What is the perceived control model of falling?

According to a 2023 study published in Age and Ageing, up to 85% of older adults report concerns about falling. The perceived control model of falling is a framework that explains how a person's perception of their ability to control a balance-threatening situation determines whether their fear of falling becomes protective or harmful. The model emphasizes that perceived control, not just the fear itself, is the critical factor in fall risk.

Quick Summary

The perceived control model of falling explains why fear of falling can be either adaptive or maladaptive based on an individual's perception of control. High perceived control leads to protective strategies, while low perceived control triggers a panic response and increases fall risk through maladaptive behaviors. This framework helps clinicians create targeted interventions.

Key Points

• Core Concept: An individual's perception of control determines if fear of falling is adaptive or maladaptive.

• Adaptive Pathway: High perceived control leads to protective behaviors like cautious movement.

• Maladaptive Pathway: Low perceived control triggers panic and inappropriate responses, increasing fall risk.

• Measurement Tool: The UP-COF scale assesses perceived control.

• Clinical Interventions: The model guides interventions combining physical and psychological strategies.

• Distinction from Balance Confidence: Perceived control is broader, including managing emotional responses.

Origins and purpose of the perceived control model of falling

Historically, the relationship between a fear of falling and an increased risk of falls was considered indirect, suggesting fear led to activity restriction, which caused deconditioning and poor balance. The Perceived Control Model of Falling, introduced by Ellmers et al. in 2023, reframed this relationship by introducing perceived control as the mediating factor. The model aims to clarify why fear of falling affects individuals differently, sometimes negatively and sometimes positively.

A core concept of the model is that a person's perception of their ability to manage a balance-threatening situation influences the outcome. The model outlines two potential pathways based on perceived control: adaptive and maladaptive.

The adaptive pathway: High perceived control

When an individual has high perceived control, their fear response is more likely to be adaptive. This fear can act as a signal, increasing attention to potential risks and promoting safe behaviors like cautious movement.

The maladaptive pathway: Low perceived control

For those with low perceived control, fear of falling can initiate a maladaptive cycle, potentially increasing fall risk. Instead of careful action, panic can occur, overwhelming logical responses. This can lead to a cycle that increases vulnerability. Maladaptive responses may include persistent worry that distracts from balance, inappropriate motor behavior, and overly cautious movement. Over time, low perceived control might result in excessive activity restriction, leading to physical deconditioning and isolation, further raising fall risk.

Measuring perceived control of falling

To aid clinical application, the Updated Perceived Control over Falling Scale (UP-COF) was developed. This scale assesses perceived control over behavioral and emotional responses in balance-threatening situations. A score of 13/20 or less indicates low perceived control, helping identify individuals whose fear might increase fall risk. The UP-COF can be used with tools like the Falls Efficacy Scale-International (FES-I) and offers a specific focus distinct from general confidence.

Comparison of Perceived Control vs. Balance Confidence

Aspect	Perceived Control (UP-COF)	Balance Confidence (FES-I)
Focus	An individual's overall perception of control over the threatening situation, including both their behavioral and emotional responses.	An individual's perceived ability to maintain balance or avoid a fall during specific daily activities.
Scope	Broader; addresses the ability to manage the entire situation, including one's emotional state.	Narrower; focuses solely on the confidence to perform a task without losing balance.
Application	Helps identify if fear will be adaptive or maladaptive and whether it will lead to panic.	Measures the level of concern for falling across a list of activities, indicating potential avoidance.
Key Insight	Explains the mechanism behind a fear of falling's positive or negative consequences.	Quantifies the degree of fear or concern in specific contexts.
Clinical Purpose	Guides interventions targeting maladaptive cognitive processes and panic.	Tracks activity avoidance and helps monitor functional decline.

Applying the perceived control model of falling in practice

For individuals with low perceived control (UP-COF score ≤ 13), interventions should target underlying maladaptive processes. This involves combining physical and psychological approaches to enhance perceived control and prevent panic. Strategies may include identifying triggers for low perceived control and providing specific physical interventions. Cognitive behavioral therapy (CBT) can help challenge negative thinking. Graded exposure can reintroduce feared activities, and strengthening exercises can improve physical ability and reinforce control.

Conclusion

The perceived control model provides a valuable framework for understanding the role of fear in fall risk. By focusing on perceived control, it helps explain why fear can be protective or harmful. The model supports tailored interventions addressing both psychological and physical factors. Assessing and improving perceived control is key to breaking the maladaptive cycle and reducing fall risk. The full article can be found at {Link: OUP Academic https://academic.oup.com/ageing/article/52/7/afad093/7224697}.

Frequently Asked Questions

How does perceived control differ from falls efficacy?

Perceived control is a broader concept that includes a person's ability to manage both their emotional reaction and physical response to a balance-threatening situation. In contrast, falls efficacy, often measured by the FES-I, focuses more narrowly on a person's confidence in their ability to perform specific tasks without falling.

Is fear of falling always a negative thing?

No. The perceived control model of falling posits that fear of falling can be adaptive and protective if an individual has a high level of perceived control. In such cases, fear can lead to safer behaviors, like moving more cautiously. It is only when perceived control is low that fear becomes maladaptive.

What is the Updated Perceived Control over Falling Scale (UP-COF)?

The UP-COF is a clinical tool used to assess an individual's level of perceived control over falling. It helps clinicians determine whether a person's fear is likely to increase fall risk due to low control, particularly if they score 13 or below out of 20.

What does a low UP-COF score indicate?

A low UP-COF score (≤13) indicates that an individual has low perceived control over falling. This suggests their fear is more likely to trigger maladaptive processes like panic and anxiety, which can disrupt balance and increase fall risk.

What happens in the maladaptive pathway of the model?

In the maladaptive pathway, low perceived control triggers a panic response characterized by catastrophic thinking and persistent worries. This impairs the ability to focus on movement, leading to inappropriate motor behaviors, increased distractibility, and undue activity restriction.

How can the perceived control model help prevent falls?

The model helps prevent falls by guiding targeted interventions for individuals with low perceived control. This can involve teaching coping strategies, using cognitive behavioral therapy to address panic and worry, and employing physical therapies to enhance physical ability and bolster a sense of control.

Does the model consider past falls?

Yes. The model incorporates the influence of thoughts and memories about previous falls or near-falls. These memories can cause an individual to appraise a situation as more threatening and can increase the likelihood of an emotional response, impacting their perceived control.