Let’s Talk: about taking back control from fear of falling

ONE IN THREE older adults experience a fall each year, and a high percentage of this group will develop a fear of falling.

In fact, many older adults have a fear of falling despite never having experienced a fall.

Fear of falling is difficult to define, but it is generally regarded as an ongoing concern about falling that leads to avoidance behaviour in common day-to-day activities.

This fear has an increased importance because it leads to a restriction in activities.

Over time, that can reduce your quality of life and importantly reduce your strength and balance which increases your risk of falls.

Like a self-fulfilling prophecy, the behaviour leads to the very thing you were trying to avoid.

When people attend our clinics, we can assess their fear of falling and how it affects their lives using tools such as the Short Falls Efficacy Scale.

This questionnaire measures concern about falling during daily tasks.

People rate their level of worry about falling while doing everyday activities such as getting dressed, taking a bath, getting in or out of a chair, going up or down stairs, reaching, walking on slopes, or going to social events.

The higher the score, the more concerned the person is about falling.

Thankfully, there are things you can do to improve your fear of falling. The main recommendation is to engage in physical activity, particularly activities that improve strength and balance.

This has been proven to reduce falls, and taking part in exercise classes, for example, can greatly increase a person’s confidence.

Exercise classes also offer the added benefit of social connection. Making that initial step is important, and it is often the hardest challenge to overcome.

Another way to improve fear of falling is through targeted education on the risk factors that may be relevant to you.

These insights can often restore a sense of control that may be lost after a fall.

They can include advice on your home environment and how to make it safer.

They may also prompt a person to have an eye review to screen for conditions such as cataracts, suggest that medications be appropriately reviewed, or highlight ways to manage general health and nutrition.

It is also important to acknowledge that fear of falling can be underpinned by anxiety, which may require intervention such as counselling or talk therapy.

Therapy can help identify and challenge catastrophic thinking, which heightens anxiety and leads to avoidance behaviours.

Building on achievable goals through gradual increases in activity, such as a short walk to the post office, can further challenge the perception that something bad will happen when out and about.

Mark Twain wrote that “courage is resistance to fear, mastery of fear, not absence of fear.”

The approach to fear of falling is to acknowledge that the fear is genuine, while taking back control so that the awareness of fear informs day-to-day living without owning it.