“Have you fallen?” and “Are you afraid of falling?” At a certain age, these questions start to be asked by healthcare providers as part of a routine office exam. It seems reasonable to ask about any recent falls or related injuries, but why ask about a fear of falling? In fact, the answer to that is important whether someone has fallen or not. 

Fear of falling or basophobia is defined as an individual’s loss of confidence in their own balance ability with an associated out of control or exaggerated fear of falling. It can have significant negative consequences both physically and emotionally and actually increases the risk of a fall. From a public health standpoint, early screening (i.e. the two fall questions), identification, and targeted interventions are aimed to prevent or reduce falling and the fear of falling. 

Some statistics

In individuals over 65, falls are the leading cause of fatal and nonfatal injury.  In 2021, approximately one in four seniors (14 million) reported a fall. There were 38,000 related deaths and falls were the most common cause of hip fractures and traumatic brain injuries. These numbers are daunting, and the number of falls reported is probably even higher as less than half tell their healthcare provider.   https://www.cdc.gov/falls/data-research/index.html    Typically, fear of falling occurs after experiencing a fall but it can also develop if a loved one or friend has fallen. Overall, it is estimated that 20 to 39 percent of older adults express anxiety about falling and this can increase to 40 to 73 percent in those who have fallen https://pmc.ncbi.nlm.nih.gov/articles/PMC8629501/ . 

Risk factors

There are multiple factors that place someone at risk for a fall and number one is a previous fall. Joint pain from osteoarthritis, vision impairment, leg weakness, neuropathy, stroke, osteoporosis, and Parkinson’s disease are some of the medical conditions that could predispose a person to falling. Certain medications such as muscle relaxants, antihistamines (including Benadryl), medications for depression and anxiety, sedatives and pain medications can also add to the risk. For a more detailed list go to : https://www.hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/QMP/Medications.pdf  

Although blood thinners do not increase fall risk, they can result in a more serious injury from bleeding. Any fall that occurs when on a blood thinner should be reported and the ongoing safety risks discussed. Poor fitting footwear is an environmental hazard, along with throw rugs, electrical cords, pets, and stairs. Being fatigued or distracted can certainly be added to this list. 

Fear of falling can develop slowly or immediately after a fall and should be acknowledged and discussed with a healthcare provider. It is a normal protective reaction, however, the concern is that it can lead to people overly restricting their activity and becoming more isolated. 

Approximately one-third to one-half of older adults are concerned enough about potential falls that they have begun to restrict or avoid activities. This fear of standing or walking contributes to a further loss of confidence and sense of helplessness — all of which sets the stage for additional falls and a vicious cycle.   

Interventions 

Having highlighted the serious consequences, it is important to explain the many ways to reduce or prevent a fall or fear of falling. If you notice that the fear of a falling is beginning to affect your daily activities, this is a red flag to be discussed with a healthcare professional. No one wants to fall, but less activity only increases the risk. The approach to preventing the frailty and potential isolation related to fear of falling should be multi-pronged and include a review of any medical conditions, environmental hazards, and all medications. 

Prescribed medications and over-the-counter medications may need to be discussed and adjusted. Has there been a recent eye exam? A physical examination should look for localized weakness, pain, or balance issues. There is an expression called “furniture surfing” for people who use their furniture and walls for support to move around their home. This is not the answer, but exercise is an answer. An exercise bike, swimming or pool aerobics are a great way to start as they provide support. Tai chi, Pilates and yoga are recommended to improve balance, core strengthening and flexibility.

Physical therapists can be extremely helpful in evaluating your gait and suggesting specific strengthening and range of motion exercises. They may recommend assistive devices such as a cane, walker, or orthotics for foot, ankle, knee, spine, or wrist. It can feel uncomfortable to start using adaptive equipment but certainly less uncomfortable than a fall.   

If there are certain activities that are no longer safe to do, find a work around or someone to help and put the stools and step ladders away. Consider some home modifications like adding grab bars in the bathroom, maybe a stair lift (can often be found used), or moving to the first floor if needed. Adequate lighting is also important to better navigate your home.  

The anxiety around falling should be considered and may require some counseling. Cognitive behavioral therapy is a type of talking therapy that helps to change thoughts and beliefs that may not be effective and offer better coping skills. Physical therapy can help build back confidence and having a medical alert system for back-up could alleviate some anxiety as well. 

The point

Falls are a serious issue for older adults but do not accept that fear of falling is a normal and irreversible part of aging. The risk of a fall does increase as we age and that is why taking a preventive approach is important. There are steps one can take (no pun intended) to help maximize independence along with personal safety. If you have fallen or if you are aware of anxiety developing around falling it is important to share this with your healthcare provider early to avoid exacerbating the problem and becoming isolated. 

Join our event

The next 6-part series of Let's Talk About: Aging & Caregiving Matters will start Tuesday April 8 at the Rogers Free Library. The first topic is called “Palliative Care & Hospice: Still Not Sure About the Difference?” Join us in person or virtually. 

Bonnie Evans, RN, MS, GNP-BC, GC-C, lives in Bristol and is a geriatric nurse practitioner, End of Life Doula, and certified grief counselor. She can be reached at bonnie@bonnieevansdoula.com.