Background: Fallrelatedconcerns have a large impact on wellbeing,balance performance and future falls. Theprimary focus in fallrelatedconcern research has generally been related to physical factors andprevious falls. This is mirrored by the use of the traditional fear avoidance model for falls in clinicalsettings, in which actual falls play a pivotal part in creating and perpetuating the cycle of fear activityavoidance fallsfear.Many researchers and clinicians, however, have started toacknowledge that more factors play a part in this complex issue.

Purpose: We aimed at investigating fallsefficacyin relation to several psychological, demographic andphysical factors in an effort to discover a more fitting model for explaining fallrelatedconcern.

Methods: We have visited a random population sample of 115 people, aged 70 or more and living in amunicipality in Northern Sweden. The participants were assessed for falls efficacy by means of theFalls Efficacy Scale International(FESI).We also collected data on selected potential covariatessuch as fear of falling, fall consequence concerns, falls history, physical performance, activity,cognitive performance, morale, medication and selected demographics. We then used multipleregression analyses in order to model covariate associations to prevalence and degree of fallrelatedconcern.

Results: The analyses show the following: The sample presents a median FESIscore of 21, and 36 % (CI.95limits: 27 %; 44 %) score 22 or higher, indicating poor fallrelatedefficacy. Further, 39% (CI.95 limits:30 %; 48 %) express some degree of fear of falling while 54 % (CI.95 limits: 45 %; 63 %) areconcerned about sustaining injuries from a fall (consequence concern). The correlation betweenfear of falling and falls efficacy seems weak (r = .55), indicating related but separate phenomena.Moreover, data indicate no significant associations between previous falls and falls efficacy, fear offalling, or consequence concern. On the other hand, FESIscores seem to be explained to a degreeof 48 % by the three variables physical performance, fear of falling, and morale (as measured by thePhiladelphia Geriatric Centre Morale scale).

Conclusion(s): These findings may contribute to a better understanding of fallrelatedconcerns. Perhaps fear,morale, and physical ability are stronger mediators than actual falls experience in itself. If so, thiswould call for the development of a new model which more adequately describes how fallrelatedconcerns are mediated while excluding falls as a cause.

Implications: The clinical implications of this model would mean a shift to include more psychosocial aspects toreduce fallrelatedconcern and risk of falling. An approach directed more towards morale, as well asincreasing efficacy and improving physical performance.