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Research Christmas 2017: Time and place

Does pride really come before a fall? Longitudinal analysis of older English adults

BMJ 2017; 359 doi: (Published 11 December 2017) Cite this as: BMJ 2017;359:j5451
  1. D McMinn, honorary research fellow1,
  2. S J Fergusson, specialty registrar in general surgery2,
  3. M Daly, associate professor in behavioural science3
  1. 1Rowett Institute of Nutrition and Health, University of Aberdeen, Aberdeen AB25 2ZD, UK
  2. 2Royal Alexandra Hospital, Paisley PA2 9PN, UK
  3. 3Department of Management Work and Organisation, University of Stirling, Stirling, UK
  1. Correspondence to: M Daly michael.daly{at}
  • Accepted 20 November 2017


Objective To test whether high levels of reported pride are associated with subsequent falls.

Design Secondary analysis of the English Longitudinal Study of Ageing (ELSA) dataset.

Setting Multi-wave longitudinal sample of non-institutionalised older English adults.

Participants ELSA cohort of 6415 participants at wave 5 (baseline, 2010/11), of whom 4964 were available for follow-up at wave 7 (follow-up, 2014/15).

Main outcome measures Self reported pride at baseline (low/moderate/high) and whether the participant had reported having fallen during the two years before follow-up.

Results The findings did not support the contention that “pride comes before a fall.” Unadjusted estimates indicate that the odds of reported falls were significantly lower for people with high pride levels compared with those who had low pride (odds ratio 0.69, 95% confidence interval 0.58 to 0.81, P<0.001). This association remained after adjustment for age, sex, household wealth, and history of falls (odds ratio 0.81, 0.68 to 0.97, P<0.05). It was partially attenuated after further adjustment for mobility problems, eyesight problems, the presence of a limiting long term illness, a diagnosis of arthritis or osteoporosis, medication use, cognitive function, and pain and depression (odds ratio 0.86, 0.72 to 1.03, P<0.1). Because the confidence interval exceeded 1 in the final model, it remains possible that pride may not be an independent predictor of falls when known risk factors are considered. People with moderate pride did not have lower odds of having fallen than those with low pride in adjusted models. Participants lost to follow-up did not differ from those retained in terms of key variables, and weighting the analyses to account for selective attrition did not produce different results.

Conclusions Contrary to the well known saying “pride comes before a fall,” these findings suggest that pride may actually be a protective factor against falling in older adults. Future studies may seek to investigate the mechanisms underpinning this relation.


  • Contributions: DM had the idea for the study. MD analysed the data. DM, SJF, and MD each made important contributions to interpreting the results and writing the manuscript. MD is the guarantor.

  • Funding: No funding was provided to conduct this secondary analysis.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Ethical approval for all the ELSA waves was granted from the National Research and Ethics Committee, and all procedures adhered to the Helsinki Declaration. Informed consent was obtained from participants before data collection.

  • Transparency declaration: The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Data sharing: No additional data available.

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