Preprint · Jun 16, 2026
Reducing Concerns about Falling in Older Adults: Effectiveness of a multi-component intervention and the role of stress and inflammation markers - Long-term effects of the FEARFALL study
By Britting S, Müller A, Kob R et al.
Background: Concerns about falling (CaF) are common in older adults and are associated with reduced activity and poorer health. The aim of this study was to investigate, for the first time, the long-term effects of a multi-component intervention program designed to reduce CaF on psychological, functional, biophysiological, and anthropometric aspects. Methods: 160 community-dwelling older adults (≥ 70 years) were randomly assigned to either a 4-month intervention featuring exercise and cognitive-behavioral training or to a sham control group. CaF, perceived stress, and other psychological symptoms were tracked by self-reports. Salivary cortisol and α-amylase were analyzed. Physical function, activity, and body composition were evaluated. Blood levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-1β (IL-1β) and tumor necrosis factor-alpha (TNF-α) served as surrogate markers for inflammatory status, assessed at baseline, post-intervention, and at an 8-month follow-up.Results: All estimates are T0–T2 estimated marginal mean differences. CaF, operationalized by Falls Efficacy Scale-International (FES-I) (estimate = 3.85, p < .001), FES-I Avoidance Behavior (FES-IAB) (estimate = 2.12, p = .001) and Updated Perceived Control over Falling (UP-CoF) (estimate = −1.68, p < .001) decreased over time with no between-group differences. Functional outcomes marginally improved throughout the study. Total diurnal output of cortisol decreased (estimate = 0.66, p = .017) and of α-amylase increased (estimate = -10.07, p = .013) significantly. Inflammatory marker changes present a non-cohesive picture, as CRP and IL-10 remain stable, IL-6 (estimate = -0.06, p = .002) and IL-1β (estimate = -0.05, p = .004) increased, and TNF-α (estimate = 0.09, p < .001) decreased. Conclusion: CaF improved to a similar extent in both the intervention and sham control groups. Similarly, changes in basal stress system activity and inflammatory cytokines were highly comparable between groups. Contrary to our primary hypothesis, the intervention did not confer additional benefits over the sham control intervention with regard to reductions in CaF.Trial registration: German Clinical Trials Register (DRKS): DRKS00029171. Registered 22 July 2022, https://drks.de/search/de/trial/DRKS00029171.KeywordsOlder adults, concerns about falling, inflammation, community-dwelling, stress, cortisol