As the elderly become more frail, they often develop a fear of falling, which in itself may have many negative implications.
While most of us recognise the dangers of an older person falling, few of us realise the highly disabling feelings of fear associated with falling.
However, should we reflect on the behaviour of our older relatives, we may then acknowledge that, yes, being afraid of falling has led many of our older relatives to avoid any physical activity.
This has inevitably resulted in lack of social interactions, and before long, that older person becomes increasingly disabled and dependent.
Fear of falling is indeed a recognised medical problem. It really stems from the knowledge that should an older person fall, they may suffer serious physical consequences such as a hip fracture or a blood clot in the brain.
This then leads to a pathological fear of sustaining a fall.
Needless to say, an older person is more likely to develop fear of falling after experiencing a fall, as that fall reminds him or her of the truth that they are getting older as well as raises the possibility of what many consider an inevitability of old age: disability and dependency.
Being female and older are two other factors that increases an older person’s risk of developing fear of falling.
While everyone will feel afraid about falling at some point, and all of us will have different fear thresholds, the fear of falling becomes maladaptive and hence a pathological condition if the older person experiences it while performing ordinary daily activities such as getting dressed, bathing, going up or down stairs, walking or going out for social activities.
What the older person then does when they develop fear of falling is to avoid any activity that they perceive could increase their chance of falling over. For instance, they would refuse to leave the house on their own, or they would refuse to go out altogether.
The severity of fear of falling can differ between individuals. In those who are mildly affected, they may just have mild restriction of normal activities, such as avoiding climbing ladders and avoiding walking on uneven surfaces.
In its most severe form, the afflicted individuals may be so petrified of falling, they may even refuse to stand up altogether.
As mentioned earlier, this behaviour is maladaptive. Often brought on immediately after a fall, the older person then avoids physical activity for fear of falling again.
Devoid of regular physical activity, muscles will waste away and bones will become more brittle. In an older person, deconditioning can occur in a matter of days, as the older and frailer you are, the less bone reserve you have.
The older person will therefore become weaker and their balance will deteriorate. Paradoxically, they will become even more likely to fall, as it’s impossible to totally avoid all physical activity, and when they fall, they are even more likely to sustain serious fractures.
The avoidance of activity inevitability leads to social isolation and loss of independence, which then increases the likelihood of developing depression.
At the moment, there is really no proven treatment for fear of falling. What many people do, should a fall occur, is to pick themselves up and carry on.
It is advisable for them to see their doctor to have a check-up, as even what is considered a simple trip may not have happened were there not a problem with eyesight or balance.
The presence of any conditions that may increase the risk of falls, such as reduced vision, hearing problems, home hazards, poor balance, medication side-effects, low blood pressure and heart problems should be treated promptly whenever possible.
The older person should also aim to improve physical fitness and balance by exercising regularly, at least 30 minutes a day, three to five times a week, and to perform strength and balance exercises such as weight-training or tai chi, rather than just cardiovascular exercises like brisk walking.
So what should an older person or family member of the older person who has developed fear of falling do apart from avoiding getting it in the first place?
Several studies have found that in individuals who have sustained falls, fear of falling is reduced after the individuals received “multifactorial” treatment, which is treatment to correct any deficits which may increase the risk of falling.
This could include a combination of cataract operations for visual problems, stopping any medications that causes drops in blood pressure, exercise for balance problems, management of any heart problems and home modifications to reduce environmental fall hazards.
Tai chi exercises have also been suggested as beneficial, and a few centres have also tried a psychological approach called cognitive behavioural therapy which involves challenging the individuals’ behaviour of avoiding falling through avoidance of activity.
Exactly how psychological therapy should be conducted remains unclear, and it has also never been tested in well-designed large studies. Therefore, the old adage “please don’t try this at home”, applies.
If you or your older family member has sustained a fall and you would like to seek further advice, we at the University of Malaya are conducting a study on multifactorial treatment for falls in older Malaysians.
Please call 03-7949 3200/016-206 6558 (9am-5pm, Mon to Fri) or e-mail: firstname.lastname@example.org for further information.
Dr Tan Maw Pin is Associate Professor at the Department of Medicine, Faculty of Medicine, University of Malaya. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public. The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail: email@example.com. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.