The cognitive consequences of fear of falling: Assessing the mediating role of social engagement and physical activity

Background and Objectives Cognitive function is crucial for older adults’ independence and quality of life. This study investigated the longitudinal relationship between fear of falling and cognitive function using data from the Korean Longitudinal Study of Ageing. Specifically, it examined whether social engagement (regular informal contact and social activities) and physical activity mediate the impact of fear of falling on cognitive function, informing targeted strategies to mitigate cognitive decline. Research Design and Methods This study analyzed seven waves (2006 to 2018) of a nationally representative longitudinal survey involving 3,453 older adults in Korea. To minimize omitted variable bias, the research applied ordinary least squares models with lagged dependent variables and conducted Sobel-Goodman mediation tests for additional insights. Results Developing a fear of falling over two years is negatively associated with cognitive function. Additionally, while fear of falling negatively impacts social activities and informal contacts, it does not significantly alter physical activity. Mediation analyses show that reduced social activities account for 31% of the cognitive decline associated with fear of falling, compared to 15% for informal social contacts. These findings highlight active social participation as a key factor in protecting cognitive health. Physical activity did not mediate this relationship. Discussion and Implications Interventions should prioritize enhancing social engagement to mitigate cognitive decline related to fear of falling. Facilitating active community participation can effectively support cognitive health and overall well-being in aging populations.