Preprint · Oct 17, 2025
Using Cluster-Based Analyses to Identify Maladaptive Concerns about Falling
By Ellmers TJ, Kal EC, van Schooten K et al.
Concerns about falling (CaF) are common among older adults. A recent review and meta-analysis showed that CaF predict future falls in community-dwelling older adults (Ellmers et al., 2025). However, interpretation of this finding is complicated by evidence that, for some individuals, CaF may serve an adaptive function, promoting caution and enhancing safety (Delbaere et al., 2010; Ellmers et al., 2022). Despite this, researchers and clinicians alike have struggled to distinguish between adaptive and maladaptive forms of CaF (Ellmers et al., 2023), limiting our ability to effectively address these concerns in clinical practice. The present study uses a cluster-based approach to test whether high CaF, when co-occurring with other negative psychological characteristics (e.g., elevated depression, low mental wellbeing), is more likely to represent a maladaptive profile—predicting adverse fall-related outcomes more strongly than high CaF alone.