The Impact of Fear of Falling on Health-Related Quality of Life in Community-Dwelling Older Adults: Mediating Effects of Depression and Moderated Mediating Effects of Physical Activity

Abstract

Background The fear of falling is a common issue among older adults that negatively affects both physical and psychological aspects of health-related quality of life, regardless of actual fall events. Interventions aimed at reducing fear of falling, independent of falls, may be effective in improving older adults’ quality of life. This study examined the moderated mediating effect of physical activity in how fear of falling affects health-related quality of life through depression in community-dwelling older adults. The specific purposes are as follows: 1) To evaluate the mediating effect of depression in the relationship between fear of falling and health-related quality of life; 2) To examine the moderating effect of physical activity on the relationship between depression and health-related quality of life. 3) To assess the moderated mediating effect of physical activity on fear of falling’s effect on health-related quality of life by mediating depression. Methods This study used secondary data from the Korea Centers for Disease Control and Prevention’s 2019 Community Health Survey. A total of 73,738 adults aged 65 years or older were included. Fear of Falling, International Physical Activity Questionnaire, Patient Health Questionnaire-9, and EuroQol 5 Dimension were used as research tools. Descriptive statistics, Pearson’s correlation coefficient, and SPSS PROCESS macro analysis were performed. For the adjusted mediating effect, samples were re-sampled 5,000 times by the bootstrapping method, and statistical significance was determined by setting a 95% confidence interval. Results In the model in which fear of falling affects health-related quality of life by mediating depression, the moderated mediating effect of physical activity was statistically significant as the bootstrapping result did not include 0 in the 95% confidence interval (Index of moderated mediation [95% CI] = 0.006 [0.004–0.007], 0.008 [0.006–0.009]). Depression and health-related quality of life impairment decreased as the level of physical activity increased through inactivity, minimal activity, and health promotion activities, as the negative mediating effects decreased. Conclusion Physical activity reduces depression and improves health-related quality of life by influencing older adults’ fear of falling. Community-based programs are needed to encourage and support older adults in maintaining moderate physical activity to manage the depression caused by fear of falling, common among older adults, and to improve their health-related quality of life.