How should we manage fear of falling in older adults living in the community?

Many older people have a variety of adverse psychosocial difficulties related to falling, including fear, anxiety, loss of confidence, and impaired perception of ability to walk safely without falling.1 2 The umbrella term for these problems is “fear of falling,” and this is found in around half of community dwelling older people who fall and in up to half of those who have never fallen.1 2 Consequences include avoidance of activity, social isolation, and increasing frailty and risk of further falls independent of physical impairment.2 3 Although fear of falling is both common and debilitating, understanding of its management is limited. Some evidence supports the use of physical therapies to improve the syndrome, and emerging evidence supports the use of psychological therapies, in particular cognitive behavioural therapy. However, as a recent systematic review and meta-analysis have shown,1 3 no definitive studies exist to guide routine practice in this area. Furthermore, data showing how such interventions could be translated from research to clinical settings are sparse; only one randomised controlled trial of a complex intervention in fear of falling has attempted such evaluation.4 Health economic data about intervention in this common clinical problem are not yet available. We searched PubMed, Medline, CINAHL, Cochrane, and Embase online databases for studies related to interventions in fear of falling in community dwelling older adults to explore this question further. ### Physical and falls risk factor interventions Concerns about falling have a clear effect on gait patterns in older people. Laboratory studies of asymptomatic older people undergoing gait and balance studies on elevated walkways show disproportionately slow walking speeds and other dysfunctional gait adjustments,5 alongside abnormalities in postural balance compared with younger subjects.6 Such experimental data and the observation of higher risk of falls and increasing physical frailty in fear of falling suggest that physical …