It is well known that older people are often at risk for falls. This month Elder Voice focuses on the debilitating fear of falling that many older people experience, whether or not they have actually had a fall.
Estimates of fear of falling among older adults varies from 3%-over 80% but has been found to be almost 50% among the one third of older people who have had falls. The fear increases with the number of falls and with age.
Consequences of fear of falling are many. They include reduction in activities, socialization and depression. These can lead to decrease in mobility and physical ability, which in turn, ironically can lead to falling–what the person is trying to avoid.
To design an effective programme that will help someone with their fear of falling, we need to understand all aspects of that fear. What exactly are they afraid of? Becoming a burden to family? Losing independence? What actions or activities in daily life make them afraid? Where are they afraid–inside or outside? In the kitchen or the washroom? Why? Is it a lack of strength? Do they become dizzy? Do they live alone? Did a parent die from a fall? Is there vision loss? Is the fear masking an underlying depression? When are they afraid? At night while getting out of bed to use a washroom? How did the fear develop? What brought it on?
As we begin to work on fear reduction, we need to acknowledge to the older person that we take them seriously, want to understand their fear and want to help. We should also make sure they want to try to get over it. You may find they are too fearful or discouraged to even try to make changes or don’t believe it is possible. If that is the case, that is where to start. If they are willing, find out what their goals are. What would they be something be different if they got over the fear?
Education about risks and causes of falls is a good place to begin. This can counter beliefs that maintain the fear. For example, they may believe they cannot get stronger. Let them know that there is very strong evidence that many people have the potential to increase gait, strength, and muscle mass at any age.
Identify which risks are relevant to them (see our list in the next article). For instance you may need to do some home renovations or modifications, install grab bars and railings, remove throw rugs, move furniture, or make dishes more easily accessible. You might need to see if medication can be changed, if sleep can be improved, if equipment such as canes or walkers need to be changed or started, or if you need to install an emergency alert system with an automatic function that calls for help even if they cannot activate it on their own.
What little is known about reducing fear of falls supports the concept that a multi pronged approach is optimal. Use a core team of professionals to teach skills to the older person and give caregivers and family ways to help. A physiotherapist will focus on exercises for balance, gait and strength (and be sure to include exercises for the upper body as well). An occupational therapist can teach skills for getting out of bed, on and off a toilet or getting in and out of a car. Exercise programmes in a gym or supervised Tai Chi and yoga might be appropriate. Keeping a progress log can be helpful and encouraging.
Counselling and psychotherapy can also be useful to reduce fear of falling. If, as noted above, someone is too discouraged to try to face their fear, a professional counsellor can work with them around that. Or,using a Cognitive Behavioural Therapy (CBT) approach, a counsellor can teach someone how to change the way they think about falls, which in turn can change how they handle their fear. Gradual Exposure, a controlled approach in which someone successfully goes through a series of small, but increasingly challenging steps can be helpful. Techniques of breathing and meditation may be helpful either with visualization or in a structured real life exposure programme. EMDR (Eye Movement Desensitization and Reprocessing) is often helpful for reducing fear and trauma.
Training in a support group may also be helpful. Working individually and together with other people who also have a fear of falling, through both talk and exercise, provides encouragement, role modelling, accountability and mutual support, all of which are known to be important to successful change and development.
Fear of falling can be debilitating, but it does not have to be. With love, care, persistence, and knowledgeable and competent help, it can be faced. Diamond Geriatrics has qualified counsellors and therapists who can help seniors, family members and caregivers with fear of falling and many of the other emotional and practical problems that arise during aging and caregiving. Call us today to see how we can help you or your loved one.
Preventing Falls: A Checklist
Falls are a leading cause of hospitalization, admission to care communities, and predictors of death in the elderly. Many of the risks are preventable. Below is a list of some of the leading causes of falls. Use it as a checklist to reduce risk. It could save your life or that or your love one.
- Over or under medication
- Sleep deprivation
- Dizziness and impaired balance
- Clutter
- Furniture which is too high or low or in the way
- Reaching for something that is out of easy grasp
- Weak or de-conditioned muscles and impaired co-ordination
- Vision loss
- Medical conditions such as high blood pressure or stroke/TIA, delirium, Urinary Tract Infections
- Malnourishment and dehydration
- Ill fitting clothes or shoes
- Equipment inappropriately sized or used
- Depression
- Alcohol
- Anxiety
- Foot problems
- Wet or uneven floors
- High bathrubs or showers
- Floor pattern or material changes
- Rugs with high piles or that are not secured to the floor
- Movement too fast for the ability of the person, rushing
- Uneven or cracked sidewalks
