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. 2025 Jun 2;25(1):400.
doi: 10.1186/s12877-025-06067-5.

Association between executive functions and fear of falling among people aged 80 years or older: a cross-sectional study

Anna Awad  1 , Anna Sundström  2 , Felicia Gramner  3 , Ursula Werneke  4 , Annika Toots  5 , Birgitta Olofsson  6 , Albin Dahlin Almevall  7 , Erik Rosendahl  5 , Stefan Söderberg  8 , Yngve Gustafson  9 , Johan Niklasson  3
Affiliations

Association between executive functions and fear of falling among people aged 80 years or older: a cross-sectional study

Anna Awad et al. BMC Geriatr. .

Abstract

Objectives: Fear of falling (FoF) is a common problem among older adults. It can lead to reduced quality of life and less physical activity, which increases fall risk. Earlier work has shown that FoF can be a manifestation of executive dysfunction in adults over 50 years, but studies on people over age 75 years are lacking. Executive functions (EFs) are cognitive functions associated with the frontal lobes and the prefrontal cortex. The aim of this study was to assess associations of EFs and FoF among people aged 80 years or older.

Methods: This cross-sectional study was based on data from the Northern Sweden Silver-MONICA study and included 434 participants aged 80 years or older. EFs were assessed with the Frontal Assessment Battery (FAB) and FoF with the Falls Self-Efficacy Scale-International (FES-I). Multivariable linear regression analysis was used to examine associations among EF, FoF, and a comprehensive set of adjustment factors. Pearson correlation analysis was used to evaluate associations of FES-I and the subitems of the FAB.

Results: EFs as measured by FAB were inversely associated with FoF (β = -0.23; 95% confidence interval, -0.42 to -0.03; p = 0.021), even after comprehensive adjustments. The FAB subitems measuring lexical fluency, inhibitory control, sustained attention, self-organization, motor programming, and planning also were inversely associated with FoF.

Conclusions: Lower EF is associated with higher FoF among people aged 80 years or older. This information is important for treating and preventing FoF in this population.

Keywords: 80 and over; Aged; Executive function; FAB; FES-I; Fear of falling.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval for the Silver-MONICA study was obtained from the Regional Ethical Review Board in Umeå (Dnr 2015–11-31 M/0 29–2015 and 2016–241-32 M) and was conducted in full accordance with the ethical principles of the World Medical Association’s Declaration of Helsinki (as revised in 2024). All participants gave written informed consent before data collection and could withdraw from participation at any time. For individuals with cognitive impairment or dementia, next of kin also was asked to consent. Consent for publication: An unauthorized version of the Swedish MMSE was used by the study team without permission, however this has now been rectified with PAR. The MMSE is a copyrighted instrument and may not be used or reproduced in whole or in part, in any form or language, or by any means without written permission of PAR (www.parinc.com). Competing interests: U.W. has received lecture honoraria from Lundbeck and Janssen and has served or serves on scientific committees for Janssen and Teva, receiving honoraria for these activities. S.S. reports speaker honoraria and participation in the scientific advisory boards for Johnson & Johnson and MSD outside the present work. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The association between FES-I and the FAB score in 434 participants in the Silver-MONICA study. LEGEND: FAB = Frontal Assessment Battery, FES-I = Falls Self-Efficacy Scale-International. Pearson correlation: R = −0.22, p < 0.001
See this image and copyright information in PMC

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