For many people, aging brings significant mobility challenges. This can lead to falls, which may have very serious consequences, such as hip fractures, brain injuries or worse. Sadly, some 14 million older adults — that’s about a quarter of all older adults — fall each year, according to data from the Centers for Disease Control and Prevention.
While not all falls result in injury, falling is still the No. 1 cause of injury for adults age 65 and older, the CDC notes. As such, preventing falls is a major focus in any senior caregiving setting.
But that focus on avoiding falls at all costs can have a downside — fall-related anxiety — which can actually increase the risk of falling for some older adults and become a major barrier to their ongoing independence.
[READ: How to Set Up Your Home for Aging in Place]
Understanding Fall-Related Anxiety
Fall-related anxiety, or living in constant fear of falling, is a very real phenomenon that can have psychological and physical manifestations, explains Lakelyn Eichenberger, gerontologist and caregiver advocate for Home Instead Inc., a network of independently owned and operated senior home care agencies headquartered in Omaha, Nebraska.
“Oftentimes when a person has a fear of falls, they start to limit their mobility and activities like walking. They may also withdraw from social outings or activities that require them to be on their feet,” she says.
It can also lead to someone feeling the need to cling to the wall or reach for pieces of furniture as they navigate their environment.
Signs of fall-related anxiety include:
— General anxiety symptoms, such as accelerated heart rate, nervousness, sweating, fatigue, irritability, restlessness or excessive worrying
— Avoidance of activities that could lead to a fall
— Withdrawal from social interactions that require walking or standing
— Muscle tension and hesitancy when walking or moving
— A decline in gait speed or stride length
— Decreased confidence when walking
[READ: Best Exercises for Preventing Falls in Older Adults.]
Fear Leading to Falls
Fall-related anxiety is more prevalent in people who have already fallen at least once, explains Marilyn R. Gugliucci, president of the Gerontological Society of America and professor and director of geriatrics education and research at the University of New England College of Osteopathic Medicine in Biddeford, Maine.
It also tends to be more prevalent in people with certain health conditions, such as Parkinson’s disease, that interfere with normal movement patterns.
Fall-related anxiety can become a vicious cycle leading to more falls.
“If you do not get up to move around regularly or engage in light exercise, then your muscles can quickly deteriorate. This may make it even more difficult to move about your environment and increase your risk of falls,” Eichenberger says.
What’s more, the less you move, the less you’re able to socialize and interact with others, Eichenberger adds, which can lead to feelings of isolation and depression.
“These mental health issues can also increase a person’s risk for falls,” she explains.
And perhaps the worst thing that this anxiety does is rob individuals of their sense of independence. Being paralyzed with fear can make you far less likely to go out into the world and experience all there is to do and enjoy.
Research has borne out all of these effects. One 2022 study explored the association between a history of falling and a variety of factors six months later. It found that gait speed, balance, physical activity levels, depression, fear of falling and motor capacity were all worse in people who had a history of falling.
Another study showed that a decline in gait speed was correlated with a higher risk of falling, which seems a little counterintuitive; slowing the pace to take care theoretically should make one safer, but it seems that decline in speed brings with it less balance and stability.
[READ: Best and Worst Exercises for Older Adults for Balance, Strength and Longevity]
Assessing and Addressing Fall Risk
While falls and a fear of them can be dangerous, there are interventions available. The first is assessing whether a senior is at risk. This is typically a key component of most senior health evaluations and may include specific fall-risk tests as well as tests of visual acuity, hearing and cognitive impairment.
In 2022, the World Falls Guidelines Task Force created updated, globally oriented fall prevention assessment guidelines and interventions for older adults. One of the recommendations they made is to use the Timed Up and Go (TUG) test. This simple and widely used clinical test involves timing how long it takes a person to get up from a chair, walk three meters (nearly 10 feet), turn around, walk back to the chair and sit back down.
Most healthy, older adults can complete the TUG test in 10 seconds or less. Those who need 12 seconds or longer to complete the route are deemed to be at high risk of falling and may benefit from interventions to improve balance, strength, stamina and overall mobility.
The 4-Stage Balance Test is a simple evaluation tool health care providers use to define a senior’s static balance capabilities. This test looks at a senior’s ability to hold four standing positions that are progressively harder to maintain. The longer the senior can hold each position without moving their feet or needing support, the more stable they are. If they are unable to hold a position for at least 10 seconds, they are considered at increased risk of falling.
Strategies to Combat Fall-Related Anxiety
When the assessment is complete, your loved one’s health care provider can help you develop a personalized fall prevention plan that will likely include several of the strategies outlined blow.
Acknowledge the fear
When trying to assist a loved one in addressing fall-related anxiety, talking with them about what they’re feeling is a great place to start, Eichenberger says.
“Encourage an open dialogue and take the time to listen to their concerns and acknowledge their fears,” she adds.
Together, you may be able to find ways to modify their living space for safety and identify ways they can better develop their strength and balance to improve their confidence in avoiding falls.
Use fall-preventive exercises
One of the best ways to combat fall-related anxiety is through physical activity that helps seniors regain mobility and their confidence in moving in ways that won’t result in a fall.
There are several approaches that are effective, and Gugliucci offers the U-ExCEL Balancing Act Manual she developed at the University of New England College of Osteopathic Medicine as a top tool for fall risk reduction training.
This program, which is available for free online, offers balance exercises tailored for beginner, intermediate and advanced training.
“Advanced action exercises include doing things like walking with one foot directly in front of the other, so losing your base of support because your feet are in line. That’s a recipe to easily topple left or right, so you wouldn’t do advanced action until you’ve worked up to that,” she explains.
She says this program works better than some others out there because it’s easier to implement — it can be self-taught and doesn’t require classes or an instructor. It has also been adapted for blind and visually impaired individuals to make it useable via voice command.
Other exercises and activities that can improve mobility and balance and reduce the risk of falling include:
— Matter of Balance, an evidence-based program geared towards reducing fear of falling. “This course is offered in many communities, and there are even online videos with sample courses,” Eichenberger notes.
— Silver Sneakers, a senior-oriented fitness program that is offered at many YMCAs and online. “It incorporates balance as part of the programming,” Eichenberger notes, and many Medicare Advantage plans cover the cost of the program.
— Gentle movement exercises, such as yoga and tai chi, which can be helpful in improving mobility and strength.
— Physical and/or occupational therapy. Ask your loved one’s health care provider for recommendations for physical or occupational therapists, sports medicine practitioners or personal trainers. “Go to the fitness club and ask somebody to work with you on balance,” Gugliucci advises.
Use mobility aids
For Alyson Austin, who recently moved from California back to Maine to become her mother’s full-time caregiver, addressing her mom’s fears of falling has been an ongoing project, and mobility aids have been a big help.
“Almost every morning we discuss how she is feeling and determine if she will use a cane or her walker for the day,” Austin says. “On days when she is tired or has not slept well, we decide she should use her walker.”
The walker, Austin adds, is easy for her mom to use around the house; Austin has ensured there’s no clutter and walkways are wide enough to accommodate the walker.
In addition, to help her mom climb the stairs to her bedroom on her home’s upper level, the family installed a motorized stair lift. This way, she can ride up and down the stairs as needed and not risk a potentially devastating fall.
Assess medication side effects
The CDC reports that certain medications can add to the risk of falling by causing side effects such as dizziness, confusion, blurred vision, changes in blood pressure, changes in sleep patterns and loss of coordination.
Check for these common culprits:
— Anticonvulsants
— Sedatives and hypnotics
— Opioids
— Benzodiazepines
— Anticholinergics
— Blood pressure medications
— Muscle relaxants
If your loved one takes more than one medication, interactions between these substances can exacerbate the problem, so tell your pharmacist everything they’re taking, including any herbal and dietary supplements, to check for potential interactions.
In addition, some medications can cause anxiety as a side effect. Talk to your loved one’s health care provider about known side effects and whether an alternative medication could work. Also ensuring that they’re taking the lowest effective dose could reduce some side effects.
Improve nutrition
A lack of proper nutrition as well as dehydration can lead to dizziness and weakness.
“Making sure they are getting well-rounded meals can help provide the strength and nourishment they need to stay strong,” Eichenberger says.
Try cognitive behavioral therapy (CBT)
When anxiety becomes disruptive to daily living, seeing a mental health professional can help. An effective option is cognitive behavioral therapy, a form of talk therapy that aims to reframe negative thought patterns and cultivate healthy coping mechanisms.
CBT for seniors has been shown to be help with depression and anxiety, including fall-related anxiety.
Find social support
While many older adults want to age in place for as long as possible, moving into a community can sometimes be safer. In an assisted living environment, seniors typically have more access to supervision and support. They also have the option to participate in social activities and engagement opportunities, helping them feel less lonely and depressed, which could reduce their risk of falling.
If your parent is to remain in the home, ensuring they have adequate caregiver support, particularly when navigating stairs or other potentially dangerous situations, is paramount.
Add a panic button
Using a fall detection device and medical alert tool can also help seniors feel less anxious about what would happen if they did fall. These devices, which are typically worn on the wrist or on a lanyard around the neck, enable seniors to call for help in an emergency. They can provide peace of mind for some seniors.
Creating a Safe and Supportive Environment
You can help your parent overcome their fear of falling by creating a safe, supportive environment though some basic home modifications, such as:
— Improving lighting in the home
— Boosting visual contrast in tricky areas like stairs
— Removing clutter and other tripping hazards
— Installing grab bars, fall detection technology and emergency call devices
“Creating safety in the home starts with analyzing the areas of the house your loved one uses,” and ensuring those risks are mitigated as much as possible, says Yelena Sokolsky, CEO at Galaxy Home Care in Brooklyn, New York.
But there’s more to fall-proofing your home than simply removing area rugs.
“We really have to get people to pick up their feet, take normal steps and engage in balance training,” Gugliucci says.
When to Seek Professional Help
When persistent anxiety becomes debilitating or a senior experiences frequent falls, it may be time to get professional help. This can take several forms:
— Hiring a full-time caregiver to assist the senior at all times. Having one “is a vital way to prevent falls,” Sokolsky says. “Home care prioritizes senior safety and independence, helping to create a safer and more comfortable environment for older adults.”
— Working with a physical or occupational therapist to develop a personalized balance and mobility improvement plan
— Speaking with a mental health professional to address the anxiety
— Providing information on how to access physical therapists, occupational therapists and mental health professionals
And it’s worth pointing out that senior mental health support offers a range of benefits beyond fall prevention, so for many, it’s a worthwhile addition to their overall care plan.
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Fear of Falls in Older Adults originally appeared on usnews.com
