What is the Falls Efficacy Scale International (FES-I)?

The Falls Efficacy Scale International (FES-I) is a 16-item self-report measure of concern about falling during various activities. Developed by Yardley et al. (2005) and validated internationally, each activity is rated 1 (not at all concerned) to 4 (very concerned). Total score ranges from 16 (no concern at all) to 64 (very concerned about all activities). The FES-I predicts future falls, activity restriction, and quality of life decline in community-dwelling older adults.

What FES-I score indicates high fear of falling?

FES-I classification: 16–19 = Low concern; 20–27 = Moderate concern; 28–64 = High concern. A score of 28 or above indicates high concern about falling, associated with significant activity restriction and substantially elevated future fall risk. The short FES-I (7 items, maximum 28) uses a cut-off of 8 for identifying concern about falling.

What is the Falls Efficacy Scale International (FES-I)?

The Falls Efficacy Scale International (FES-I) is a 16-item self-report measure of concern about falling during various activities. Developed by Yardley et al. (2005) and validated internationally, each activity is rated 1 (not at all concerned) to 4 (very concerned). Total score ranges from 16 (no concern at all) to 64 (very concerned about all activities). The FES-I predicts future falls, activity restriction, and quality of life decline in community-dwelling older adults.

What FES-I score indicates high fear of falling?

FES-I classification: 16–19 = Low concern; 20–27 = Moderate concern; 28–64 = High concern. A score of 28 or above indicates high concern about falling, associated with significant activity restriction and substantially elevated future fall risk. The short FES-I (7 items, maximum 28) uses a cut-off of 8 for identifying concern about falling.

Falls Efficacy Scale International (FES-I) Calculator

Falls Efficacy Scale International (FES-I)

Score all 16 daily activities on a 1–4 concern scale (1 = not at all concerned → 4 = very concerned). Total score 16–64. Classifies fear of falling as low (16–19), moderate (20–27), or high (≥28) concern. Predicts future falls and activity restriction in older adults.

NMClinically reviewed byDr. Nikhil Mahajan, PT, MPT · Jan 15, 2026

FES-I — Score Classification and Clinical Interpretation

FES-I Score	Concern Level	Activity Restriction	Fall Risk	Clinical Action
16 – 19	Low	Minimal activity restriction	Lower risk	Education, falls prevention exercise class
20 – 27	Moderate	Some avoidance of activities	Moderate risk	PT referral, group exercise, cognitive reframing
28 – 64	High	Significant activity restriction likely	High risk of future falls	Comprehensive PT assessment, individualised exercise, CBT for fear

FES-I Score

Concern Level

Activity Restriction

Fall Risk

Clinical Action

16 – 19

Low

Minimal activity restriction

Lower risk

Education, falls prevention exercise class

20 – 27

Moderate

Some avoidance of activities

Moderate risk

PT referral, group exercise, cognitive reframing

28 – 64

High

Significant activity restriction likely

High risk of future falls

Comprehensive PT assessment, individualised exercise, CBT for fear

What Is the FES-I?

The Falls Efficacy Scale International (FES-I) is a 16-item questionnaire measuring concern about falling during daily activities, developed by Yardley et al. and published in Age and Ageing in 2005. It was developed from the original FES (Tinetti et al., 1990) as an international version with expanded activities and improved psychometric properties. The FES-I assesses fear of falling not as a single yes/no question but across 16 specific daily activities, capturing the breadth and severity of fall-related concern.

Why Fear of Falling Matters Clinically

Fear of falling is prevalent in 25–55% of community-dwelling older adults and in 30–73% of those who have previously fallen. Even in older adults who have not fallen, fear of falling predicts future falls, activity restriction, social isolation, functional decline, depression, and nursing home admission. Crucially, fear of falling can become a self-fulfilling prophecy: reduced activity leads to deconditioning, muscle weakness, and impaired balance — all of which increase actual fall risk, creating a vicious cycle. The FES-I identifies patients at risk of this cycle before the falls occur.

FES-I as a Falls Prevention Outcome Measure

The FES-I is one of the most responsive measures for tracking the psychological component of falls prevention intervention. Exercise programs, cognitive behavioural therapy for fear of falling, and environmental modification all reduce FES-I scores. A reduction of 4 or more points is considered clinically meaningful. The FES-I is included in the UK NICE falls prevention guidelines and is widely used as a primary or secondary outcome in falls prevention randomised controlled trials.

Dr. Nikhil Mahajan, PT, MPTReviewed January 15, 2026 · View full credentials

Frequently Asked Questions

What does a FES-I score of 28 or above mean?

A FES-I score of 28 or above indicates high concern about falling. Patients at this level frequently restrict activities to avoid perceived fall risk — a behavioural pattern associated with progressive deconditioning, social withdrawal, depression, and paradoxically increased fall risk. Comprehensive physiotherapy assessment, individualised exercise prescription, and cognitive behavioural approaches to address fall-related anxiety are all indicated at this score level.

Is FES-I a self-report or clinician-administered tool?

The FES-I is designed as a self-report questionnaire that can be self-administered or clinician-administered through interview. When administered by interview, the clinician reads each activity and the patient selects their response verbally. The interview format is preferred for patients with reading difficulties or cognitive impairment. When used as a self-administered questionnaire, it takes approximately 5 minutes to complete.

How does the FES-I differ from the original FES?

The original Falls Efficacy Scale (FES, Tinetti et al. 1990) had 10 items focused on basic indoor ADLs, scored 1–10 for confidence. The FES-I (Yardley et al. 2005) expanded to 16 items including outdoor activities (visiting friends, going to the shops, walking on uneven surfaces, social events), uses a 1–4 concern scale rather than a 0–100 confidence scale, has been validated in 16+ languages, and has superior psychometric properties including better floor and ceiling avoidance, making it the preferred international standard for fear of falling measurement.