Background
Preventing falls and reducing fear of falling among older adults is a key public health issue worldwide. Falls are one of the leading causes of injury1 and unintentional injury deaths among older individuals2, with approximately 684,000 deaths globally each year2. Beyond actual falls, many older adults experience a fear of falls (FoF), defined as a psychological concern about falling and its potential consequences that may lead to activity limitation and avoidance3,4. Recent data suggest that nearly 50% of older adults worldwide often experience fear of falls5. This fear is strongly linked to poor health outcomes, including depressive symptoms6, lower life satisfaction7, and reduced physical activity8.
To address these adverse outcomes, various community-level interventions have been developed to prevent falls and reduce the fear of falling. Accordingly, much of the literature has focused on evaluating the effectiveness of these interventions. Within this field, existing studies offer key insights in three main directions. First, activity-related interventions consistently show the strongest effect9,10. Activities such as Pilates, yoga and Tai Chi significantly reduce the fear of falling, especially when supervised by instructors and offered in community settings rather than unsupervised or home-based programs11,12. Second, educational and awareness programs, including fall risk education and body awareness also help reduce FoF13. Older adults who fail to adequately assess their personal fall risk are more likely to experience falls14. Third, family involvement enhances intervention effectiveness. Educating family members and caregivers on fall prevention strategies supports older adults in managing FoF and preventing falls15.
While much of the existing research has focused on interventions, studies examining how community-dwelling older adults individually cope with the fear of falling remain scarce. Existing studies have predominantly explored coping among hospitalized older adults16–18, individuals in assisted-living facilities19, and older adults’ caregivers20,21, with some research also examining the diversity of coping strategies among those who experience fear of falling and those who do not22. However, this field has largely overlooked community-dwelling older adults, who often individually develop coping strategies to manage fear of falling in everyday life.
This research aims to address this gap by identifying the coping strategies that community-dwelling seniors develop individually during their daily activities. To achieve this, the study employs the lens of the stress and coping model23, which posits that coping depends on personal appraisal, available resources, and contextual factors, ultimately serving to reduce stress. Coping involves both problem-focused strategies, aimed at addressing the problem itself, and emotion-focused strategies, dealing with managing emotional response, both of which contribute to sustaining individuals’ well-being.
Addressing this gap is particularly important given the high prevalence of falls worldwide. In this context, a deeper understanding of the coping strategies developed and employed by older adults can provide valuable insights for designing technologies, guiding health care practitioners, and developing accessible awareness campaigns to effectively reduce falls and fear of falling, especially in settings with limited community support.
Data and methods
Data collection
This study is based on qualitative data obtained through verbal protocol interviews24 with older adults, in which study participants verbalized their thoughts while performing routine tasks. This method provided rich contextual data that reflected the lived experiences of older adults’ daily routines and strategies that they develop within their own settings. Initially, 15 community-dwelling adults participated; however, only 13 provided explicit responses regarding fear of falling and were thus included in the analysis. During the study, participants performed everyday activities in real-world indoor and outdoor environments while wearing devices such as eye-tracking glasses and biological sensors. At the same time, they verbalized their actions, explaining why they performed each activity in a particular way, while engaging in conversation with a member of the research team. In addition, they were asked about their experiences with falls, their fear of falling, and the strategies they use to mitigate this fear and prevent falls. For the purposes of this study, only the data obtained through verbal protocol interviews were analyzed; data from sensors and glasses will be used in a separate project. The verbal protocol interviews lasted between 14 and 128 minutes (μ = 57.34, sd = 31.06). Data collection took place between July and December 2023.
Older adults were recruited through the Jane and Finch Family Centre from the Jane and Finch neighborhood in Toronto. The study participants were selected using purposive sampling. To be eligible, respondents had to be aged 55 or older. Written informed consent was obtained from all participants prior to their participation in the study, and consent for publication of the study was also obtained.
Study participants
There was a total of 13 study participants, most of whom were female (84.6%), had a high school education (46.2%), and resided in the Jane and Finch neighborhood in Toronto, an urban area in Ontario. The majority of participants were in the 55–64 (38.5%) and 70–79 (38.5%) age groups. In terms of living arrangements, over half lived with family members (53.8%). Almost all participants reported having various chronic diseases, such as arthritis, hypertension, and diabetes. A detailed description of the participants is presented in Table 1.
Table 1. Socio-demographic characteristics of the study participants.
| # Study Participant | Age group | Gender | Highest degree of education | Living arrangement | Chronic disease |
|---|
| 1 | 65–69 | Female | Less than high school | Alone | Diabetes, arthritis |
| 2 | 55–64 | Female | Less than high school | Alone | Diabetes, asthma |
| 3 | 70–79 | Female | Less than high school | Alone | Diabetes, arthritis |
| 4 | 65–69 | Female | High school | With a husband | Diabetes |
| 5 | 45–54 | Female | High school | With a husband | No chronic disease |
| 6 | 70–79 | Female | High school | Alone | Hypertension, arthritis |
| 7 | 55–64 | Female | High school | Alone | Hypertension, arthritis |
| 8 | 70–79 | Female | High school | With a son | Arthritis |
| 9 | 70–79 | Female | Less than high school | Alone | Diabetes, arthritis |
| 10 | 55–64 | Male | Graduate school | With a wife | Hypertension |
| 11 | 55–64 | Female | Graduate school | With a husband, and a son | Hypertension, diabetes |
| 12 | 70–79 | Male | High school | With a wife | Hypertension, heart attach angina |
| 13 | 55–64 | Female | College/University | With 2 sons and a husband | Hypertension |
Data analysis
The qualitative data derived from verbal protocol interviews were transcribed verbatim by a research team member with a sociological background. The thematic analysis method proposed by Braun and Clarke25 was used to analyze the transcribed data. We performed the analysis using ATLAS.ti Version 25.0.1 software. Overall, the data analysis consisted of 3 steps. First, the researchers read all the textual content to familiarize themselves with the data. Second, two researchers independently began coding, which was then discussed with all members of the research team. After reaching consensus on the coding, codes were consolidated into themes aligned with the conceptual framework on fear of falling proposed by Kolpashnikova et al.26. Additionally, we conducted a co-occurrence analysis of codes27 in ATLAS.ti to identify coping strategies that are interconnected and simultaneously employed by older adults.
Results
Overall, 51 codes, categorized into six themes, emerged from the data analysis. These themes cover coping strategies across the following domains: physical activities, social interactions, environment, psychological resilience, physical health, and use of devices. As the data indicate, the most common strategies are activity adaptation (n=97), social support (n=54), and environmental modification strategies (n=37). In contrast, psychological resilience (n=36), health and wellness strategies (n=25) and use of supportive devices (n = 22) are the least common. A detailed description of the identified themes is shown in Table 2.
Table 2. Descriptive statistics of derived themes.
| Theme of coping strategies | Quotes (n) | Codes (n) |
|---|
| Activity adaptation | 97 | 17 |
| Social support | 54 | 7 |
| Environmental modification | 37 | 6 |
| Psychological resilience | 36 | 14 |
| Health and wellness | 25 | 3 |
| Use of supportive devices | 22 | 4 |
Activity adaptation
Activity adaptation coping strategies are the most commonly used among older adults. These strategies involve modifying or carefully managing activities to maintain balance and reduce the risk of falling. In practice, older adults often adjust how they perform tasks to make them safer. For example, they move more slowly, carry out movements gradually, and break tasks into smaller steps to avoid rushing. They may also avoid activities that could increase their risk, such as lifting heavy objects, and instead seek assistance when needed. In addition, many older adults build short breaks into their routines. The aim of this strategy is to prevent fatigue, maintain balance, and enhance safety in daily life. One of the participants noted:
‘Yeah, I feel tired. Like especially when I'm washing the dishes. It takes one hour for me to wash the dishes and clean. Yeah, so after this, washing the dishes, I feel tired, somewhat tired, so then I take some rest, go and sit down and take some rest and then come back again, start cooking.’ (Participant 13: Female, aged 55–64, lives with her husband and two sons, and has a history of hypertension)
Social support
Social support is also widely used strategy among older adults, primarily involving assistance from family, friends, or the community. Such support may include help with daily tasks like cooking, grocery shopping, and cleaning, as well as emotional support.
‘Doctors taught me to vacuum. They stopped me to do the mopping. So when my daughter was living with me, she used to do it for me. So now she’s gone. I do it myself. Sometimes she comes and she helps me.’ (Participant 2: Female, aged 55–64, lives alone and has some history of diabetes and asthma)
Importantly, older adults are not only passive recipients of social support but also active contributors. Many provide help to family or peers. Several participants emphasized that supporting others like their friends or relatives gives them a sense of purpose and meaning:
‘[Her friend] She lives over this building. Sometimes, two times a week, I cook for her, carry food. But I am doing it because I want to help her.’ (Participant 4: Female, aged 65–59, lives with her husband, and has a history of diabetes)
Environmental modification
Among older adults, environmental coping strategies, particularly those involving home and design modifications, are also common. Many install bars or barriers to make spaces safer and reduce the risk of falls. They pay close attention to floor safety, ensuring that surfaces remain dry and free of obstacles.
‘Maybe I’m a little bit careful. I put the lights on, make sure that the floors are not wet where I am walking around. Otherwise, I have a fall while doing this activity’ (Participant 10: Male, aged 55–64, lives with his wife and has a history of hypertension)
To further enhance comfort and reduce hazards, some place mats or rugs in frequently used areas such as bedrooms and kitchens. One of the study participants mentioned:
‘I just got these mats here. I put them not to slide on the barefoot. I don’t want the next fall.’ (Participant 9: Female, aged 70–79, lives alone, and has a history of diabetes and arthritis)
Psychological resilience
Optimism and acceptance are also important coping strategies for older adults. Despite experiencing poor health outcomes and fear related to potential falls, older adults tend to maintain a positive mindset toward the challenges they face.
‘I try not to think about that. I just try to think positive every day. I wake up in the morning. I try to stay positive in doing whatever I have to do for the day. But you cannot think ‘Oh, this morning I’m gonna fall’. No, you don’t think that way. We always try to think positive.’ (Participant 12: Male, aged 70–79, lives with wife and has a history of hypertension and heart attack angina)
Additionally, religiosity plays an important role for some older individuals in building resilience. As one of the study participants mentioned:
‘That is life. Since my daughter passed away. But thank God, God be with me. God, be with me. We are talking. But God doesn't leave me. I'm happy.?’ (Participant 6: Female, aged 70–79, lives alone, and has a history of hypertension and arthritis)
Health and wellness strategies
Taking care of physical health is another important strategy employed by older adults to prevent fear of falling. Walking, doing mild exercises, and stretching daily were most often mentioned as strategies that help reduce pain and improve mobility. Consistency appears to be key - as some participants noted, even during winter, when walking outside poses many hazards, they continue walking daily indoors. One of the study participants noted:
‘I go on walk every day. Yeah, every day. The hallway is my first walk. When I wake in the morning at eight o'clock. Before I just have breakfast. I just walk the hallway like that and to this end like 10 times go and come’ (Participant 4: Female, aged 65–69, lives with her husband and has a history of diabetes)
In contrast, maintaining a healthy diet is one of the least frequently used health-related strategies, partly due to the financial constraints older adults face. As one participant explained, it is difficult to follow the doctor’s recommendations because of high food prices.
‘My doctor recommends measuring my blood pressure and having a balanced diet, but it’s sometimes hard to follow because of the high food prices.’ (Participant 5: Female, aged 45–54, lives with a husband and has no history of chronic disease)
Using supportive devices
Older adults use a variety of devices to maintain balance and prevent falls. First, they pay attention to their footwear, often choosing indoor slippers with good grip to reduce the risk of slipping. Second, for those who have difficulty maintaining balance or experience pain while moving, mobility aids such as walkers are commonly used. Finally, many older adults rely on technology to stay connected with family and seek assistance when needed. Devices like smartwatches with communication functions allow them to contact relatives easily, providing both reassurance and safety. As one of the study participants highlighted:
When you live alone, you have to be careful, right? If I get hurt, what can I do? My daughter bought me that Apple Watch she said, ‘Mommy, we're here all the time. I can know if something is wrong with you’. (Participant 2: Female, aged 55–64, lives alone and has a history of diabetes and asthma)
Co-occurrence analysis of coping strategies
To identify which coping strategies are applied simultaneously, we conducted a co-occurrence analysis. The results reveal that activity adaptation strategies most frequently co-occur with social support strategies (value 5), indicating that older adults manage their fear of falling by both adapting activities independently and relying on support from relatives and peers. Additionally, individuals who apply environmental modifications also tend to adopt activity adaptations (value 3) or use supportive devices (value 3). Furthermore, activity adaptation is often implemented together with health and wellness strategies (value 3) and psychological resilience (value 3). A detailed summary of this analysis is provided in Table 3.
Table 3. The results of co-occurrence analysis.
| ○Activity adaptation
Gr=97 | ○Use of supportive devices
Gr=22 | ○Environmental modification
Gr=37 | ○Health and wellness
Gr=25 | ○Psychological resilience
Gr=36 | ○Social support
Gr=54 |
|---|
○Activity adaptation
Gr=97 | 0 | 1 | 3 | 3 | 3 | 5 |
○Use of supportive devices
Gr=22 | 1 | 0 | 3 | 0 | 0 | 1 |
○Environmental modification
Gr=37 | 3 | 3 | 0 | 0 | 2 | 1 |
○Health and wellness
Gr=25 | 3 | 0 | 0 | 0 | 2 | 1 |
○Psychological resilience
Gr=36 | 3 | 0 | 2 | 2 | 0 | 2 |
○Social support
Gr=54 | 5 | 1 | 1 | 1 | 2 | 0 |
Discussion
This study identified coping strategies that community-dwelling older adults develop individually to mitigate the fear of falling while performing their routine activities. The findings indicate that seniors tend to use the strategies across the following domains: activity adaptation, social support, environmental modification, psychological resilience, health and wellness strategies, and the use of supportive devices. The research also shows that older adults often employ multiple coping strategies simultaneously. The most common combination involves activity adaptation and social support, reflecting both individuals’ personal agency and their reliance on social networks.
In general, this research provides important findings regarding the coping strategies of seniors, which align with previous studies, particularly in terms of activity adaptation17,18, environmental modifications18,28, psychological resilience19, social support22. However, it adds to the literature several crucial findings. First, while previous research shows that family, friends, and community support are central to social support coping strategies, this study reveals that seniors are not only recipients of assistance but also active providers, exercising agency in helping family and friends. Second, the research demonstrates that health and wellness strategies are also important for mitigating the fear of falling among seniors, although some strategies, such as maintaining a healthy diet, may be constrained by financial capacities. This finding requires further exploration, particularly in terms of how socioeconomic background conditions fear of falls and the employment of various coping strategies. Third, the study highlights the growing interest of older adults in using devices to mitigate the fear of falling. Seniors often use devices such as smartwatches to stay in touch with family, which has important implications for the further development of technologies tailored to fall prevention among the elderly.
Next, older adults tend to employ multiple coping strategies simultaneously. In particular, this research reveals that seniors most frequently rely on both social support and activity adaptation to mitigate their fear of falling. This finding contributes theoretically to coping and stress theory23 in the context of older adults’ coping. While individually developed activity adaptations reflect problem-focused coping, social support reflects both problem-focused and emotion-focused coping, as seniors mentioned two dimensions: assistance with activities and emotional comfort. Moreover, this finding has important practical implications, suggesting that interventions, devices, or awareness campaigns for community-dwelling older adults should address both their individual agency and their social networks when targeting the fear of falling.
A strength of this study is that data were collected through verbal protocol interviews while seniors were performing their activities. This approach allowed participants to fully reflect on their steps and activities, and to describe in detail their fear of falling as well as the techniques and strategies they use to mitigate it. Additionally, this is one of the first studies to employ co-occurrence analysis to identify strategies that seniors use simultaneously.
Despite its strengths, the study also has several limitations that should be acknowledged. One concern is the limited sample size, as recruiting participants from the marginalized population, such as the seniors in the Jane and Finch community, can be challenging. However, this limitation is partly mitigated by the diversity of participants in terms of age group, education and living arrangements included in the sample.
Building on the results of this study, future research should further explore several key directions. First, it would be valuable to further examine the use of devices as a coping strategy that seniors employ in their everyday lives. Additionally, future studies should continue investigating how different coping strategies are used in combination, as this approach can provide a more nuanced understanding of seniors’ behavioral responses. Another promising area for future inquiry is the role of socioeconomic background in shaping both the fear of falling and the adoption of coping strategies. Exploring these dimensions would deepen understanding of the complexity of fall-related experiences among older adults.
Conclusions
This study provides insights into how community-dwelling older adults develop and employ coping strategies to mitigate their fear of falling in everyday life. Furthermore, these findings can inform awareness campaigns, community interventions, technology design, and policy measures aimed at preventing both the fear of falling and actual falls among older adults.
Ethics and consent
Ethical approval for this study was obtained from the Research Ethics Board of York University (Toronto, Canada; approval number e2022-204). Written informed consent for participation and publication was obtained from all study participants.
Data and software availability
The dataset of this study is not publicly available due to the privacy concern of participants. Access to the data may be granted for research purposes upon reasonable request. Requests should be directed to Dr. Shital Desai at desais@yorku.ca. Access will be reviewed on a case-by-case basis and is subject to ethical approval and data-use conditions.
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