Mediating effect analysis: How frailty affects fear of falling and fall risk in elderly patients with ischemic stroke

This study aimed to examine how frailty affects fall risk in elderly ischemic stroke patients through the mediating role of fear of falling, by analyzing their associations and pathways. A total of 280 elderly ischemic stroke patients were recruited by convenience sampling. Evaluations included the Chinese versions of the elderly falls risk self-assessment scale, modified falls efficacy scale (MFES), tilburg frailty indicator (TFI), hospital anxiety and depression scale (HADS), and family APGAR index, all showing good reliability (Cronbach α ≥ 0.80). Data were analyzed using Pearson correlation, univariate analysis, and multiple linear regression. Age increased fall risk, while exercise and assistive devices reduced it (P < .0001). Multiple regression analysis confirmed the effects of age (β = 0.8233, P < .0001) and use of assistive devices (β = -0.0143, P < .0001). Scores across frailty dimensions (mean = 5.12) were strongly and positively associated with fall risk (R = 0.886, P < .001). Conversely, fear of falling showed a significant negative correlation with fall risk (r = -0.834, P < .001), suggesting that higher levels of fear may reduce actual fall events through defensive or avoidance behaviors. Frailty significantly increased fall risk in elderly patients with ischemic stroke, while fear of falling served as a partial mediator in this process. Greater frailty was associated with stronger fear of falling, which in turn contributed to an elevated fall risk. This underscores the importance of addressing both frailty and psychological factors (e.g., fear of falling) in clinical care for this population. Future interventions should target both physical frailty and fear of falling to reduce fall incidence, alleviate patients' physical and psychological burdens, and improve safety and quality of life. The novelty of this study lies in being the first to construct and validate a frailty-fear of falling-fall risk mediation model in elderly patients with ischemic stroke, thereby providing new evidence on the mechanisms underlying fall risk in this group. The observed association may be partly explained by the fact that patients with higher fear levels tend to adopt more protective or avoidance behaviors.