Falls Efficacy Scale International (FES-I)
Also known as: FES-I, International Falls Efficacy Scale, Falls Self-Efficacy
The Falls Efficacy Scale-International (FES-I), developed by Lucy Yardley and colleagues in 2005, is a validated tool measuring fear of falling and confidence in balance in older adults and others at risk of falls. The 16-item scale assesses how confident a person feels performing daily activities without falling (self-efficacy for fall avoidance). Fear of falling is not anxiety disorder but a rational concern that, if excessive, can lead to activity restriction, deconditioning, and further fall risk. The FES-I is used internationally in clinical practice and research to identify patients at risk for this vicious cycle and guide fall prevention interventions.
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When to use it
Administer the FES-I to older adults (≥65 years), anyone with recent falls, those with balance or mobility impairment, Parkinson's disease, stroke, or other neurological conditions affecting balance. Use in: geriatric clinics, fall prevention programs, rehabilitation settings, and community health screening. Baseline assessment guides fall prevention intensity; serial assessment after interventions tracks response. The FES-I is particularly valuable for identifying patients with excessive fear-driven activity avoidance who paradoxically have high fall risk.
Strengths & limitations
- Captures psychological dimension of fall risk—addresses fear of falling and self-efficacy, which are independent predictors of falls and activity decline.
- Activity-specific assessment—lists specific daily activities, prompting realistic self-reflection about confidence in concrete situations.
- Validates patient experience—legitimizes fear of falling as a valid clinical concern rather than dismissing it as overcautiousness.
- Predicts future falls—FES-I score predicts subsequent falls, activity restriction, and hospitalization; identifies high-risk patients for intervention.
- Widely translated—available in 20+ languages with good cross-cultural validation.
- No copyright restrictions for most uses—freely available for clinical and research use.
- Does not measure actual balance or fall risk—FES-I assesses perceived confidence, not objective balance or strength; a patient with strong balance but high fear may report low efficacy.
- Does not distinguish fear-based limitation from physical limitation—high FES-I scores could reflect either excessive fear or legitimate physical decline; clinical assessment is needed.
- Self-report bias—cognitively impaired older adults may not accurately report confidence or understand the questions.
- Ceiling and floor effects—younger, very active older adults may score uniformly low; very frail patients may score uniformly high.
Frequently asked
My patient has a high FES-I score but strong balance on testing. What does this mean?
Patients with strong balance but high FES-I scores have fear-based activity avoidance rather than true balance deficit. They need reassurance, education about their actual balance capacity, and gradual progressive activity engagement—not further rest or restriction. Balance training may help, but psychological support addressing excessive worry is more important.
Is fear of falling normal, or should all patients score low on FES-I?
Some level of caution is adaptive; FES-I scores of 16–22 reflect appropriate caution. Scores ≥28 indicate excessive fear disproportionate to actual balance capacity. When fear interferes with desired activities or leads to self-imposed isolation, intervention is appropriate.
Should I restrict activities of patients with high FES-I scores to prevent falls?
No. Restriction reinforces fear and causes deconditioning, worsening fall risk. Instead, provide fall prevention education, address misconceptions about balance, conduct home safety assessment, and guide progressive activity engagement. Balance training, strength exercise, and successful completion of previously feared activities rebuild confidence.
Can FES-I scores improve with intervention?
Yes. Fall prevention training, progressive activity programs, and successful completion of challenging activities improve FES-I scores. Reassess after 8–12 weeks of intervention to document improvement. Scores that do not improve may indicate need for referral to psychology or physical therapy for specialized assessment and treatment.
Sources
- Yardley, L., Beyer, N., Eklund, K., et al. (2005). Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing, 34(6), 614-619. DOI: 10.1093/ageing/afi196 ↗
- Tinetti, M. E., Mendes de Leon, C. F., Doucette, J. T., & Baker, D. I. (1994). Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. J Gerontol, 49(3), M140-M147. DOI: 10.1093/geronj/49.3.M140 ↗
How to cite this page
ScholarGate. (2026, June 3). Falls Efficacy Scale International (FES-I). ScholarGate. https://scholargate.app/en/nursing/falls-efficacy-scale
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