Intended for healthcare professionals

CCBYNC Open access

Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study

BMJ 2010; 341 doi: (Published 19 August 2010) Cite this as: BMJ 2010;341:c4165
  1. Kim Delbaere, postdoctoral researcher123,
  2. Jacqueline C T Close, associate professor14,
  3. Henry Brodaty, professor56,
  4. Perminder Sachdev, professor57,
  5. Stephen R Lord, professor1
  1. 1Falls and Balance Research Group, Neuroscience Research Australia, University of New South Wales, Randwick, NSW 2031, Sydney, Australia
  2. 2Department of Experimental-Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Belgium
  3. 3Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Belgium
  4. 4Prince of Wales Clinical School, University of New South Wales, Randwick, Sydney, Australia
  5. 5School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Randwick, Sydney, Australia
  6. 6Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia.
  7. 7Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, Sydney, Australia
  1. Correspondence to: S R Lord s.lord{at}
  • Accepted 8 June 2010


Objectives To gain an understanding of elderly people’s fear of falling by exploring the prevalence and determinants of perceived and physiological fall risk and to understand the role of disparities in perceived and physiological risk in the cause of falls.

Design Prospective cohort study.

Setting Community sample drawn from eastern Sydney, Australia.

Participants 500 men and women aged 70–90 years.

Main outcome measures Baseline assessment of medical, physiological, and neuropsychological measures, with physiological fall risk estimated with the physiological profile assessment, and perceived fall risk estimated with the falls efficacy scale international. Participants were followed up monthly for falls over one year.

Results Multivariate logistic regression analyses showed that perceived and physiological fall risk were both independent predictors of future falls. Classification tree analysis was used to split the sample into four groups (vigorous, anxious, stoic, and aware) based on the disparity between physiological and perceived risk of falling. Perceived fall risk was congruent with physiological fall risk in the vigorous (144 (29%)) and aware (202 (40%)) groups. The anxious group (54 (11%)) had a low physiological risk but high perceived fall risk, which was related to depressive symptoms (P=0.029), neurotic personality traits (P=0.026), and decreased executive functioning (P=0.010). The stoic group (100 (20%)) had a high physiological risk but low perceived fall risk, which was protective for falling and mediated through a positive outlook on life (P=0.001) and maintained physical activity and community participation (P=0.048).

Conclusion Many elderly people underestimated or overestimated their risk of falling. Such disparities between perceived and physiological fall risk were primarily associated with psychological measures and strongly influenced the probability of falling. Measures of both physiological and perceived fall risk should be included in fall risk assessments to allow tailoring of interventions for preventing falls in elderly people.


  • Contributors: KD and SRL drafted the manuscript. SRL, JCTC, and KD helped write the grant application for this project. All authors contributed to the manuscript’s critical review and approved the final version. KD is guarantor for the study and had full access to all of the study data and takes responsibility for their integrity and the accuracy of the data analysis.

  • Funding: This research was conducted as part of a study on “understanding fear of falling and risk-taking in older people,” which was funded by the Australian National Health and Medical Research Council (grant No 400941). The participants in this study were drawn from the Memory and Ageing Study of the Brain and Ageing Program, School of Psychiatry, University of New South Wales, funded by a National Health and Medical Research Council grant (No 350833).

  • Competing interests: The physiological profile assessment (NeuRA FallScreen) is commercially available through the Neuroscience Research Australia.

  • Ethical approval: The University of New South Wales Human Research Ethics Committee approved the study protocol HREC 04229.

  • Data sharing: The authors are willing to share data on request, providing a collaborative research proposal can be presented.

  • Accepted 8 June 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

View Full Text