‘DeFeeting’ the Fear of Falling

Falling forwardIn one of my recent posts ‘Tips for Staying Topside’, I wrote that falling is right at the top of a ‘Worry List’ for older adults. Adding to this worry are the unwelcome and, often, all to visible signs of the consequences of falling, such as bruising, pain and other soft tissue injury.

However, one very powerful negative consequences of falling is actually invisible and, perhaps because of this, is often misunderstood or under appreciated by family members and younger adults.

Fear of falling (FOF) is a form of psychological trauma, caused by extreme worrying about falls. Society at large knows little about this condition, but, though invisible, research has shown it to be a significant risk for falls in older adults. Up to 60% of community-dwelling older adults are affected. Click here for more information about falls and fear of falling and, more importantly, what you can do about it.

For a person experiencing FOF, daily activities that were once taken for granted are either curtailed, or approached with a great deal of caution. For example they may not walk as frequently – or as far – and when they do walk, their gait is stooped and often reduced to a slow, cautious shuffle. They often also have to rely on external supports to maximize their feeling of stability, just like the lady in this picture.

Shuffling gaitAs a result of these self imposted limitations, autonomy and quality of life is dramatically reduced and the risk of depression increases. The Catch 22 here is that the extreme caution and activity limitation they exhibit as a result of being afraid of falling, is the very thing that produces a reduction in strength and balance! So, it actually increases their chance of falling!

Ok enough of the downside – what’s the upside here? (Pun intended). What can we do to first identify those who suffer from FOF,  and then reduce that fear?

How can we identify persons with FOF?

  • Ask them
    This is not as simple as it may seem. Simply asking people “Are you afraid of falling” is not ideal, since they may not be comfortable with such a direct approach.
  • Give them a questionnaire
    The most effective way to assess overall risk is to ask someone to rate their confidence in performing a range of activities – and then add or average the responses.checklist-41335__180

The most well known of these questionnaires is the Falls Efficacy Scale (FES), developed by Dr. Mary Tinetti, one of the foremost researchers in the world on Fall Prevention. You can download the Falls Efficacy Scale here.

  • Observe them
    Regardless of whether you complete the FES or not, if you – or one of your loved ones – worry about falling while going about their daily activities, or have stopped doing them because of this, there is cause for concern

How can we reduce FOF?

  • The single best way to reduce fear of falling is to increase confidence in your ability to live your life the way you want.
  • You can achieve this by educating yourself on the realities of falling and – you guessed it – increasing your strength and balance!
  • As you notice your functional abilities improving, so you become more confident about what you do, and want to do in life.

REMINDER: Several of my previous posts provide guidance on the best way to start and continue with a program of strength training. You can also leave a comment below, and I will respond.

Man on RockStrength is the foundation of autonomy and quality of life

I’d like to finish this post with a story about a gentleman I worked with about a year ago. Jack was slow moving and walked with a bit of a shuffle. He was also relatively weak for his age (82). He started strength training rather apprehensively but, with the strong support of his wife, who was very independent, he began to look forward to our sessions. His functional assessments improved and – highly related to the topic of this post – the tipping point occurred when he did something that was not a specific exercise. It was actually while he was on his way to doing a specific exercise.

Prior to doing his bicep curls, Jack would typically pick up his dumbbells from the rack, walk to the front of the bench and slowly back into it to sit down and perform the exercise. On this occasion, however, as he approached the bench, instead of backing slowly into it as before, he lifted his leg over the bench to straddle it and then sat down – all while carrying the dumbbells!

He actually balanced on one leg while swinging the other over the bench! I saw it happen, and it was done with no hesitation. When I pointed this out to him (I was excited!), he just smiled and said “Yes, I feel much steadier now”.

The message from Jack – and many others I have worked with – is clear: taking purposeful action to improve your strength and balance can ‘DeFeet’ the of fear of falling!

How did you (or your loved one) score on the Falls Efficacy Scale?
If you were at or above a score of 70, enter a comment below. if you include your email, I will send you more information on the best next steps.

Be part of the conversation – record your thoughts or opinions on this post in the comments box below – or ask a question of your own.
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