Nutritional status and mental health burden among adults living with disabilities in urban Ghana: a cross-sectional study.

Falls are a major health problem among older adults worldwide and can negatively affect health, well-being, and quality of life [–]. In addition to physical injuries, falls can cause psychological problems, including in those without a history of falling [–]. A common psychological outcome is concern about falling (CaF) [, ], which often persists and is linked to activity avoidance, impaired balance, and increased risk of future falls [–]. However, CaF can also promote adaptive behaviours when individuals regulate their emotions and consistently use protective fall-prevention strategies [–]. Perceived control is a key psychological factor shaping emotional, physiological, and behavioural responses to the perceived threat of falling and is informed by prior health performance and outcomes. Individuals with higher perceived control tend to have better physical health, mental health, and overall well-being [–]. Perceived control over falling is a key determinant of whether CaF is adaptive or maladaptive []. It reflects one’s sense of control over threatening situations, including (i) the ability to manage balance and prevent falls and (ii) the capacity to channel fear into safer behaviours. Thus, individuals with high perceived control can modulate high CaF through conservative behavioural adaptations that enhance safety. In contrast, low perceived control can amplify emotional reactions, leading to an overestimation of harm, overly cautious movement, and impaired cognitive and attentional control of motor performance, resulting in inappropriate motor behaviours, heightened distractibility by external threats, and unnecessary activity restriction []. Alternatively, low perceived control may foster a sense of fatalism; when older adults perceive fall prevention as futile, they may disregard necessary safety precautions and persist in risky behaviours, further increasing their objective fall risk [, ]. These adverse consequences underscore how low perceived control shapes CaF and dictates whether behavioural responses become maladaptive []. Perceived control generally follows a non-linear lifespan trajectory, increasing through early adulthood, peaking in midlife, and declining in later life as control expectations and self-efficacy diminish alongside age-related biological, cognitive, and social change [, , ]. A substantial body of work shows that perceived control is shaped by demographic, socioeconomic, and cultural factors and is associated with physical performance, cognitive functioning, and psychological outcomes in later life [, ]. These findings highlight the importance of individual differences in perceived control among older adults with CaF and help explain why some experience serious consequences while others do not after similar fall events.