well as extensive research in international scientific literature.
I live in the French Alps☀️🏔️, where I enjoy the simple pleasures of life (+ I’m a Wikipedia consultant and the founder of Wikiconsult).