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The purpose of this study was to provide the basis for a new theoretical understanding of the psychological response to falls. We tested a hypothesised model of multiple dimensions of falls-efficacy (FE) in older adults. The model involved two main components of posttraumatic stress disorder (PTSD) – fear and dysphoria – that were hypothesised to be directly associated with FE. The model proposed three pathways related to FE: ‘at the moment FE’ related to fear, ‘constant FE’ related to dysphoria and ‘elaborated FE’ related to fear of falls (FoF). In this cross-sectional study a convenience sample of 119 older adults hospitalised in Poland due to fall-related injuries completed a survey involving fear of falls, FE and PTSD assessment. All three hypothesised pathways related to FE were supported, which accounted for 61% of the variance in falls efficacy. Very strong relationships were found between FE and dysphoria (.447, 95% CI [.303, .632],  p  = .006), FE and fear (.261, 95% CI [.109, .416],  p  = .009), and FE and FoF (-.286, 95% CI [-.396, −.183],  p  = .006). FE is not a unidimensional concept but acts differently depending on what influences it. Dysphoria appears to be central to the fall-related constructs of FE and FoF and responsible for their maladaptivity. FoF, which is often misinterpreted as FE, was found to be less prominent in the analyses. Thus, fear of falls may not always be negative, as it is commonly believed, but adaptive and protective.

Falls-efficacy as a multiple dimension construct: the role of post-traumatic symptoms