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a Department of Public Health and Community Medicine, University of Sydney, New South Wales, Australia
b Health Promotion Unit, Central Sydney Area Health Service, Sydney
c Division of Geriatrics, Royal Prince Alfred Hospital, Sydney
Correspondence: Robert G. Cumming, Department of Public Health and Community Medicine, Building A27, University of Sydney, Sydney NSW 2006, Australia E-mail: bobc{at}pub.health.usyd.edu.au.
Decision Editor: William B. Ershler, MD
Background. The aim of this study was to assess the impact of fear of falling on the health of older people.
Methods. A total of 528 subjects (mean age 77 years) were recruited from two hospitals in Sydney, Australia, and followed for approximately 12 months. Eighty-five subjects died during follow-up, and 31 were admitted to an aged care institution. Tinetti's Falls Efficacy Scale (FES) was successfully administered to 418 subjects as part of the baseline assessment. Among those with baseline FES scores, ability to perform 10 activities of daily living (ADLs) was assessed at baseline and follow-up in 307 subjects, and SF-36 scores were assessed at baseline and follow-up in 90 subjects recruited during the latter part of the study. Falls during follow-up were identified using a monthly falls calendar.
Results. Compared with those with a high fall-related self-efficacy (FES score = 100), those with a low fall-related self-efficacy (FES score 
75) had an increased risk of falling (adjusted relative risk 2.09, 95% confidence interval [CI] 1.31–3.33). Those with poorer fall-related self-efficacy had greater declines in ability to perform ADLs (p < .001): the total ADL score decreased by 0.69 activities among persons with low FES scores (75) but decreased by only 0.04 activities among persons with FES scores of 100. Decline in ADLs was not explained by the higher frequency of falls among persons with low FES scores. SF-36 scores (particularly scores on the Physical Function and Bodily Pain subscales) tended to decline more among persons with poor fall-related self-efficacy. Nonfallers who said they were afraid of falling had an increased risk of admission to an aged care institution.
Conclusions. Fear of falling has serious consequences for older people. Interventions that successfully reduce fear of falling and improve fall-related self-efficacy are likely to have major health benefits.
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