Prevalence of Fear of Falling and Associated Factors among Community-Dwelling Older Adults in Urban Northeastern Thailand: A Cross-Sectional Study
DOI:
https://doi.org/10.55489/njcm.170720266692Keywords:
Fear of falling, Accidental falls, Aged, Community-dwelling older adults, Nocturnal awakenings, Sex factorsAbstract
Background: Fear of falling (FOF) is a major issue for older adults, significantly increasing their risk of falling. Few studies have explored this topic in urban areas of Thailand. This current study was aimed at assessing the prevalence of FOF and identifying factors associated with FOF among community-dwelling older adults.
Methods: A cross-sectional study was conducted among 350 older adults aged ≥ 60 years in Ban Ped Sub-district, Khon Kaen, Thailand. Participants were sampled using systematic sampling. FOF was assessed using the Thai Falls Efficacy Scale-International (Thai FES-I), with FOF defined as a score ≥ 22. Univariable and multivariable logistic regression analyses were performed to identify factors associated with FOF.
Results: FOF prevalence was 54% (95% CI: 48.91-59.59). High frequency items for FOF were walking on a slippery surface and walking up or down a slope. Four factors were found to be significantly associated with FOF: the female gender (AOR=2.88; 95% CI: 1.57-5.31), age ≥ 80 years (AOR=3.57; 95% CI: 1.23-10.37), a history of falls (AOR=2.10; 95% CI: 1.04-4.23), and nocturnal awakenings (AOR=3.37; 95% CI: 1.97-5.76).
Conclusion: More than half of older adults experienced FOF. Female gender, advanced age, a history of falls, and nocturnal awakenings were significantly associated with FOF. Interventions should prioritize high-risk groups, particularly by addressing modifiable factors, such as nocturnal awakenings through sleep hygiene programs, nocturnal toileting management, and referral pathways to see specialist physicians for older adults with sleep disorders.
References
World Health Organization. Ageing and health [Internet]. Geneva: World Health Organization; 2025 Oct 1 [cited 2026 Mar 17]. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
World Health Organization. Thailand: facts and figures – healthy ageing [Internet]. WHO Regional Office for South-East Asia; 2025 [cited 2026 Mar 17]. Available from: https://cdn.who.int/media/docs/default-source/searo/ageing-and-health/fact-sheets-2024/thailand---facts-and-figures---healthy-ageing.pdf?sfvrsn=b27a508e_2
Pereira CB, Kanashiro AMK. Falls in older adults: a practical approach. Arq Neuropsiquiatr. 2022;80(5 Suppl 1):313-323. DOI: https://doi.org/10.1590/0004-282x-anp-2022-s107 PMid:35976297 PMCid:PMC9491436
Li Y, Hou L, Zhao H, Xie R, Yi Y, Ding X. Risk factors for falls among community-dwelling older adults: A systematic review and meta-analysis. Front Med (Lausanne). 2023;9:1019094. DOI: https://doi.org/10.3389/fmed.2022.1019094 PMid:36687461 PMCid:PMC9853191
Xiong W, Wang D, Ren W, Liu X, Wen R, Luo Y. The global prevalence of and risk factors for fear of falling among older adults: a systematic review and meta-analysis. BMC Geriatr. 2024;24(1):321. DOI: https://doi.org/10.1186/s12877-024-04882-w PMid:38580924 PMCid:PMC10998426
Vo MTH, Thonglor R, Moncatar TJR, Han TDT, Tejativaddhana P, Nakamura K. Fear of falling and associated factors among older adults in Southeast Asia: a systematic review. Public Health. 2023;222:215-228. DOI: https://doi.org/10.1016/j.puhe.2022.08.012 PMid:36229238
Lee D, Tak SH. A concept analysis of fear of falling in older adults: insights from qualitative research studies. BMC Geriatr. 2023;23(1):651. DOI: https://doi.org/10.1186/s12877-023-04364-5 PMid:37821830 PMCid:PMC10568775
Sitdhiraksa N, Piyamongkol P, Chaiyawat P, Chantanachai T, Ratta-Apha W, Sirikunchoat J, et al. Prevalence and Factors Associated with Fear of Falling in Community-Dwelling Thai Elderly. Gerontology. 2021;67(3):276-280. DOI: https://doi.org/10.1159/000512858 PMid:33677442
Silangirn P, Chaichana K, Thummayot S, Srisuttha P, Sadjapong U, Chaipin E, et al. Study of knee pain, fear of falling, and quality of life among community-dwelling older adults, Northern Thailand. Narra J. 2024;4(2):e915. DOI: https://doi.org/10.52225/narra.v4i2.915 PMid:39280307 PMCid:PMC11391954
Cochran WG. Sampling techniques. 3rd ed. New York: John Wiley & Sons; 1977. Available from: https://www.wiley.com/en-us/Sampling+Techniques,+3rd+Edition-p-9780471162407
Canever JB, Danielewicz AL, Leopoldino AAO, de Avelar NCP. Is the self-perception of the built neighborhood associated with fear of falling in community-dwelling older adults? Arch Gerontol Geriatr. 2021;95:104395. DOI: https://doi.org/10.1016/j.archger.2021.104395 PMid:33765655
Cole JA, Gonçalves-Bradley DC, Alqahtani M, Barry HE, Cadogan C, Rankin A, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2023;2023(10):CD008165. DOI: https://doi.org/10.1002/14651858.CD008165.pub5 PMid:37818791 PMCid:PMC10565901
Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40-43. DOI: https://doi.org/10.1016/j.sleh.2014.12.010 PMid:29073412
Ohayon MM, Krystal A, Roehrs TA, Roth T, Vitiello MV. Using difficulty resuming sleep to define nocturnal awakenings. Sleep Med. 2010;11(3):236-241. DOI: https://doi.org/10.1016/j.sleep.2009.11.004 PMid:20075004 PMCid:PMC2830306
Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988;10(2):61-63. DOI: https://doi.org/10.3109/09638288809164103 PMid:3403500
Sihapark S, Kuhirunyaratn P, Chen H. Severe Disability Among Elderly Community Dwellers in Rural Thailand: Prevalence and Associated Factors. Ageing Int. 2014;39(3):210-20. DOI: https://doi.org/10.1007/s12126-013-9190-7
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179-186. DOI: https://doi.org/10.1093/geront/9.3_Part_1.179 PMid:5349366
Podsiadlo D, Richardson S. The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-148. DOI: https://doi.org/10.1111/j.1532-5415.1991.tb01616.x PMid:1991946 PMCid:PMC10973134
Bischoff HA, Stähelin HB, Monsch AU, Iversen MD, Weyh A, von Dechend M, et al. Identifying a cut-off point for normal mobility: a comparison of the timed "up and go" test in community-dwelling and institutionalised elderly women. Age Ageing. 2003;32(3):315-320. DOI: https://doi.org/10.1093/ageing/32.3.315 PMid:12720619
Bohannon RW. Reference values for the five-repetition sit-to-stand test: a descriptive meta-analysis of data from elders. Percept Mot Skills. 2006;103(1):215-222. DOI: https://doi.org/10.2466/pms.103.1.215-222 PMid:17037663
Thiamwong L. Psychometric testing of the Falls Efficacy Scale-International (FES-I) in Thai older adults. Songkla Med J. 2011;29(6):277-287. http://smj.medicine.psu.ac.th/index.php/smj/article/view/207/206
Delbaere K, Close JCT, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR. The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age Ageing. 2010;39(2):210-216. DOI: https://doi.org/10.1093/ageing/afp225 PMid:20061508
Baurangthienthong S, Yindee O. The study among risk of falls, fear of falls and managements of prevention for falls in client of geriatric clinic. Vajira Nursing Journal. 2021;23(2):30-43. https://he02.tci-thaijo.org/index.php/vnj/article/view/252648
Hosmer DW, Lemeshow S, Sturdivant RX. Applied logistic regression. 3rd ed. Hoboken: John Wiley & Sons; 2013. DOI: https://doi.org/10.1002/9781118548387
Kim JH. Multicollinearity and misleading statistical results. Korean J Anesthesiol. 2019;72(6):558-569. DOI: https://doi.org/10.4097/kja.19087 PMid:31304696 PMCid:PMC6900425
Auais M, Alvarado BE, Curcio CL, Garcia A, Ylli A, Deshpande N. Fear of falling as a risk factor of mobility disability in older people at five diverse sites of the IMIAS study. Arch Gerontol Geriatr. 2016;66:147-153. DOI: https://doi.org/10.1016/j.archger.2016.05.012 PMid:27327236
Vitorino LM, Marques-Vieira C, Low G, Sousa L, Cruz JP. Fear of falling among Brazilian and Portuguese older adults. Int J Older People Nurs. 2019;14(2):e12230. DOI: https://doi.org/10.1111/opn.12230 PMid:30860668
Ubonsutvanich N, Petchlorlian A, Manasvanich BA, Samalapa R, Hengpongthorn T, Champaiboon J, et al. Multifactorial Risk Assessment of Falls in Thai Community-Dwelling Older Adults: Findings from a Geriatric Cohort Study. Geriatrics (Basel). 2025;10(5):118. DOI: https://doi.org/10.3390/geriatrics10050118 PMid:40981288 PMCid:PMC12452555
Geraci A, Calvani R, Ferri E, Marzetti E, Arosio B, Cesari M. Sarcopenia and Menopause: The Role of Estradiol. Front Endocrinol (Lausanne). 2021;12:682012. DOI: https://doi.org/10.3389/fendo.2021.682012 PMid:34093446 PMCid:PMC8170301
Birhanie G, Melese H, Solomon G, Fissha B, Teferi M. Fear of falling and associated factors among older people living in Bahir Dar City, Amhara, Ethiopia- a cross-sectional study. BMC Geriatr. 2021;21(1):586. DOI: https://doi.org/10.1186/s12877-021-02534-x PMid:34674654 PMCid:PMC8532299
Izadi-Avanji FS, Safa A, Abedzadeh-Kalahroudi M, Shaterian N. Fear of falling and its related factors in older adults following a fall in Kashan, Iran (2023-2024). BMC Geriatr. 2024;24(1):965. DOI: https://doi.org/10.1186/s12877-024-05560-7 PMid:39567872 PMCid:PMC11577670
Preston J, Biddell B. The physiology of ageing and how these changes affect older people. Medicine (Abingdon). 2021;49(1):1-5. DOI: https://doi.org/10.1016/j.mpmed.2020.10.011
Xu Q, Ou X, Li J. The risk of falls among the aging population: A systematic review and meta-analysis. Front Public Health. 2022;10:902599. DOI: https://doi.org/10.3389/fpubh.2022.902599 PMid:36324472 PMCid:PMC9618649
Rosenstock IM. Historical Origins of the Health Belief Model. Health Education Monographs. 1974;2(4):328-335. DOI: https://doi.org/10.1177/109019817400200403 PMCid:PMC8517795
León-Barriera R, Chaplin MM, Kaur J, Modesto-Lowe V. Insomnia in older adults: A review of treatment options. Cleve Clin J Med. 2025;92(1):43-50. DOI: https://doi.org/10.3949/ccjm.92a.24073 PMid:39746731
McBean AL, Najjar RP, Schuchard RA, Hall CD, Wang CA, Ku B, Zeitzer JM. Standing Balance and Spatiotemporal Aspects of Gait Are Impaired Upon Nocturnal Awakening in Healthy Late Middle-Aged and Older Adults. J Clin Sleep Med. 2016;12(11):1477-1486. DOI: https://doi.org/10.5664/jcsm.6270 PMid:27448415 PMCid:PMC5078702
Chen TY, Lee S, Hsu KW, Buxton OM. Poor sleep health predicts the onset of a fear of falling among community-dwelling older adults. Sleep Health. 2024;10(1):137-143. DOI: https://doi.org/10.1016/j.sleh.2023.10.007 PMid:38092638 PMCid:PMC12102778
Badrasawi M, Hamdan M, Vanoh D, Zidan S, ALsaied T, Muhtaseb TB. Predictors of fear of falling among community-dwelling older adults: Cross-sectional study from Palestine. PLoS One. 2022;17(11):e0276967. DOI: https://doi.org/10.1371/journal.pone.0276967 PMid:36395173 PMCid:PMC9671337
Choi NG, Gell NM, DiNitto DM, Marti CN, Kunik ME. Depression and activity-limiting fall worry among older adults: longitudinal reciprocal relationships. Int Psychogeriatr. 2020;32(4):495-504. DOI: https://doi.org/10.1017/S1041610219000838 PMid:31317852
Svinøy OE, Hilde G, Bergland A, Strand BH. Timed Up and Go: Reference Values for Community-Dwelling Older Adults with and without Arthritis and Non-Communicable Diseases: The Tromsø Study. Clin Interv Aging. 2021;16:335-343. DOI: https://doi.org/10.2147/CIA.S294512 PMid:33654390 PMCid:PMC7914052
Chang HT, Chen HC, Chou P. Factors Associated with Fear of Falling among Community-Dwelling Older Adults in the Shih-Pai Study in Taiwan. PLoS One. 2016;11(3):e0150612. DOI: https://doi.org/10.1371/journal.pone.0150612 PMid:26933882 PMCid:PMC4775068
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Copyright (c) 2026 Pawinee Saybungkla, Piyathida Kuhirunyaratn, Nipitphon Seeooppalat, Bangonsri Jindawong, Pat Nonjui, Prasert Prasomruk, Nichanun Panyaek, Surakarn Ruaisungnoen, Pinet Tatiwechakul, Thanakij Rungrueangrattanakul, Kritsana Aunthakhot

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