Understanding the aetiology of fear of falling from the perspective of a fear-avoidance model – A narrative review

Approximately half of older adults experience fear of falling (FoF) but the aetiology is unclear. The aim is to review the literature on physiological, mood and cognitive factors associated with FoF and to interpret these findings in the context of a fear-avoidance model that provides a causal framework for the development of FoF. There is growing evidence that the development of FoF is influenced by balance problems and falls, and emerging evidence for a role for cognitive factors, particularly attention and processing of sensory information. While there may also be a role for mood/temperament in the development of FoF, current evidence is weak. We argue that these factors co-exist and interact, which complicates assessment and design of the most appropriate intervention. The fear avoidance model offers a novel framework for explaining the mechanism of developing FoF and the discrepancy between experienced and perceived fall risk. This model specifically capitalizes on recent insights into fundamental learning mechanisms underlying emotion and fear. The proposed models provide hypotheses for future research and indications for improving efficacy of existing treatment programs.