While aging is inevitable, increasing evidence suggests aging as a negative state does not have to be a foregone ordained experience of downward spiraling events and perceptions. This review explored the possible contribution of fears of falling to frailty development and exacerbation, along with any observed frailty, falls risk associations with a view to providing more insight into opportunities to limit or avert some age associated adverse outcomes. These include, but are not limited to a heightened risk of disability, low levels of functional autonomy, high numbers and impact of one or more comorbid diseases, falls and falls injuries, plus multiple degrees of cognitive impairment.

On the other hand, while not definitive, and needing more careful study, it appears safe to say a fairly solid case can be made for the promise of dedicated efforts that attempt to prevent the risk of poor health status and outcomes attributable to frailty in elderly populations, including those elderly who exhibit persistent fears of falling and/or have fallen as a result of frailty. As well as preventing frailty where possible, preventing falls is strongly indicated as well, because even those older adults who are healthy, but incur a falls injury or an actual hip fracture injury, may be at risk for frailty that can perpetuate a downward spiral of health events, even though their association is clearly complex and largely likely to prove non linear and cumulative [see Figure 1].

It is also evident that this is not only an urgent public and social health concern as a whole, but a promising new field of endeavor where most peer reviewed articles have been published within the last five years and among these several are successful studies that show frailty can be somewhat reversed 57. Moreover, those who are less frail are more likely to be more autonomous and less subject to falls injuries and sedentarity 55.

At the same time, and bearing in mind, insights, answers and optimal solutions take considerable time to emerge, attention directed towards those most vulnerable to frailty or becoming frail who appear to be women in the higher age groups, those living in poverty, those with low educational levels, living in unsafe housing who are underweight as well as those with diabetes, dementia, disability, and/or depression and that accepts disability is a part of aging 5859, as well as those that have a falls history 8, might be targeted preferentially using the most promising approaches examined in randomized studies. These include, but are not limited to various forms of physical activity; physical activity combined with nutrition; physical activity plus nutrition plus memory training; home modifications; pre-habilitation (physical therapy plus exercise plus home modifications) and comprehensive geriatric assessments 60.

Alternately, in light of the independent as well as collective impact of both frailty and falls fears on multiple personal dimensions of health, as well as the broader social and political dimensions of wellbeing 55, the failure to address this burgeoning issue in an integrated rather than a fragmented manner will predictably produce higher levels of irreversible disability, hospitalization, low life quality, and premature deaths than not 3638. Moreover, since falls in their own right are not only increasing in numbers in the elderly, frailty which appears associated with falling and fear of falling to a high degree 56 can undoubtedly be expected to increase if associated fears of falling are neglected and inadvertently reduce activity involvement as well as involvement in rehabilitation interventions 5261.

To this end, ample evidence implies an urgent need for multiple far reaching collective efforts to better understand why some older adults are more vulnerable to frailty than others, and to more effectively discriminate and untangle the most promising potentially preventable antecedents using actionable preventative approaches. There must also surely be improved practical efforts to not only avert falls as well as falls fears, but to better understand the origins of falls attributable to excess fear that can prevail even in the absence of any actual overt falls experience. Based on the current literature, it also appears comprehensive assessments, longitudinal exploratory studies, plus an inter disciplinary approach, along with well designed efficacy studies that focus on heightening positive cognitions, provider knowledge, falls self-efficacy, efforts to counter the multiple negative mythologies of aging as purely a declining and negative economic state, plus personalized home-based one dimensional or multi component exercise interventions, and the provision of access to safe indoor and outdoor environments, efficacious social support, medication safety, and needed nutrient and educational resources will be especially helpful in this regard and are strongly encouraged 62636465666768.