An older adult is treated in an emergency room every 11 seconds for a fall-related injury, according to the National Council of Aging. While multiple factors cause falls, the fear of falling is often part of the equation.

Fearing falling can be nearly as detrimental to seniors as actually falling. Having a significant fear of falling limits mobility, causing reduced mental and physical health. Socially withdrawing makes seniors more likely to experience muscle and balance weakness. According to Heather Timothy, PT, RAC-CT, clinical director at Powerback Rehab, who has spent over two decades working as a physical therapist (PT) in senior care, “The fear of falling can occur in people who have fallen, but also in people who have never fallen before, and it can be so debilitating.”

While senior care providers proactively pursue strategies to reduce falls, few focus on mitigating the psychological effects of falls. For Timothy, having a proactive, data-driven approach to address residents’ fear of falling can significantly improve resident outcomes and even reduce fall risk overall.

“We need a much more proactive approach to addressing the psychology of falls before they ever occur,” says Timothy.

Understanding the psychology behind falls

Fear plays a significant role in the fall cycle. Residents who fear falling often limit their physical activity, which weakens their strength, balance, and mobility. Ironically, fear actually increases a senior’s risk of falling when they restrict movement. It’s an ongoing cycle that significantly impacts seniors’ quality of life.

Consider the following studies indicating how fear of falling affects seniors’ health:

• In a study of three long-term care programs in Upstate New York, nearly half (48%) of the residents reported a fear of falling. Among those, 76% restricted their daily activities due to that fear.
• A 2023 study of 93 older adults similarly found 47.3% of older adults in a retirement community reported fear of falling. Although their overall physical activity didn't differ from those without fear, their performance on objective physical function tests was significantly worse.
• A 2025 systematic review and meta-analysis of studies found a link between fear of falling and actual falls. There was a 3% higher risk of future falls for every one-point increase in concern about falling.

Signs of increased fall risk

Senior care facilities sometimes overlook subtle signs indicating a resident is at higher risk of falling. These include:

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• Slower gait speeds
• Incremental changes in balance
• Slight increases in assistance needed for daily tasks

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Early identification of these signs that may be attributed to a resident’s fear of falling can help prevent declines before they become significant. “If we're able to identify some of those things early on and address them with rehab and modifications, we're much more likely to get residents back to where they need to be before that fall occurs,” says Timothy.

A practical checklist for reducing the fear of falling

From physical therapists to dietitians, the entire senior care team needs to be involved in helping residents manage their fear of falling. “Falls are so multifactorial that it's not just one provider who can address it,” says Timothy.

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It helps to build questions about a fear of falling into your documentation. Timothy suggests adopting the following practical steps to manage the psychology of falls:

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Quality-of-life assessments

The most well-run facilities Timothy has seen are those that do quality of life rounding with residents at least quarterly. This includes asking residents if anything has changed as well as interviewing staff, like CNAs, who work most closely with the residents. She recommends doing the following:

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• Include interdisciplinary teams (PT, OT, SLP, nursing, CNA, pharmacy, and dietitian)
• Evaluate subtle changes in residents’ behavior and physical condition
• Align these evaluations with the Minimum Data Set (MDS) schedule every 92 days will make it easier and more likely to complete them

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Data-driven assessments

Besides taking qualitative measures of a resident’s risk of falling, senior care providers need to use consistent assessments that are backed by data. Over time, these can show even subtle decline.

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Consider the following assessments: 

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• Falls Efficacy Scale-International (FES-I): A scale to measure concern about falling that has been shown to have good reliability and validity.
• Activities, Balance and Confidence Scale (ABC)
• Fear Avoidance Behavior Questionnaire
• Gait and balance assessments by physical therapists

Collaborative team interventions

Once you determine a fear of falling is affecting a resident’s mobility level, addressing it requires collaboration across the team. 

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Medication reviews: Pharmacists can adjust any medications that might contribute to fall risks.

‍Therapy interventions: Physical therapists can assist with strength, balance, and gait issues through individualized rehab plans.

‍Cognitive and communication evaluations: Speech therapists can support residents who struggle with expressing their needs. Therapists can work with residents to build their confidence by gradually challenging their abilities with incremental successes that build confidence.

‍Administrators: Staff with purchasing decision-making power can ensure senior care spaces are designed to reduce falls and include furniture that mitigates the risk of falls.

Empowering residents by supporting independence

Throughout her career, Timothy has observed significant improvement when residents feel empowered and independent rather than feeble. By offering encouragement, as well as choices such as selecting between balance exercises, residents become active participants in their therapy, which leads to reduced anxiety and increased engagement.

“Giving them autonomy in a care plan gives residents a sense of control, and when they have more control, it helps combat some of that fear," says Timothy.

Making therapy enjoyable

Timothy can’t emphasize enough the importance of making therapy engaging and personalized. "A lot of people don't like to do exercise, but if you make it enjoyable and fun, it can become something they want to do and can be really positive," she says. 

Why addressing the fear of falling matters

While breaking the psychological cycle of falls requires thoughtful strategies tailored to each person, every plan should address the fear of falling. “The reason for a fall is never the same for any individual, so the approach to solving the problem depends, but all of them need help getting past the fear of falling,” says Timorthy.

Facilities that adopt a comprehensive, proactive approach, as outlined by Timothy, improve residents' physical health while also enhancing their overall quality of life.

By integrating psychological factors into a proactive care strategy, senior care administrators are more likely to break the cycle of falls that increases with residents’ fear of falling.

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