Longitudinal associations of psychosocial factors and fear of falling in older adults: a systematic review

Abstract Background Fear of falling (FOF) is a phenomenon prevalent among older adults associated with adverse outcomes, including reduced mental and physical health, decreased quality of life, and an overall reduction in social participation. Based on cross-sectional and longitudinal studies, recent reviews have provided information on the prevalence of FOF and its association with different health outcomes. To gain a deeper understanding of factors relevant to interventions to prevent or reduce FOF, this review goes beyond previous evidence syntheses by focusing on psychosocial factors that are longitudinally associated with FOF. The objective of the review is to provide an overview on evidence levels of psychosocial factors assumed to be longitudinally associated with FOF. Methods Studies examining associations between psychosocial factors (predictors) and FOF (outcome) longitudinally were included. Cochrane CENTRAL, Embase, Scopus, and Web of Science were searched up to October 25, 2025. An ordinal rating scheme was used for data synthesis to assess beyond sociodemographic variables and other psychosocial factors. A modified version of the Newcastle–Ottawa scale was employed to evaluate study quality. Results Sixteen studies (n at baseline: 255–9,060) with a total of 30,724 participants reported longitudinal associations of 14 psychosocial factors with FOF. Higher depressive symptoms, anxiety, negative affect, and symptom burden, lower social activity, social participation, emotional support, and feeling older were linked to higher FOF. The relationship between depressive symptoms and higher FOF showed the most robust evidence, with six studies finding evidence for incremental validity of depressive symptoms beyond sociodemographic variables and other psychosocial factors. In contrast, higher self-efficacy, positive affect, social support, and social cohesion were associated with lower FOF. In some cases, the magnitude of associations was reduced when controlling for other variables. Conclusion The evidence base remained weak for psychosocial factors other than depressive symptoms. Further longitudinal research is needed on the role of psychosocial factors for FOF. Such studies enlarge the evidence base for factors identified in this review and should include additional factors (e.g., loneliness). Our findings highlight the need for further research on the relationship between depressive symptoms and FOF for the development of effective interventions. Trial registration Pre-registration ID: https://doi.org/10.17605/OSF.IO/X5ZGR