“I don’t want to be a burden”: the double-edged role of filial piety in fall-risk perception among community-dwelling older adults in China

Background: Falls are a major threat to healthy aging, yet older adults' subjective appraisal of their likelihood and consequences of falling may differ from objective physiological risk. Fall-risk perception is broader than fear of falling or activity-specific concern and is relevant because it may inform older adults' willingness to disclose falls, seek help, modify the home environment, and participate in balance or strength training. Aim: This study aimed to explore how community-dwelling older adults in China experience and understand fall risk in everyday life and family relationships, with particular attention to filial piety and the desire not to become a burden to adult children. Methods: A descriptive phenomenological design was used. Nineteen community-dwelling older adults in Changsha, China, were purposively recruited through maximum variation sampling and stratified by levels of concern about falling assessed using the Falls Efficacy Scale-International (FES-I). The FES-I was used as a sampling aid rather than as an operational measure of the broader phenomenon of fall-risk perception. Semi-structured individual interviews were conducted between March and May 2023. Data were analyzed using Colaizzi's seven-step method. Reporting followed the Consolidated Criteria for Reporting Qualitative Research. Results: Three overarching themes were identified. First, embodied and relational experiences were associated with heightened fall-risk perception, including adverse fall-related events, perceived efficacy of prevention, awareness of physical decline, environmental vigilance, and caregiver monitoring. Second, cognitive, identity-related, and contextual experiences were associated with reduced risk appraisal or constrained prevention, including misconceptions about falls, normalization of "harmless" falls, denial and overconfidence, over-reliance on assistive devices, living circumstances limiting home-safety practices, and limited professional support. Third, filial responsibility appeared in two contrasting forms: the wish not to burden adult children was associated with greater caution, while some participants also concealed minor falls to avoid causing family worry. Conclusion: Participants' accounts suggest that fall-risk perception among community-dwelling older adults in China is experienced not only as an individual appraisal but also within family and cultural relationships. Community nurses should consider integrating objective fall-risk assessment with family-sensitive communication strategies that promote mobility, autonomy, and family well-being while minimizing guilt, stigma, and concealment.