Hostname: page-component-546b4f848f-zwmfq Total loading time: 0 Render date: 2023-06-04T18:41:18.862Z Has data issue: false Feature Flags: { "useRatesEcommerce": true } hasContentIssue false

Falls self-efficacy and falls incidence in community-dwelling older people: the mediating role of coping

Published online by Cambridge University Press:  08 November 2017

Christine C. Loft
Psicon, Kent, UK
Fergal W. Jones*
Salomons Centre for Applied Psychology, Canterbury Christ Church University, Kent, UK
Ian I. Kneebone
Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
Correspondence should be addressed to: Fergal W. Jones, Salomons Centre for Applied Psychology, Canterbury Christ Church University, 1 Meadow Road, Tunbridge Wells, Kent TN1 2YG, UK. Phone: +44 (0) 1227 927110. Email:



A cognitive behavioral model predicts that coping responses mediate the relationship between falls related psychological concerns and falls incidence, in community-dwelling older people. If empirical support could be found for this pathway then interventions could be developed to reduce falls risk by targeting coping strategies. Therefore, this study aimed to begin the process of testing whether coping responses mediate the association between falls self-efficacy (a principal element of falls related psychological concerns) and falls incidence, in community-dwelling older people.


In a cross-sectional design, 160 community-dwelling older people (31 male, 129 female; mean age 83.47 years) completed the Falls Efficacy Scale–International, the Revised-Ways of Coping Questionnaire, the Turning to Religion subscale of the COPE, and a falls questionnaire. Data were analyzed via mediation analysis using a bootstrapping approach.


Lower falls self-efficacy was associated with higher falls incidence, and more self-controlling coping was found to be a partial mediator of this association, with a confidence interval for the indirect effect of (0.003, 0.021) and an effect size of κ2 = 0.035. The association was not mediated by the other measured coping responses; namely, turning to religion, distancing, seeking social support, accepting responsibility, escape-avoidance, planful problem-solving, and positive reappraisal.


Self-controlling coping may mediate the association between falls self-efficacy and falling. If longitudinal studies confirm this finding then coping could be targeted in interventions to reduce falls.

Research Article
Copyright © International Psychogeriatric Association 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Anderson, J. C. and Gerbing, D. W. (1988). An updated paradigm for scale development incorporating unidimensionality and its assessment. Journal of Marketing Research, 25, 186192. doi:10.2307/3172650.Google Scholar
Carver, C. S., Scheier, M. F. and Weintraub, J. K. (1989). Assessing coping strategies: a theoretically based approach. Journal of Personality & Social Psychology, 56, 267283. doi:10.1037/0022-3514.56.2.267.CrossRefGoogle ScholarPubMed
Catanzaro, S. J., Horaney, F. and Creasey, G. (1995). Hassles, coping and depressive symptoms in an elderly community sample: the role of mood regulation expectancies. Journal of Counseling Psychology, 42, 259265. doi:10.1037/0022-0167.42.3.259.CrossRefGoogle Scholar
Chou, L. W., Chi, I. and Chiu, A. Y. (2005). Incidence and predictors of falls in the Chinese elderly. Annal: Academy of Medicine, 34, 6072.Google Scholar
Delbaere, K., Close, J. C., Mikolaizak, A. S., Sachdev, P. S., Brodaty, H. and Lord, S. R. (2010). The falls efficacy scale international (FES-I). A comprehensive longitudinal validation study. Age and Ageing, 39, 210216. doi: 10.1093/ageing/afp225.CrossRefGoogle ScholarPubMed
Department of Health (2001). National Service Framework for Older People. London: Stationary Office.Google Scholar
Filiatrault, J. and Desrosiers, J. (2011). Coping strategies used by seniors going through the normal aging process: does fear of falling matter? Gerontology, 57, 228236. doi:10.1159/000314529.CrossRefGoogle ScholarPubMed
Fisher, B. M., Segal, D. I. and Coolidge, F. L. (2003). Assessment of coping in cognitively impaired older adults: a preliminary study. Clinical Gerontologist, 26, 312.CrossRefGoogle Scholar
Folkman, S. and Lazarus, R. S. (1989). Ways of Coping Questionnaire: Manual. California: Mind Garden.Google Scholar
Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A. and Gruen, R. J. (1986). Dynamics of a stressful encounter: cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50, 9921003. doi:10.1037/0022-3514.50.5.992.CrossRefGoogle ScholarPubMed
Fritz, M. S. and MacKinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18, 233239. doi:10.1111/j.1467-9280.2007.01882.x.CrossRefGoogle ScholarPubMed
Ganz, D. A., Higashi, T. and Rubenstein, L. (2005). Monitoring falls in cohort studies of community-dwelling older people: effect of the recall interval. Journal of the American Geriatrics Society, 53, 21902194. doi:10.1111/j.1532-5415.2005.00509.x.CrossRefGoogle ScholarPubMed
Gillespie, L. D., Gillespie, W. J., Robertson, M. C., Lamb, S. E., Cumming, R. G. and Rowe, B. H. (2003). Interventions for preventing falls in elderly people. Cochrane Database of Systemic Review, 4, CD000340. doi:10.1002/14651858.CD000340.Google Scholar
Hauer, K., Lamb, S. E., Jorstad, E. C., Todd, C. and Becker, C. (2006). Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age and Ageing, 35, 510. doi: 10.1093/ageing/afi218.CrossRefGoogle ScholarPubMed
Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York: Guilford.Google Scholar
Hsu, H. and Tung, H. (2011). Coping strategies and adaptation for the disabled elderly in Taiwan. Geriatric Gerontology International. 11, 488495. doi:10.1111/j.1447-0594.2011.00701.x.CrossRefGoogle ScholarPubMed
Hughes, C. C., Kneebone, I., Jones, F. W. and Brady, B. (2015). A theoretical and empirical review of psychological factors associated with falls related psychological concerns in community dwelling older people. International Psychogeriatrics, 27, 10711087. doi:10.1017/S1041610214002701.CrossRefGoogle ScholarPubMed
Hull, S. and Kneebone, I. I. (2007). Revision and assessment of the evidence for a revised cognitive-behavioural model for fear of falling. Paper Presented to the World Congress of Behavioral and Cognitive Therapies, Barcelona, Spain.Google Scholar
Jung, D., Lee, J. and Lee, S. (2009). A meta-analysis of fear of falling treatment programs for the elderly. Western Journal of Nursing Research, 31, 616. doi:10.1177/0193945908320466.CrossRefGoogle Scholar
Koenig, H. G., George, L. K. and Peterson, B. L. (1998). Religiosity and remission of depression in medically ill older patients. American Journal of Psychiatry, 155, 536542. doi:10.1176/ajp.155.4.536.CrossRefGoogle ScholarPubMed
Lamb, S. E., Jorstad-Stein, E. C., Hauer, C. and Becker, C. (2005). Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus. Journal of the American Geriatrics Society, 53, 16181622. doi:10.1111/j.1532-5415.2005.53455.x.CrossRefGoogle ScholarPubMed
Lazarus, R. S. and Folkman, S. (1984). Stress, Appraisals and Coping. New York: Springer Publishing Company.Google Scholar
Lincoln, N. B., Kneebone, I. I., Macniven, J. and Morris, R. (2012). Psychological Management of Stroke. Chichester, UK: Wiley.Google Scholar
Moore, D. S. and Ellis, R. (2008). Measurement of fall-related psychological constructs among independent-living older adults: a review of the research literature. Aging and Mental Health, 12, 684699. doi:10.1080/13607860802148855.CrossRefGoogle ScholarPubMed
Oliver, D., Daly, F., Martin, F. C. and McMurdo, M. E. (2004). Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age and Ageing, 33, 122130. doi: 10.1093/ageing/afh017.CrossRefGoogle ScholarPubMed
Powell, L. E. and Myers, A. M. (1995). The activities-specific balance confidence (ABC) Scale. Journals of Gerontology Series A-Biological Sciences & Medical Sciences A, 50, M28M34. doi:10.1093/gerona/50A.1.M28.CrossRefGoogle Scholar
Schwarzer, R. and Christine Schwarzer, C. (1996). A critical survey of coping instruments. In Zeidner, M. and Morris, N. S. (eds.), Handbook of Coping. New York: Wiley.Google Scholar
Shumway-Cook, A., Ciol, M. A., Hoffman, J., Dudgeon, B. J., Yorkston, J. and Chan, L. (2009). Falls in the medicare population: incidence, associated factors, and impact on health care. Journal of Physical Therapy, 89, 324332. doi:10.2522/ptj.20070107.CrossRefGoogle Scholar
Tanner, D. (2007). Starting with lives: supporting older people's strategies and ways of coping. Journal of Social Work, 7, 730. doi: 10.1177/1468017307075987.CrossRefGoogle Scholar
Tinetti, M. and Speechly, M. (1989). Prevention of falls among the elderly. New England Journal of Medicine, 320, 10551059. doi:10.1056/NEJM198904203201606.Google ScholarPubMed
Tinetti, M., Richmond, D. and Powell, L. (1990). Falls efficacy as a measure of fear of falling. Journals of Gerontology, 45, 239243. doi: 10.1093/geronj/45.6.P239.CrossRefGoogle ScholarPubMed
Vitaliano, P. P., Russo, J., Carr, J. E., Maiuro, R. D. and Becker, J. (1985). The ways of coping checklist: revision and psychometric properties. Multivariate Behavioral Research, 20, 326.CrossRefGoogle ScholarPubMed
Ward-Griffin, C., Hobson, S., Melles, P., Kloseck, M., Vandervoort, A. and Crilly, R. (2004). Falls and fear of falling among community-dwelling seniors: the dynamic tension between exercising precaution and striving for independence. Canadian Journal on Aging-Revue Canadienne Du Vieillissement, 23, 307318. doi:10.1353/cja.2005.0028.CrossRefGoogle ScholarPubMed
Yardley, L. and Smith, H. (2002). A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist, 42, 1723. doi:10.1093/geront/42.1.17.CrossRefGoogle ScholarPubMed
Yardley, L., Beyer, N., Hauer, K., Kempen, G., Piot-Ziegler, C. and Todd, C. (2005). Development and initial validation of the falls efficacy scale-international (FES-I). Age and Ageing, 34, 614619. doi:10.1093/ageing/afi196.CrossRefGoogle Scholar
Zijlstra, G. A. R., van Haastregt, J. C. M., van Eijk, J. T. M., van Rossum, E., Stalenhoef, P. A. and Kempen, G. I. J. M. (2007). Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age and Ageing, 36, 304309. doi:10.1093/ageing/afm021.CrossRefGoogle ScholarPubMed
Supplementary material: File

Loft et al supplementary material

Tables S1-S2

Download Loft et al supplementary material(File)
File 39 KB