Fear of falling

Since the identification of the post-fall syndrome(1) and use of the term "ptophobia" (the phobic reaction to standing or walking)(2) in the early 1980s, fear of falling (FOF) has gained recognition as a health problem of older adults. In an attempt to measure this entity, various definitions have evolved. Tinetti and Powell(3) described FOF as an ongoing concern about falling that ultimately limits the performance of daily activities. Other authors(4.5) have referred to FOF as a patient's loss of confidence in his or her balance abilities. Still other authors(6) defined FOF as a general concept that described low fall-related efficacy (low confidence at avoiding falls) and being afraid of falling. Subjects in one study(7) indicated then did not describe themselves as being "afraid of falling," but rather were "worried" about falling. In the early phase of research, FOF was largely believed to be a consequence of falling. Researchers discussed FOF as resulting from the psychological trauma of the fall, leading to reduced activity and subsequent losses in physical capabilities.(2.8-10) Recent research, however, has revealed FOF in those who have not fallen(4.11,12) and, furthermore, leas uncovered a relationship to physical, psychological, and functional changes in older adults.(6) Ongoing studies are focusing on the causes of FOF, dispelling misconceptions (eg, FOF being a result of the normal aging process), and identifying the interventions that address FOF most effectively. The researchers, however, agree that FOF is multifactorial in etiology,(12,13) and they suggest that FOF may be a more pervasive and serious problem than falls in older adults(6.13) and thus deserves attention. The purpose of this update is to increase the reader's awareness of the current findings about FOF, including its prevalence among the growing older adult population in the United States, how it is measured, the relationships of FOF to other conditions, and the interventions that are being used to address this problem. The need for further research in the areas of measurement and intervention will be discussed.