Addressing fear of falling in older adults: a public health implication and the emerging role of the BATHE technique

Abstract

Fear of Falling (FOF) is a common and disabling geriatric syndrome with substantial consequences for physical function, mental health, and overall quality of life in older adults. Beyond its link to actual falls, FOF is associated with activity avoidance, reduced confidence, social withdrawal, depressive symptoms, and increased use of healthcare services, making it a significant public health issue. Although multifactorial interventions, such as exercise programmes, environmental modifications, and cognitive-behavioural strategies, have demonstrated effectiveness, the psychosocial aspects of FOF are often insufficiently addressed in routine care, particularly in low-resource and busy clinical settings. This narrative review explores FOF from a public health and psycho-social perspective, with particular emphasis on the emerging role of the BATHE technique (Background, Affect, Trouble, Handling, Empathy). BATHE technique is a brief, structured, person-centred approach that enables clinicians to explore patients’ concerns, emotional responses, coping strategies, and support systems within routine consultations. The review synthesises literature on the epidemiology and public health impact of fear of FOF, the psychological mechanisms underlying fear-related avoidance behaviours, and the role of patient-centred communication in geriatric care. Evidence on the use of the BATHE technique in addressing anxiety, fear, and functional concerns is critically examined, highlighting its feasibility, acceptability, and potential relevance in geriatric and primary care settings. Overall, the BATHE technique appears to be a practical and inexpensive counselling strategy that promotes empathy, patient engagement, and adaptive coping. However, its effectiveness as a standalone intervention for reducing FOF has not been conclusively demonstrated, and existing evidence is limited by methodological weaknesses and a lack of long-term follow-up. Future robust studies are required to confirm its clinical effectiveness.