Association between Multimorbidity and Fear of Falling among Community-Dwelling Older Adults: mediation analysis

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Bashaier Alosaimi, Maha Almarwani
Purpose:

To examine the association between multimorbidity and fear of falling and its mediators among community-dwelling older adults in Saudi Arabia.


Methods:

This study is cross-sectional among community-dwelling older adults in Riyadh, Saudi Arabia. The outcome measures collected demographic data, multimorbidity, and fear of falling. The mediators’ variables consisted of measures related to polypharmacy, fall history, body mass index, hand grip strength, functional capacity, activity of daily living, frailty, balance, and health self-perception.


Results:

A total of 190 community-dwelling older adults (the majority of participants were female (59.5%) and had a mean age of 65.75 ± 5.33 years). A multimorbidity showed a high association with the fear of falling (r = 0.72, P0.01) and (β =4.15, p0.05). A path analysis was conducted to explore the relationship between multimorbidity and fear of falling, with various factors potentially mediating this association. The analysis revealed a total standardized effect of 0.71, with a direct effect of 0.28 and an indirect effect of 0.43. Key mediators included polypharmacy (0.64), fall history (0.19), and mental health self-perception (0.77), all significant at p 0.05. The model explained 40% of the variance in fear of falling. The multivariable logistic regression analysis further showed that stroke, depression, joint disease, and chronic respiratory disease were associated with significantly higher fear of falling levels prospectively, with the OR ranging from 0. 1.51 (95% CI = 0.83 - 2.17) for chronic respiratory disease to 2.69 (95% CI = 1.56–3.51) for stroke. 


Conclusion(s):

The findings of this study highlight the complexities of multimorbidity, including the mediation effect of polypharmacy, fall history and mental health self-perception on fear of falling. Future research should focus on developing targeted interventions to address the fear of falling among older adults in Saudi Arabia to promote healthy aging and improve quality of life.


Implications:

Healthcare providers should Assess multimorbidity and related factors to better understand fall risk. Targeted interventions, such as reducing polypharmacy, managing fall risks through education, and improving mental health, are essential. Personalized care plans addressing both multimorbidity and psychological impacts can enhance outcomes and reduce fear of falling. Future research should focus on developing targeted interventions to address fear of falling in older adults, promoting healthy aging and improving quality of life.


Funding acknowledgements:
This work was funded by Saudi national institute for health (36503370).
Keywords:
Multimorbidity
fear of falling
older adults
Primary topic:
Older people
Second topic:
Neurology
Third topic:
Non-communicable diseases (NCDs) and risk factors
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
This study was approved by the College of Medicine Institutional Review Board at King Saud University.
Provide the ethics approval number:
(IRB #E-22-7295)
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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