Your Fear of Falling May Cause You to Fall

Older adults who are afraid of falling actually have a higher risk of having a fall.

Say what?

You would think—if you are afraid of having a fall, you are going to be more cautious and therefore have a decreased risk of falling, right?

But it’s true. Statistically speaking, when you have a fear of falling, you have a higher risk of having a fall. How sad.

Here’s why. Fear of falling and the instance of having a fall have a cyclical nature. The cycle goes like this:


1. An imbalance event

This is typically a loss of balance such as a trip, a near-fall, or an actual fall with or without injury


This could also be a medical event like a hospitalization or a new diagnosis

2. Increased fear of falling

The psychological consequences of an imbalance event (#1) come into play.


Fear of falling appears for the first time OR increases as the person becomes less confident in their ability to move and stay balanced during daily activities.

3. Limited activity

Because of the presence of fear of falling, the person attempts to decrease the risk of falls by limiting physical activity

  • This may include a decrease in participation in recreational activity. (no more golf; no more eating out at restaurants; no more gardening)

  • This may include a decrease in instrumental activities of daily living. (no more housework; no more church activities; no more grocery shopping)

  • This may include a decrease in self care tasks. (sponge bathing rather than showering; wearing pajamas all day rather than getting dressed each morning; wearing incontinence briefs rather than getting up to use the restroom throughout the day)

4. Another imbalance event

As the person’s activity becomes more limited, their strength and balance systems take the hit.


Without the input of standing up from a chair; walking over different surfaces such as carpet, tile, grass, or concrete; and the movements involved in the regular and daily living tasks previously completed, the body no longer has the muscle memory and strength needed to complete those tasks safely.


This decline in physical wellness leads to another trip, near-fall, or fall.


The fear of falling previously experienced is then reinforced.


The cycle begins again

  • increased fear of falling > decreased activity > another fall

  • increased fear of falling > decreased activity > another fall

How to break the cycle

Full acknowledgement here: our bodies were unfortunately not created to maintain the limberness and forgiveness of our 20-year-old selves into older adulthood. The effects of aging are inevitable. HOWEVER: your quality of life should not suffer the consequences of repeated falls and the psychological costs of a fall-related event. The ability to maintain your roles in your self-care and leisure routines is of utmost importance to the quality of life that you live. To maintain those roles, breaking the cycle of fear of falling and its relation to subsequent falls is a necessity.

Check in on your fear of falling

Ask yourself: “Am I afraid of falling?” I guarantee that your family and friends can answer this one for you. Ask them for their opinions.


List the daily activities you have changed or are avoiding because you are afraid of falling.

  • What hobbies have you given up?

  • How has your social life been affected?

  • Are you taking care of yourself by getting dressed each morning, showering routinely, and attending your doctor’s appointments?

Exercise

I know, I know. This is the point that the eye rolls come. We all know we should be exercising, but many of us can’t find the motivation or the time.


And for those that are reading this and are really struggling with the fear of falling, I know what you’re thinking, “I can’t do that anymore. My body won’t let me.” Wrong. Exercise may be even more important as the body ages.


The recommendation for exercise in adults aged 65 and older is at minimum 150 minutes weekly—that’s about 30 minutes a day, five days a week (2020).


I don’t care if you must start by only walking to the kitchen sink and back three times daily. Start an exercise program today.


Consider your walking aid

Do you use a cane or walker?


Over 47,000 American older adults reported to the emergency room with a walker or cane related fall each year according to this CDC study (2009).


You should not simply go and purchase a walker or a cane without the recommendation of your physician, a physical therapist, or an occupational therapist.


You should not rely on a walking aid such as a walker or cane simply because you have a fear of falling—if you do not have the physical need for a walking aid, you will actually be doing more harm than good by changing your posture, your gait, and your muscle reactions.


If you are using a walker or a cane, you should receive an in-depth physical therapy or occupational therapy evaluation with recommendations on sizing of the walking aid and training in usage

Don’t take daily living tasks for granted

Giving up meaningful and purposeful daily activity is a slippery slope—you may go from giving up your hobby of quilting today to choosing to wear incontinence briefs versus getting up to walk to the restroom in just 6 months to a year’s time. Seriously. I have seen the decline in activity happen that quickly.


I recommend three categories of activity to be completed daily to maintain your quality of life throughout the lifespan:

  • 1. Self care

  • dressing; bathing; grooming and hygiene; and any special tasks that “make you feel like a person.”

  • 2. Care for others

  • taking care of your own household with housework, meal preparation, grocery shopping, or organizing

  • volunteer work such as through community organizations or church

  • 3. Leisure

  • Anything that brings you effortless joy (ie golf, fishing, quilting, card games, crossword or Sudoku, visiting a friend, or reading)

  • Watching television is not included—choose something that causes you to move your body and engage your mind

**each of these three categories can and should be modified to fit your current physical state and time availability. I recommend you chose at least one task from each category to complete daily.

Think on the goals you want to accomplish and not on the conditions you want to avoid

In my experience, it is much easier to work towards a goal rather than run away from an undesired condition such as a fall.


When you choose to work towards goals like walking one mile, cooking Thanksgiving dinner, or finishing your quilting project you will experience more success, a better physical condition, and an improved quality of life than if your goal is to avoid a fall.


Check in periodically (I like monthly) on your goals and make changes when needed. Remember, you may get to retire, but you don’t get to quit.

Are you afraid of falling? Choose today to live without fear. Stop avoiding the very activities that bring you meaning and purpose. Break the cycle.

In all stages of life, live today. Live better tomorrow. And inspire others to do the same.

Your OT,

Ashley




The information written in this blog post is intended to be for general informational purposes only, and should not be used as a substitute for medical or therapeutic advice and/or treatment. You should maintain your safety by participating in activities only within your physical and cognitive capabilities. Please consult your physician or occupational therapist for specific and personal treatment regarding those capabilities.


How much physical activity do older adults need? (2020, April 10). Retrieved June 22, 2020, from https://www.cdc.gov/physicalactivity/basics/older_adults/index.htm


Press Release. (2009). Retrieved June 22, 2020, from https://www.cdc.gov/media/pressrel/2009/r090629.htm


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