Assessment of Fear of Falling in Older Adults: The Falls Efficacy Scale-International (FES-I)

Issue #29 of General Assessment Series

WHY: Any older adult who falls, with or without sustained injury, may develop a fear of falling. This may cause curtailment of activities, leading to reduced mobility and physical fitness, and increasing risk of falling and injury (CDC, 2021; Vellas et al., 1997). Assessment of fear of falling, followed by appropriate interventions, is crucial to promote independence, mobility, function, wellness, and safety of older adults.

BEST TOOL: The Falls Efficacy Scale-International (FES-I) is a short, easy to administer tool that measures the level of concern  about falling during 16 social and physical activities inside and outside the home whether or not the person actually does the activity. The level of concern is measured on a four-point Likert scale (1=not at all concerned to 4=very concerned) (Yardley et al., 2005). The FES-I was developed in a collaborative effort with members of the Prevention of Falls Network Europe (ProFaNE), European Committee focused on fall prevention and the psychology of falling. The group tested the FES-I using different samples in different countries and translated the tool into several languages.

TARGET POPULATION: Older adults with or without a history of fear of falling.

VALIDITY AND RELIABILITY: Upon initial development and validation, the FES-I had excellent internal validity (Cronbach’s alpha=0.96) as well as test-retest reliability (ICC=0.96) (Yardley, Beyer et al., 2005). This tool was developed to expand on the initial Falls Efficacy Scale (FES) (Tinetti et al., 1990) to include social activities that may be considered more challenging by more active people, thereby potentially causing more concerns about falling than the basic activities presented in the initial FES. These additional activities correspond to items 11-16 on the FES-I. The FES-I was developed with factor analysis and demonstrates excellent psychometric properties in comparison to the FES. Research demonstrated validity and reliability with both cognitively intact and cognitively-impaired older adults (Hauer et al., 2011).

STRENGTHS AND LIMITATIONS:  The wording of the items on the FES-I accounts for cross-cultural differences (Yardley et al., 2005) and has been translated into many languages. The FES-I provides more detail regarding concerns about falling in relation to conducting various activities compared to a single item rating measure (Greenberg et al., 2016). The FES-I, as opposed to the Short FES-I is recommended for clinicians and researchers interested in all 16 activities accounted for on the scale.

FOLLOW UP: As needed or on a yearly basis to assess for fear of falling.



Best practice information on care of older adults: HIGN

Department of Health and Human Services. Centers for Disease Control and Prevention (CDC). (2021). Older adult fall prevention: Facts about falls. Retrieved August 30, 2022 from

Falls Efficacy Scale-International (FES-I) website:

Greenberg, S. A. (2012). Analysis of measurement tools of fear of falling among high-risk, community-dwelling older adults. Clinical Nursing Research, 21(1), 113-130.

Greenberg, S. A., Sullivan-Marx, E., Sommers, M. S., Chittams, J., & Cacchione, P. Z. (2016). Measuring fear of falling among high-risk, urban, community-dwelling older adults. Geriatric Nursing, 37(6), 489-495.

Hauer, K.A., Kempen, G.I., Schwenk, M., Yardley, L., Beyer, N., Todd, C., Oster, P., & Zijlstra, G.A. (2011). Validity and sensitivity to change of the Falls Efficacy Scales International to assess fear of falling in older adults with and without cognitive impairment. Gerontology, 57(5), 462-472.

Kempen, G.I., Todd, C.J., Van Haastregt, J.C., Zijlstra, G.A., Beyer, N., Freiberger, E., Hauer, K.A., Piot-Ziegler, C., & Yardley, L. (2007).

Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: Results from Germany, the Netherlands and the UK

were satisfactory. Disability and Rehabilitation, 29(2), 155-162.

Kempen, G. I., Yardley, L., van Haastregt, J. C., Zijlstra, G. A., Beyer, N., Hauer, K., & Todd, C. (2008). The Short FES-I: A shortened version of the Falls Efficacy Scale-International to assess fear of falling. Age and Ageing, 37(1), 45-50.

Tinetti, M.E., Mendes de Leon, C.F., Doucette, J.T., & Baker, D.I. (1994). Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. Journal of Gerontology: Medical Sciences, 49(3), M140-M147.

Tinetti, M.E., Richman, D., & Powell, L. (1990). Falls efficacy as a measure of fear of falling. Journal of Gerontology, 45(6), P239-P243

Yardley, L., Beyer, N., Hauer, K., Kempen, G., Piot-Ziegler, C., & Todd, C. (2005). Development and initial validation of the Falls Efficacy

Scale-International (FES-I). Age and Ageing, 34(6), 614-619.

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