Have you recently cancelled plans because you were worried about falling? Maybe you have already experienced a fall or are consumed by anxious thoughts of possibly falling. Fear of falling is a major concern among many older adults and can result in a decreased quality of life.

Before we go any further, let’s define what fear of falling is:

Fear of Falling Definition:

Tinetti and Powell define it as, “The ongoing concern about falling that ultimately limits the performance of daily activities.”

In other words, fear of falling is the loss of confidence in your ability to maintain balance.

Prevalence of people falling: You are not alone

In the community, fear of falling has been reported in 12% to 65% of older adults (60 years of age and up), who have not previously fallen. In those who have experienced a fall, fear of falling is reported in 29% to 92% of older adults.

As we can see the fear of falling is prevalent in both individuals who have experienced a fall and those who have not.

The downward spiral:

As a result of this fear, a snowball effect occurs in which anxiety builds up, social isolation and avoidance of activity occurs.  This results in deconditioning and increased frailty and thus a greater risk of falling occurs.

A study by Lachman et al. found that going out when it’s slippery and reaching overhead are two activities most people avoid due to fear of falling.

Causes of fear of Falling:

The fear of falling may be a more serious problem than actual falls in older adults and therefore deserves close attention. Many resort to justifying fear of falling as a “normal aging process.” Though it may have some validity, fear of falling is multifactorial, meaning there are many reasons that could play into why you feel this way. Some reasons may include, though not exhaustive:

• Poorer health status and functional decline
• Frailty
• Impaired balance
• Not being able to get up immediately or at all
• Psychological factors: depression and anxiety

What should I do: overcoming my fear and getting my confidence back

Because falls and fear of falling occur from a combination of factors, they require a multifactorial, interdisciplinary approach, i.e. more than one health professional.  Programs that are targeted to multiple patient-specific risk factors are most effective. For the purposes of this article, we will focus on how physiotherapy can help you decrease your fear of falling and prevent any future falls.

As mentioned above, a major reason for fear of falling can be loss of confidence in one’s own balance. Training balance has been shown to significantly reduce falls.

A Physiotherapist can perform a thorough assessment looking at different musculoskeletal components that may play into impaired balance. These include, your lower body strength, range of motion, sensation in your feet, proprioception, foot deformities as well as your general posture and amount of sway in different positions.

With this information, your physiotherapist will determine your limit of stability. Your physiotherapist can help you safely push this limit and train your balance. In addition, there are several reliable tools that can be used to assess your balance ability along with questionnaires to assess the severity of your fear of falling. These tools can be used to target your treatment appropriately and provide you with an objective way to track change over time.

Cognitive-behaviour therapy (a type of therapy that can help challenge negative thoughts to avoid the consequence of negative behaviour) coupled with balance, gait and strength training by a physiotherapist has shown to help improve results on the outcome measures used to assess fear of falling and increase one’s confidence and functional performance significantly.

Training balance:

• Balance can be trained statically (maintaining stability without movement) and dynamically (maintaining stability with movement).

• Balance can be trained in different positions:
• Sitting
• Standing
• Two point kneeling
• Four point kneeling
• Walking
• Balance can be challenged in different ways:
• Reducing your base of support (feet together, heel to toe, braiding)
• Removing your visual feedback (eyes closed)
• Various surfaces (foam versus a hard surface)
• Internal perturbations (reaching over head or combing your hair)
• External perturbations (having someone gently apply force moving you in different directions)

Most importantly, balance exercises can be performed doing functional tasks such as folding laundry while standing to mimic activities of daily living you find are limited in.

If you have fallen in the past 12 months or have a fear of falling, contact your Physiotherapist today to see how you can beat this fear and prevent any future falls.

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• My back hurts
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References:

Gomez, F., & Curcio, C-L. (2007). The development of a fear of falling interdisciplinary intervention program. Clinical Intervention Aging, 2 (4), 661-667. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686320/

Gillespie, L.D., Gillespie, W.J., Robertson, M.C., Lamb, S.E., Cumming, R.G., & Rowe, B.H. (2001). Interventions for preventing falls in elderly people. Cochrane database systematic review, 3. https://www.ncbi.nlm.nih.gov/pubmed/11686957

Legters, K. (2016). Fear of Falling. The journal of American Physiotherapy Association, 82 (3), 264-272. https://doi.org/10.1093/ptj/82.3.264

Scheffer, A.C., Schuurmans, M.J., Van Dijk, N., Van Der Hooft, T., & De Rooij, S.E. (2007). Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Oxford Journals, 37 (1), 19-24. http://ageing.oxfordjournals.org/content/37/1/19.long