Mediating effect values and proportion of effect.

Objective
Falls represent a common injury among older adults, and fear of falling is a prevalent psychological stressor in this population. This study aims to investigate the relationship between fear of falling and depression in older adults, as well as the chained mediating effects of attitudes toward aging and social networks.
Methods
Using stratified cluster sampling, 1,158 adults aged 60 and older were surveyed between July and August 2022. Instruments included the Modified Fall Effectiveness Scale (MFES), Geriatric Depression Scale-15 (GDS-15), Attitudes Toward Aging Questionnaire (AAQ), and Local Social Network Scale-6 (LSNS-6). Correlation analysis and mediation effect testing were conducted using SPSS 26.0 and Stata 18.0.
Results
Fear of falling was positively correlated with depression (β = 0.36, p < 0.001). Attitudes toward aging (Effect = 0.13, 95% CI (0.09, 0.17)) and social networks (Effect = 0.09, 95% CI (0.05, 0.13)) served not only as independent mediators between fear of falling and depression but also as chain mediators (Effect = 0.02, 95% CI (0.01, 0.03)).
Conclusion
Fear of falling is associated with depression in older adults through aging attitudes and social networks. Healthcare providers should prioritize addressing older adults’ fear of falling and develop strategies based on this pathway to reduce the risk of depression in older adults.