Synopsis
Identify fear of falling as a treatable interaction between perceived threat, actual risk and lost confidence, exclude unresolved medical and environmental danger, and restore valued activity through graded, progressive and psychologically informed rehabilitation.
- Ask directly about fear, confidence and which activities have stopped; people may report being careful rather than describe anxiety.
- First-line assessment treats acute injury, syncope, gait, vision, vestibular, pain, medicine and home hazards before concluding fear is the main limiter.
- The Falls Efficacy Scale–International can quantify concern across activities, but it does not replace history or prove that actual risk is low.
Key red flags
New inability to weight bear, groin pain or pain on passive hip movement after a fall requires fracture imaging.
Abrupt fear with pain, focal signs, delirium or collapse symptoms indicates medical reassessment.
Investigation priorities
Identify the trigger and degree of activity loss.
Management branches
Activity has reduced after a fall, near-fall or illness.
- Reconstruct the event, baseline and stopped activities and screen injury, syncope, gait, mood, cognition and safeguarding.
- Observe mobility and the feared task and identify person, treatment and environment factors maintaining avoidance.
Key medicines
SertralineFor depression, the licensed adult starting dose is 50 mg orally once daily. For panic disorder, PTSD or social anxiety, use 25 mg once daily for one week then 50 mg once daily; if needed, increase in 50 mg steps no more often than weekly to a maximum 200 mg daily.