ORIGINAL ARTICLE: EPIDEMIOLOGY,
CLINICAL PRACTICE AND HEALTH
Psychological correlates of fear of falling: Findings
from the German Aging Survey
and Hans-Helmut König
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany
Aim: The aim of the present study was to identify general psychological factors related to fear of falling.
Methods: Data drawn from national probability sampling of the German population aged ≥40 years were used
(German Aging Survey; n = 7779). The fear of falling and the psychological factors of loneliness, life satisfaction,
positive affect, negative affect, optimism, self-efﬁcacy, self-esteem, self-regulation and perceived stress were collected
in self-administered questionnaires. Multiple logistic regression models controlling for sociodemographic, lifestyle
and health-related variables were used to determine the psychological correlates of fear of falling.
Results: The prevalence of fear of falling was 18% for all individuals. All psychological factors showed strong
bivariate associations with fear of falling. In the multiple regression analyses, higher levels of loneliness, lower life sat-
isfaction, lower positive affect and higher negative affect, as well as lower levels of optimism, self-efﬁcacy, self-esteem,
self-regulation and more perceived stress, were associated with increased fear of falling after controlling for sociode-
mographic factors, various lifestyle factors and morbidity.
Conclusions: The psychological factors considered in the present study are important for characterizing people
with fear of falling. Because effective interventions to treat the fear of falling are available, our study might help to
address this target group more accurately. Geriatr Gerontol Int 2018; 18: 396–406.
Keywords: aged, cross-sectional studies, falling, Germany, psychological factors.
More than 30% of community-dwelling older individ-
uals experience a fall each year. Therefore, and regard-
less of the physical consequences, some individuals
develop a fear of falling (FOF). FOF is also common in
older adults who have not yet experienced a fall. As
FOF is strongly related to age, it is expected that the
number of individuals with FOF will increase markedly
as a result of demographic shifts. FOF ultimately results
in social isolation, avoidance of physical activities, loss
decreases in mental health
worse quality of life.
Furthermore, it is associated with
admissions to a nursing home
and overestimation of
A schematic diagram of how FOF
can affect balance performance was recently introduced
Hence, it is important to know the factors
associated with FOF.
To date, various studies have examined the associa-
tion of sociodemographic factors, functional outcomes
and mental health with FOF.
However, only a small
body of literature has examined the psychological cor-
relates of FOF.
These studies are mostly restricted
to psychological correlates that are directly related to
FOF. Very few studies have found associations between
FOF and general psychological factors, such as general
self-efﬁcacy or optimism, suggesting that these general
psychological correlates should be further investigated.
The study presented here speciﬁcally examined the fol-
lowing general psychological factors: loneliness, life
satisfaction, positive affect, negative affect, optimism,
self-efﬁcacy, self-esteem, self-regulation and perceived
These factors were selected because they appeared
to be theoretically or empirically relevant. More speciﬁ-
cally, it has been shown that loneliness is associated
with various adverse health outcomes, including
fatigue, depression, backache, headache, dizziness and
Furthermore, a cross-sectional study in
Accepted for publication 27 August 2017.
Correspondence: Dr André Hajek PhD, Department of Health
Economics and Health Services Research, Hamburg Center for
Health Economics, University Medical Center, Hamburg-
Eppendorf, Hamburg, Germany. Email: email@example.com
*These authors contributed equally to this work.
| doi: 10.1111/ggi.13190 © 2017 Japan Geriatrics Society
Geriatr Gerontol Int 2018; 18: 396–406