The impact of fear of falling and social support on self-awareness of falls in older adult patients with cardiovascular multimorbidity: a multiple mediation model

Objective To construct and validate a multiple mediation model of self-awareness of falls in older adult patients with cardiovascular multi-morbidity (CMM), and to elucidate the direct effects of fear of falling and social support on self-awareness of falls, as well as the mediating roles of emotion and cognitive function in these associations. Methods A cross-sectional study was conducted. From September 2025 to February 2026, 358 older adult patients with cardio-metabolic multi-morbidity were recruited from 8 communities in Anhui Province by convenience sampling. Data were collected using a general information questionnaire, the Self-Awareness of Falls Scale (SAFE), the Falls Efficacy Scale-International (FES-I), the Hospital Anxiety and Depression Scale (HADS), the Perceived Social Support Scale (PSSS), and the Montreal Cognitive Assessment (MoCA). Univariate analysis, Pearson correlation analysis, and multiple linear regression analysis were performed using SPSS 26.0. Structural equation modeling and path analysis were conducted with AMOS 26.0, and the bias-corrected Bootstrap method was applied to examine the mediating effects. Results The total score of self-awareness of falls in older adult patients with CMM was 61.27 ± 9.28. The structural equation model showed excellent fit ( χ 2 /d f = 1.517, CFI = 0.962, TLI = 0.974, RMSEA = 0.038) and accounted for 62.9% of the variance in self-awareness of falls. Both fear of falling ( β = 0.411) and social support ( β = 0.356) directly and positively predicted self-awareness of falls. Mediation analysis indicated that anxiety and cognitive function served as significant parallel mediators between the two independent variables and self-awareness of falls. (1) Pathway “fear of falling → anxiety → self-awareness of falls” (indirect effect = 0.043, 95% CI: 0.009–0.087): fear of falling was positively correlated with anxiety ( r = 0.187), suggesting that fall-related concern is associated with moderate risk anxiety, which in turn is associated with higher self-awareness of falls. (2) Pathway “fear of falling → cognitive function → self-awareness of falls” (indirect effect = 0.055, 95% CI: 0.025–0.102): fear of falling was significantly positively correlated with cognitive function ( r = 0.252), suggesting that individuals with better cognitive function have a more accurate perception of their own fall risk. (3) Pathway “social support → anxiety → self-awareness of falls” (indirect effect = 0.083, 95% CI: 0.040–0.144): social support was significantly negatively correlated with anxiety ( r = 0.287), and anxiety was positively correlated with self-awareness of falls ( r = 0.490, p < 0.01), suggesting that social support may be associated with self-awareness of falls through a risk perception activation pathway, mediated positively by anxiety. (4) Pathway “social support → cognitive function → self-awareness of falls” (indirect effect = 0.068, 95% CI: 0.025–0.134): social support was significantly positively correlated with cognitive function ( r = 0.295), suggesting that social support may enhance individuals’ ability to identify fall risks by promoting cognitive reserve, thereby associating with self-awareness of falls. Conclusion In older adult patients with CMM, self-awareness of falls is directly and positively associated with fear of falling and social support, with anxiety and cognitive function serving as mediator variables, respectively. Clinical interventions should target precise management of anxiety: while utilizing the alerting function of fear, efforts should be made to strengthen social support networks and cognitive maintenance, so as to synergistically improve patients’ fall awareness.