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J Gerontol A Biol Sci Med Sci. 2018 Aug 10;73(9):1212-1215. doi: 10.1093/gerona/glx237.

Fear of Falling Predicts Incidence of Functional Disability 2 Years Later: A Perspective From an International Cohort Study.

Author information

School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
Department of Chiropractic, Macquarie University, New South Wales, Australia.
Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
Office of Public Health Studies, University of Hawaii at Manoa, Honolulu.
Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island.
Department of Health Services, Policy & Practice, Brown University, Providence, Rhode Island.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore.



To study the extent to which fear of falling (FOF) is associated with the onset of functional disability over a 2-year period in older adults using self-reported and performance-based measures.


In 2012, 1,601 participants (aged 65-74 years) were recruited from four sites: Kingston and Saint-Hyacinthe, Canada; Manizales, Colombia; and Natal, Brazil. They were re-assessed in 2014. We quantified FOF using the Fall Efficacy Scale-International (FES-I; range: 16-64). Functional disability measures were (i) self-reported incident mobility disability, defined as difficulty climbing a flight of stairs or walking 400 m and (ii) incident poor physical performance, defined as a score <9 on the Short Physical Performance Battery. In the Poisson regression analysis, we included only those participants without functional disability at baseline to calculate incident risk ratios in 2014.


1,355 participants completed the 2014 assessment, of which 917 and 1,078 had no mobility disability and poor physical performance at baseline, respectively. In 2014, 131 (14.3%), and 166 (15.4%) participants reported incident mobility disability and poor physical performance, respectively. After adjusting for age, sex, socioeconomic, and health covariates, a one-point increase in FES-I at baseline was significantly associated with a 4% increase in the risk of reporting incident mobility disability (95% CI: 1.02-1.05) and a 3% increase in the risk of developing poor physical performance at follow up in the overall sample (95%CI: 1.01-1.05).


FOF is associated with a higher risk of incident mobility disability and poor physical performance in a cohort of older adults. It is increasingly important to study FOF's effect on functional disability and to take necessary measures to prevent the transition to end-stage disability.

[Available on 2019-08-10]

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