The relationship between fall anxiety and fall behaviors in geriatric patients undergoing orthopedic surgery with a history of falling| JOURNAL OF GERONTOLOGY AND GERIATRICS

Abstract

Background. Falls in older adults pose significant health risks and have both physical and psychological effects. This condition is an important factor influencing fall anxiety and fall behaviors.
Aim. The aim of this study is to examine the relationship between fall anxiety and fall behaviors in geriatric patients who were admitted to the orthopedic ward and underwent orthopedic surgery due to a fall.
Method. A cross-sectional correlational study was conducted with 97 patients aged 65 and above in the orthopedic clinic of a state hospital between September 2023 and September 2024. Data were collected
through face-to-face surveys using the “Patient Identification Form”, the “International Falls Efficacy Scale”, and the “Fall Behaviors Scale for Older Adults”, and statistical analysis was performed.
Results. The average age of the patients was 72.62 ± 6.52, with 55.7% being male, 76.3% married, 86.6% unemployed, and 40.2% having completed primary school. 76.3% had chronic illnesses, and 75.3% had a history of surgery. 85.6% of the patients reported fall anxiety, and 78.4% had a fall history. High levels of fall anxiety and risk were found, and demographic factors were found to be associated with these behaviors.
Conclusions. A strong relationship between fall anxiety and fall risk was observed in older individuals. To reduce this, it is suggested to implement physical activity programs, educational interventions, environmental adjustments, and psychosocial support. Additionally, the need for multidisciplinary research is emphasized.

INTRODUCTION

In many countries around the world, the population is rapidly aging, and this demographic transformation brings with it significant problems in terms of health, social, and economic issues ¹. Aging is a natural phenomenon that all living beings encounter throughout their lifespan, and it leads to declines in physical, mental, and social functioning ². With aging, irreversible changes occur in the body, and there is a loss of function in all organ systems, which increases the risk of falls ³. Falls in older individuals threaten their health and independence, while also leading to high healthcare costs ³. Studies show that one-third of older adults fall at least once a year, and individuals with a history of falls have two to three times the risk of falling again ^4,5. Falls are one of the leading causes of both fatal and non-fatal injuries in the elderly, and severe injuries may require hospitalization ^3,6. In addition to physical and emotional pain, some patients may require prolonged hospitalization ^1,5.

Fear of falling is a condition frequently observed in individuals who have experienced a fall. This fear leads individuals to feel inadequate in performing daily activities and often causes them to limit their movements. However, these limitations further increase the risk of falling ^7,8. Falls have many different causes and risk factors. Most of these risk factors are preventable, and biological, behavioral, and environmental factors are among the elements that increase the risk of falling ^4,6. With the rapid growth of the elderly population, it is observed that the fall risk factors have increased as well, which has raised the fall rates among older adults ^3,5. Environmental factors at home play a significant role in more than half of falls ³.

In elderly patients who undergo orthopedic surgery, physical activity levels decrease in the post-operative period, and patients often refuse mobilization due to fear of falling ⁹. This situation causes patients to remain immobile for extended periods and leads to the development of many unwanted complications. Therefore, it is necessary to assess the fear of falling and examine fall behaviors to encourage patient mobilization. Especially in individuals with a history of falls, it is recommended that these factors be studied in depth ¹⁰.

As a result, with the increase in the elderly population, it has been observed that the frequency of falls has also risen, leading to serious health problems ^1,3. In this context, examining the fall risk factors, fear of falling, and fall behaviors in elderly individuals is of great importance. Our study aims to investigate the relationship between fear of falling and fall behaviors in elderly patients who have been admitted to the orthopedic department and undergone surgery.

MATERIALS AND METHODS

PURPOSE AND TYPE OF THE STUDY

This study was conducted as a cross-sectional, correlational research to examine the relationship between fear of falling and fall behaviors and the influencing factors in elderly patients who were admitted to the orthopedic service and underwent orthopedic surgery due to falls.

POPULATION AND SAMPLES

The population of the study consists of patients receiving treatment in the orthopedic clinic of a public hospital between September 2023 and September 2024. The sample size was calculated using G*Power 3.1.9.7 software for an Independent t-test with an effect size of 0.3, alpha= 0.05, power= 0.90, and an allocation ratio of 1:1, resulting in a required total sample size of 97 participants ¹¹. Additionally, post hoc power analysis confirmed that this sample size provides sufficient power for subgroup analyses based on education level and surgical history. However, subgroup analyses with smaller groups may have limited statistical power, which is acknowledged as a limitation of the study.

The final sample included 97 patients who met the inclusion criteria. Patients who met the inclusion criteria were those aged 65 and older, who had undergone orthopedic surgery (surgical treatment of a lower extremity fracture) due to a history of falls, were on the first postoperative day, had been mobilized at least once, volunteered for the study, understood and spoke Turkish, had no communication problems, and had no diagnosed psychiatric conditions.

Dependent variables

The dependent variables of the study were the postoperative fear of falling and fall behavior mean scores of the patients.

Independent variables

The independent variables were the patients’ age, gender, marital status, educational status, employment status, presence of chronic diseases, number of chronic diseases, surgical history, number of surgeries, and fall history.

DATA COLLECTION TOOLS

Patient identification form

A form used to collect socio-demographic information and health status data of patients (such as age, gender, marital status, education, occupation, fall history, chronic diseases, number of chronic diseases, previous surgery history, and number of surgeries).

International Fall Efficacy Scale (FES-I)

This scale, developed by Yardley et al. (2005) to determine fall-related fear in the elderly, was validated in Turkish by Ulus et al. in 2012 ^12,13. The scale assesses elderly individuals’ confidence in daily living activities and their level of fear of falling. The scale consists of 16 items, with each item scored on a four-point scale (4= very concerned, 3= fairly concerned, 2= somewhat concerned, 1= not concerned at all). The total score ranges from 16 (no fear of falling) to 64 (extreme fear of falling). If the total score is below 24, the fear of falling is considered low, while a score of 24 or above indicates high fear of falling. The Cronbach’s Alpha value for the original scale was 0.96, for the Turkish validation study it was 0.94, and for this study, it was 0.95.

Fall behavioural (FaB) scale for older adults

Developed by Clemson, Cuming, and Heard (2003) and validated for Turkish by Uymaz and Nahcivan (2013), this scale aims to assess the behaviors and awareness exhibited by elderly individuals to prevent falls ^14,15. The tool is designed for self-reporting or interview methods and is based on the individual’s perception of their own behaviors. The scale uses a four-point Likert-type response, consisting of 30 items and 10 sub-dimensions. Six items are reverse-scored. The total score is obtained by summing the points from all items and dividing by the number of items. Similarly, scores for sub-dimensions are calculated by summing the item scores for each sub-dimension and dividing by the number of items. The total scale and sub-dimension scores range from 1 to 4, with higher scores indicating safe/protective behaviors and lower scores indicating risky behaviors. In the Turkish adaptation study by Uymaz and Nahcivan (2013), Cronbach’s Alpha was 0.90, and in this study, Cronbach’s Alpha was 0.91.

DATA COLLECTION

Data were collected between September 2023 and September 2024 from elderly patients who visited the emergency department due to falls and later underwent orthopedic surgery in the orthopedic clinic of the healthcare institution where the study was conducted. Patients who met the inclusion criteria were orally informed about the purpose of the study and that participation was voluntary, and written consent was obtained. The assessments were conducted after patients had undergone surgery, received adequate analgesia, and had been mobilized at least once, but before the initiation of physical therapy. This ensured that participants completed the forms at a time when they felt physically comfortable and free of pain. To prevent interaction with other patients, they were instructed to complete the form independently. On average, it took 15-20 minutes for each patient to complete the form.

DATA EVALUATION

The data were analyzed using the IBM SPSS 26.0 statistical program. Descriptive data for the patients were presented as frequency, percentage, mean, and standard deviation. The normality of the data was assessed using the Shapiro-Wilk test. For normally distributed data, the Independent t-test, ANOVA, Post hoc (Games-Howell), and Pearson correlation tests were used. To control for the increased risk of Type I error due to multiple comparisons, Bonferroni correction was applied where appropriate during subgroup analyses.

In the inferential analyses, a simple linear regression was initially conducted to examine the relationship between fear of falling and fall behaviors. Sociodemographic and health-related variables found to be significant (p < 0.05) − particularly gender, educational status, and health conditions-were subsequently included in a multiple linear regression model to evaluate their combined effects. Potential confounding variables were controlled for within the models. All statistical tests were conducted with a 95% confidence interval and a significance level set at 5%.

RESULTS

The socio-demographic and health-related data of the patients are presented in Table I. The mean age of the patients is 72.62 ± 6.52, with 55.7% being male, 76.3% married, 86.6% unemployed, and 40.2% having graduated from elementary school. 76.3% have a chronic disease, and 66% have one chronic illness. 75.3% of the patients have a surgical history, and 60.8% have undergone surgery once. Additionally, 85.6% have a fear of falling, and 78.4% have a fall history (Tab. I).

The average scores for the FES-I and the FaB are given in Table II. The mean total score of the FES-I was 36.06 ± 9.35. The mean total score of the FaB was 2.75 ± 0.32. Among the subscales of the FaB, the highest score was 3.44 ± 0.57 for attentiveness, while the lowest score was 2.31 ± 0.81 for the subscale of answering the phone.

A comparison of the descriptive characteristics of the patients with the mean total scores of the scales is provided in Table III. There was a significant difference between the total scores of the FES-I and factors such as gender, employment status, education level, presence of chronic disease, number of chronic diseases, surgical history, number of surgeries, fear of falling, and fall history (p < 0.05). Women, the unemployed, those with two chronic diseases, those who were illiterate, those with two surgeries in their history, and those with a fear of falling or a fall history had higher scores (p < 0.05). There was also a significant difference in the mean scores of the FaB between education level, chronic disease, surgical history, and fear of falling (p < 0.05). Those with chronic diseases, a surgical history, or fear of falling, and those who were illiterate had higher scores. Significant differences between groups remained significant after Bonferroni correction (p < 0.05).

Table IV presents the results of the simple linear regression analysis. According to this model, age, female gender, lower educational level, presence of chronic disease, and history of falling significantly predicted FES-I scores, with the model explaining 29.2% of the total variance. Among these, history of falling and presence of chronic disease emerged as the strongest predictors of FES-I scores.

In contrast, the regression model for FaB scores was not statistically significant, and the explained variance was notably low (5.5%). None of the independent variables significantly predicted FaB scores (Tab. V).

A moderate positive significant relationship was found between the age variable and the total scores of the FES-I (r= 0.303; p= 0.003), while a weak positive significant relationship was found between age and the total scores of the FaB (r= 0.235; p= 0.021). Moreover, a strong positive significant relationship was identified between the FES-I and the FaB (r= 0.802; p < 0.001) (Tab. VI).

DISCUSSION

Our study revealed that fear of falling is considerably high among older adults who were admitted to the hospital due to falls. According to a global meta-analysis, the prevalence of fear of falling among older individuals can reach up to 49.6%, with a range varying between 6.96% and 90.34%. Subgroup analyses showed that the pooled prevalence estimates were higher in developing countries (53.40%) compared to developed countries (46.7%) ¹⁶. A systematic review also reported increased fear of falling following hip fractures ¹⁷.

The findings further indicated that fear of falling significantly increases with age, which is consistent with existing literature. Indeed, international studies have frequently emphasized that both the incidence and risk of falls increase in individuals aged 65 years and above ^18-20. Several studies have demonstrated that the frequency of falls is significantly higher among individuals aged 80 and over ²¹. Kılıç et al. (2021) reported fear of falling in 54.7% of individuals aged 65-74, 72.5% in the 75-84 age group, and 94.1% in those aged 85 and above ¹⁹. Similarly, Curcio et al. (2020) highlighted that advanced age is a significant risk factor for fear of falling. Age-related physiological changes-such as decreased muscle strength, functional limitations, and increased dependency-contribute to heightened concerns about falling ^3,19 which, in turn, directly affect fall behaviors.

Fear of falling has also been associated with regular medication use, female gender, utilization of healthcare services, low physical activity, increased dependency, and higher mortality ^24-27. In our study, high levels of fear of falling were significantly predicted by variables such as age, female gender, low educational attainment, presence of chronic disease, and history of falling. Together, these variables explained 29.2% of the variance in FES-I scores. Notably, fall history and chronic illness emerged as the strongest predictors of FES-I scores. These results align with national and international findings ^18,19,24-29. For example, a study conducted in Brazil reported that 63.9% of older adults experienced fear of falling, with higher prevalence observed among women, individuals with chronic illnesses, and those with prior fall experiences ²⁹. Especially in women, reduced bone mineral density with aging increases the risk of falling and reinforces fear of falling ^22,30-35. In the study by Birimoğlu Okuyan & Bilgili (2018), 65.3% of older adults reported fear of falling, and 49.2% had experienced at least one fall in the past year. Other studies have emphasized the bidirectional relationship between experiencing a fall and fear of falling ^18,36.

Our findings also showed elevated fear of falling among older adults who were unemployed (retired or otherwise) and those with a history of surgery. Although these findings are in line with previous studies ^{19,31-33,37,38}. regression analyses indicated that these variables were not statistically significant predictors of fear of falling. Nevertheless, further studies are warranted to explore the behavioral impact of employment status and surgical history on fear of falling.

According to the sub-dimensions of the FES-I scale, the highest mean score was found in the attentiveness subscale (3.44 ± 0.57), whereas the lowest was observed in the answering-the-phone subscale (2.31 ± 0.81). Compared to previous studies ^11,37 our overall FES-I scores appear to be lower. In Özcan & Alparslan’s study, the highest scores were found in the cognitive adaptation subscale ³⁷, while the answering-the-phone subscale had similarly low scores. The consistent finding of low scores in this latter subscale suggests that answering the phone may be perceived as a particularly risky behavior among older adults.

Furthermore, our study found that individuals who were illiterate exhibited higher levels of awareness regarding fall behaviors ^19,31-33,38. This may imply that individuals with lower educational levels tend to behave more cautiously. On the other hand, some studies suggest that higher education levels are associated with reduced fear of falling, potentially due to enhanced social engagement and psychological resilience ^38,39.

One of the most striking findings of our study is the strong positive correlation (r = 0.802; p < 0.001) between fear of falling and fall-prevention behaviors. This suggests that individuals with greater fear of falling tend to adopt more careful and intentional behaviors ^40-42. However, such behaviors are not always functional. Fear of falling can reduce balance confidence, limit physical activity, lead to social withdrawal, and result in the avoidance of daily life activities. Although these avoidance behaviors may appear protective in the short term, they can paradoxically increase fall risk in the long term due to deconditioning, loss of muscle strength, and increased functional dependency ^43,44. This cyclical relationship has also been emphasized by Delbaere et al. (2018) and Hadjistavropoulos et al. (2017), who noted that fear of falling triggers avoidance behaviors, which in turn lead to further physical decline ^40,45. Scheffer et al. (2017) showed that this pattern is particularly pronounced in women, individuals with prior fall history, and those with low balance confidence ⁴¹. Zijlstra et al. (2018) highlighted that perceived balance capacity is directly linked to fear and may lead to an overestimation of fall risk ⁴⁶.

Ultimately, it is understood that while these psychological factors lead individuals to adopt precautionary behaviors, excessive avoidance may jeopardize their independent living. Individuals with high fear of falling may develop more careful yet sometimes maladaptive behaviors, indicating that fear can indeed influence behavioral change. In this regard, Lavedán et al. (2018) emphasized that fear of falling among older adults in Europe is both a cause and a consequence of falls ³².

In conclusion, factors such as cultural beliefs, access to healthcare systems, the presence of social support networks, and availability of preventive programs may account for differences across countries. The high level of fear observed in our sample may be linked to the physical vulnerability associated with the postoperative period, inadequate support after discharge, anxiety about readmission, and social isolation following a fall. However, the absence of direct investigation into these factors represents a significant limitation in terms of the generalizability of our findings.

LIMITATIONS

Our study has several limitations. First, we did not specify the types of orthopedic surgeries undergone, and the results are limited to patients from a single hospital, which may affect generalizability. The cross-sectional design also restricts causal interpretations, as fear of falling and fall behaviors may influence each other bidirectionally. Future longitudinal or interventional studies are needed to clarify these relationships. Additionally, factors such as family structure, home environment, social isolation, pain, and fatigue were not assessed, which may bias the understanding of fall fear and behaviors. The sample may not represent different cultural or socioeconomic groups, limiting wider applicability. Finally, fall fear and behaviors were evaluated only through self-report scales (FES-I and FaB), which, despite good psychometric properties, can be influenced by social desirability and perceptual biases. The lack of objective mobility tests is another limitation.

STRENGTHS

Despite these limitations, this study contributes significantly by focusing on elderly patients after orthopedic surgery due to falls. The unique sample provides valuable insights into post-surgical fall fear. The use of internationally validated scales and face-to-face data collection enhances reliability. Examining both fear and behaviors together offers a comprehensive perspective, potentially guiding future interventions.

CONCLUSIONS AND RECOMMENDATIONS

Our study found high levels of fall fear and fall behaviors among elderly patients, with significant relationships between fall fear and factors such as gender, employment status, education level, chronic diseases, surgical history, and the number of surgeries. Based on these findings, we recommend:

1. expanding studies with larger populations and multi-center research to validate findings in broader elderly populations;
2. raising awareness among healthcare professionals and caregivers about fall fear and behaviors in elderly patients through educational activities;
3. implementing psychosocial interventions to reduce fall fear in elderly individuals;
4. regular evaluations for elderly individuals with chronic diseases to assess fall risk and fear.

Conflict of interest statement

The authors declare no conflict of interest.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

SA: conceptualization, methodology, software; SŞ: conceptualization, data curation, visualization, writing-original draft preparation; SÇ: supervision, investigation; EK: writing-reviewing and editing.

Ethical considerations

Before starting the study, ethical approval was obtained from the Ethics Committee of the University of Social and Human Sciences (date-protocol No= 08.17.2023-2023-SBB-0448). Preliminary research permission was granted by the hospital’s chief physician, institutional approval was obtained from the Provincial Health Directorate, and written permission was received via email from the authors who conducted the Turkish validity and reliability of the FES-I and FaB. Patients were informed about the purpose of the study, that the information collected would only be used for research purposes, that they would not be individually affected by the study’s results, and that their names would not appear in the research findings. All participants were informed verbally about the study and then provided written informed consent before participating.

History

Received: May 24, 2025

Accepted: September 9, 2025

Figures and tables

References

1. World Health Organization (WHO). UN decade of healthy ageing. 2021a. Publisher Full Text
2. Bilgili N, Kitiş Y. Aging and elderly health. Vize Publishing: Ankara; 2018.
3. The National Council on Aging (NCOA). Falls prevention for older adults. 2022. Publisher Full Text
4. World Health Organization (WHO). Step safely: strategies for preventing and managing falls across the life-course. Geneva; 2021b.
5. Republic of Turkey Ministry of Health. Turkey Healthy Aging Action Plan and Implementation Program 2021-2026. Public Health General Directorate Printing House: Ankara; 2021.
6. Centers for Disease Control and Prevention (CDC). Older adults fall prevention. Facts about falls. 2021. Publisher Full Text
7. Thiamwong L, Suwanno J. Fear of falling and related factors in a community-based study of people 60 years and older in Thailand. Int J Gerontol. 2017; 11:80-84. DOI
8. Glover L, Kinsey D, Clappison DJ. “I never thought I could do that…”: findings from an Alexander technique pilot group for older people with a fear of falling. Eur J Integr Med. 2018; 17:79-85. DOI
9. Demirtunç D. Investigation of factors triggering kinesiophobia in patients with total knee arthroplasty. Master’s Thesis. 2023.
10. Mete Z. Determining the relationship between the surgical fear levels and post-operative pain levels in patients scheduled for total knee replacement surgery. Master’s Thesis. 2020.
11. Birimoğlu Okuyan B, Bilgili N. Mobility and fall behaviors in the elderly: a study of nursing home. J Educ Res Nurs. 2018; 15:1-8. DOI
12. Yardley L, Beyer N, Hauer K. Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing. 2005; 34:614-619. DOI
13. Ulus Y, Durmus D, Akyol Y. Reliability and validity of the turkish version of the Falls Efficacy Scale International (FES-I) in Community-Dwelling Older Persons. Arch Gerontol Geriatr. 2012; 54:429-433. DOI
14. Ekşi Uymaz P, Nahcivan N. Yaşlılar İçin Düşme Davranışları Ölçeğinin geçerlik ve güvenirliği. Florence Nightingale J Nurs. 2013; 21:22-32.
15. Clemson L, Bundy C, Cumming G. Validating the falls behavioural (FaB) scale for older people: a Rasch analysis’. Disabil Rehabil. 2007; 30:498-506. DOI
16. Xiong W, Wang D, Ren W. The global prevalence of and risk factors for fear of falling among older adults: a systematic review and meta-analysis. BMC Geriatr. 2024; 24:321. DOI
17. Gadhvi C, Bean D, Rice D. A systematic review of fear of falling and related constructs after hip fracture: prevalence, measurement, associations with physical function, and interventions. BMC Geriatr. 2023; 23:385. DOI
18. Sayar S, Köse B, Yılmaz R. Frequency of falls in the elderly and factors affecting falls: a descriptive study. Turkiye Klinikleri J Gerontol. 2022; 1:1-8. DOI
19. Solmaz T, Altay B. Medication use in the elderly and determinatıon of fall factors causing. Balıkesir Health Sciences Journal. 2019; 8:129-134.
20. United Nations (UN), Department of economic and social affairs, population division. World Population Ageing 2019. United Nations: New York; 2020.
21. Talarska D, Strugala M, Szewcyczak M. Is independence of older adults safe considering the risk of falls?. BMC Geriatr. 2017; 17:66. DOI
22. Kılıç D, Ata G, Hendekçi A. One of the ımportant health problems of the aging period: falling and factors affecting falling. Acıbadem Univ. Sağlık Bilim. Derg. 2021; 12:517-523. DOI
23. Curcio CL, Wu YY, Vafaei W. A regression tree for identifying risk factors for fear of falling: the International Mobility in Aging Study (IMIAS). J Gerontol A Biol Sci Med Sci. 2020; 75:181-188. DOI
24. Belloni G, Büla C, Santos-Eggimann B. Fear of falling and all-cause mortality among young-old community-dwelling adults: a 6-year prospective study. Eur Jof Ageing. 2022; 19:293-300. DOI
25. Mortazavi H, Tabatabaeichehr M, Taherpour M. Relationship between home safety and prevalence of falls and fear of falling among elderly people: a cross-sectional study. Mater Sociomed. 2018; 30:103.
26. Pereira MEA, Santos GS, Almeida CR. Association between falls, fear of falling and depressive symptoms in community-dwelling older adults. Healthcare (Basel). 2024; 12:1638. DOI
27. Zhao Y, Li J, Wang S. Fear of falling, depression, and physical activity as determinants of health-related quality of life in older adults. BMC Public Health. 2024; 24:1205. DOI
28. Aktürk Ü, İster E. Some features of hospitalized elderly and effects of fall behavior on fall risk. Medicine Science. 2019; 8:606-612. DOI
29. Vitorino LM, Marques-Vieira C, Low G. Fear of falling among Brazilian and Portuguese older adults. Int J Older People Nurs. 2019; 14:E12230. DOI
30. Wu H, Ouyang P. Fall prevalence, time trend and its related risk factors among elderly people in China. Arch Gerontol Geriatr. 2017; 73:294-299. DOI
31. Rivasi G, Kenny RA, Ungar A. Predictors of incident fear of falling in community-dwelling older adults. J Am Med Dir Assoc. 2020; 21:615-620. DOI
32. Lavedán A, Viladrosa M, Jürschik P. Fear of falling in community-dwelling older adults: a cause of falls, a consequence, or both?. Plos One. 2018; 13:E0194967. DOI
33. Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults. United States. J Safety Res. 2016; 58:99-103. DOI
34. Kundakçi GA, Yılmaz M, Sözmen MK. Investigation of falls in the elderly and characteristics. Ege University Journal of Nursing Faculty. 2018; 34:73-88.
35. Ek S, Rizzuta D, Fratiglioni L. Risk factors for injurious falls in older adults: the role of sex and length of follow-up. J Am Geriatr Soc. 2019; 67:246-253.
36. Gencer GYG, İpek L, Kara DS. Investigation of studies on falling and balance in the elderly in Turkey. Elderly Issues Research Journal (EIRJ). 2021; 14:70-83. DOI
37. Özcan G, Balcı Alparslan G. The relationship between physical activity and falling behaviour of elderly ındividuals staying in nursing home. STED. 2022; 31:57-66. DOI
38. Kozak DA, Bahar NT, Ay F. Falling situations of older adults in Turkey. Antropoloji. 2021; 41:11-20. DOI
39. Kim T, Choi SD, Xiong S. Epidemiology of fall and its socioeconomic risk factors in community-dwelling Korean elderly. Plos One. 2020; 15:E0234787.
40. Delbaere K, Close JC, Heim J. A multifactorial approach to understanding fall risk in older people with cognitive impairment. J Am Geriatr Soc. 2010; 58:1679-1685. DOI
41. Scheffer AC, Schuurmans MJ, van Dijk N. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. 2008; 37:19-24. DOI
42. Deshpande N, Metter EJ, Lauretani F. Activity restriction induced by fear of falling and objective risk of falls: a longitudinal cohort study. J Am Geriatr Soc. 2008; 56:615-620. DOI
43. Liu-Ambrose T, Donaldson MG, Ahamed Y. Falls prevention interventions in older adults: systematic review and meta-analysis. Cochrane Database Syst Rev. 2019; 12
44. Tinetti ME, Kumar C. The patient who falls: “It’s always a trade-off”. JAMA. 2017; 317:1034-1043.
45. Hadjistavropoulos T, Delbaere K, Fitzgerald TD. Reconceptualizing the role of fear of falling and balance confidence in fall risk. J Aging Health. 2011; 23:3-23. DOI
46. Zijlstra GA, van Haastregt JC, van Rossum E. Interventions to reduce fear of falling in community-living older people: a systematic review. J Am Geriatr Soc. 2007; 55:603-615. DOI