Research Article: “I don’t want to be a burden”: the double-edged role of filial piety in fall-risk perception among community-dwelling older adults in China

Abstract:
Falls are a major threat to healthy aging, yet older adults’ subjective appraisal of their likelihood and consequences of falling may differ from objective physiological risk. Fall-risk perception is broader than fear of falling or activity-specific concern and is relevant because it may inform older adults’ willingness to disclose falls, seek help, modify the home environment, and participate in balance or strength training. This study aimed to explore how community-dwelling older adults in China experience and understand fall risk in everyday life and family relationships, with particular attention to filial piety and the desire not to become a burden to adult children. A descriptive phenomenological design was used. Nineteen community-dwelling older adults in Changsha, China, were purposively recruited through maximum variation sampling and stratified by levels of concern about falling assessed using the Falls Efficacy Scale-International (FES-I). The FES-I was used as a sampling aid rather than as an operational measure of the broader phenomenon of fall-risk perception. Semi-structured individual interviews were conducted between March and May 2023. Data were analyzed using Colaizzi’s seven-step method. Reporting followed the Consolidated Criteria for Reporting Qualitative Research. Three overarching themes were identified. First, embodied and relational experiences were associated with heightened fall-risk perception, including adverse fall-related events, perceived efficacy of prevention, awareness of physical decline, environmental vigilance, and caregiver monitoring. Second, cognitive, identity-related, and contextual experiences were associated with reduced risk appraisal or constrained prevention, including misconceptions about falls, normalization of “harmless” falls, denial and overconfidence, over-reliance on assistive devices, living circumstances limiting home-safety practices, and limited professional support. Third, filial responsibility appeared in two contrasting forms: the wish not to burden adult children was associated with greater caution, while some participants also concealed minor falls to avoid causing family worry. Participants’ accounts suggest that fall-risk perception among community-dwelling older adults in China is experienced not only as an individual appraisal but also within family and cultural relationships. Community nurses should consider integrating objective fall-risk assessment with family-sensitive communication strategies that promote mobility, autonomy, and family well-being while minimizing guilt, stigma, and concealment.

Introduction:
Falls are a major threat to healthy aging, yet older adults’ subjective appraisal of their likelihood and consequences of falling may differ from objective physiological risk. Fall-risk perception is broader than fear of falling or activity-specific concern and is relevant because it may inform older adults’ willingness to disclose falls, seek help, modify the home environment, and participate in balance or strength training.

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