Fear of Falling and Its Associations With Depressive Symptoms, Physical and Cognitive Function in Active Older Adults

Background : Fear of falling (FoF) is common among older adults and may be linked not only to physical limitations but also to cognitive and psychological vulnerabilities. Aims: To examine the associations between FoF, cognitive function, depressive symptoms, and physical performance in socially and physically active adults aged ≥50 years. Methods : A cross-sectional study was conducted with 120 participants (mean age 64.6 ± 7.8 years; 85% women) from the UCS Senior program in Brazil. FoF was assessed using the Falls Efficacy Scale-International (FES-I-Brasil) and participants were categorized into low (n=68) and high (n=52) FoF groups. Cognitive function, depressive symptoms, and physical activity were evaluated using validated questionnaires, and physical function was assessed through gait speed, timed-up-and-go, sit-to-stand, balance, and handgrip strength. Results : High FoF was associated with lower cognitive performance (adjusted mean difference = -1.41, 95% CI: -2.69 to -0.13, p=0.031), greater depressive symptoms (1.33, 95% CI: 0.38 to 2.28, p=0.006), and reduced handgrip strength (-3.43 kg, 95% CI: -6.30 to -0.56, p=0.020). The odds of mild cognitive impairment (OR=2.11) and depression (OR=4.23) were higher in the high FoF group but did not reach statistical significance. No significant differences were observed in other functional tests or physical activity levels. Conclusions : FoF was linked to poorer cognition, higher depressive symptoms, and reduced muscle strength, independent of fall history. These findings support FoF as a potential early screening marker of cognitive and psychological vulnerability in socially and physically active older adults.