Being frightened of falling over is likely to increase an old person's risk of having a fall, researchers have found.
The link remained even when they were not actually at a high risk, the study in the British Medical Journal found.
The Australian and Belgian researchers said anxieties should be taken into account when assessing someone's risk of falling
UK experts said services to help elderly people needed to be improved.
Fear of falling is common in older people and is associated with poor balance, anxiety, depression and falls.
But the team of researchers from Australia and Belgium said not enough emphasis had been given to the effect of irrational fears on falls.
Five hundred Australians aged 70-90 were asked about exercise levels and incidental activity, as well as taking tests for depression and anxiety.
All the participants also underwent extensive medical and psychological checks before being assessed for their actual risk of falling.
During the year-long study, 43% (214) reported one or more falls.
Further analysis was then used to split the sample into four groups based on the disparity between their actual and perceived risk.
In reality, those in the "anxious" group had a low risk of falls - but perceived their risk as high. This was linked to an increased likelihood of depressive symptoms, neurotic personality traits and poor physical health.
Almost 40% of this group had several falls over the year of the study.
In contrast, the "stoic" group had a high physical risk of falling but did not think they did.
Only one in three experienced one or more falls.
The researchers found this outlook offered some protection against falling and was related to a positive outlook on life, physical activity, and community participation.
Writing in the BMJ, the researchers, led by Dr Stephen Lord from the University of New South Wales, said: "Excessive fear of falling can lead to needless restriction in participation in physical and social activities, resulting in physical deconditioning, poor quality of life, social isolation, depression and psychological distress."
They said strategies aimed at reducing fear of falling - such as cognitive behavioural therapy - should be implemented for those who were anxious.
Michelle Mitchell, charity director at Age UK, said: "It's well known that fear of falling among older people and those who care for them reduces people's quality of life and wellbeing and can lead to isolation and loneliness.
"Yet despite clear evidence that falls can be reduced through improving people's strength and balance, there is a chronic shortage of these services across the country."