Fear of Falling and Its Impact on Social Participation in Elderly Populations: A Burden-of-Disease Perspective

Abstract

This cross-sectional descriptive study aimed to explore the association between fear of falling and limitations in social participation among 384 older adults (age ≥60 years) who visited community health centers and outpatient physiotherapy departments in Karachi and Hyderabad, Sindh, Pakistan. The Falls Efficacy Scale-International (FES-I) and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) were used to gather data, specifically around the participation domain. 52.7% reported a high fear of falling, and 41.9% had marked restrictions in social participation on the WHODAS 2.0 participation subscale. The participants with high fear had significantly lower scores on ‘engagement in community, recreational and social activities’ than those with low fear scores. Spearman’s correlation showed a significant positive association between fear of falling and restricted social participation (rs = 0.549, p < 0.001). Fear of falling was the strongest independent predictor of restricted participation, remaining significant after adjustment for age, sex, and comorbidity status (regression analysis). Older adults who lived alone had significantly higher fear-of-falling scores and greater limitations in activities than those who lived with family. The results highlight fear of falling as a unique and changeable risk factor for social isolation among aged people, which calls for the implementation of psychologically-oriented fall prevention and rehabilitation programs for community reintegration in Pakistan’s rehabilitation services.