Fall Prevention: Fear of Falling

Canadian Statistics

• 5.8% of people aged 65+ reported having a fall injury in the past 12 months

• Falls were the leading cause of injury deaths, and hospitalizations, emergency department visits and disability for individuals aged 65+

• Across the lifespan, the rate of hospitalization associated with falls increased sharply among those aged 65 years and over

• Falls are the leading cause of injury for older adults across Canada, accounting for over 81% of all injury related hospitalizations

• 4 out of 5 injury hospitalizations involving seniors were because of a fall

• In Ontario, falls was the single highest contributor of emergency room visits and causes of injury across all age groups

• In Ontario, older adults over the age of 80 experienced most fall-related injuries resulting in emergency room visits

Why does fear of falling lead to a greater falls risk?

Having a fear of falling often starts earlier than we may realize. It may have started with that near miss (slipped but caught yourself) you experienced in the kitchen after slipping on the wet floor while doing the dishes. Was it that time you were going up the stairs in the dark and you missed that one step almost leading to a fall down the stairs? Maybe you were walking outside as the frost sets in and hit that patch of ice leading to the wipe out that may or may not have broken your wrist.

Whether it was a full blown nosedive/wipeout/tumble/plummet or a close call/near miss, whether you were or were not injured, these events can lead to an increased fear of falling. And once you're scared of falling there are many factors that can increase your risk of falling. You may start to notice you become less physically active, you may be less likely to participate in social

events. This can lead into a downward spiral of inactivity, deconditioning and loss of confidence. Which will further increase your fall risk.

Now, did your fear of falling limit your mobility, or did decreased mobility lead to your fear of falling? It's like the chicken or the egg?? Hard to say which came first, but the two are very closely linked and as one increases so does the other.

Fear of falling is not only tough on your physical health, but it can have a large impact on your quality of life and emotional well-being.

Check out the fear of falling questionnaire.

The higher the score the greater your fear of falling is, which in turn can lead to a greater risk of falling.

If you or someone you know has a high score there are multiple approaches to consider to improve your confidence and decrease your fear of falling.

Tips to help decrease your risk of falling

1. Create a safe environment. Consider modifications for both indoors and outdoors. Safer bathrooms, safer bathing, consider the use of grab bars. Preventing falls on stairs by improving lighting, solid and sturdy handrails, remove any clutter on the steps.

2. Good footwear. Appropriate footwear can significantly reduce the risk of falling on icy surfaces. Rate My Treads website provides ratings for various types of winter footwear for their slip resistance in different winter conditions. This is based on the research from the Toronto Rehabilitation Institute - University Health Network.

3. Regular eye exams. As we age so do our eyes, this can lead to a reduction of how our surroundings can be seen at any given time. Wear your glasses when you need them and make sure to update your prescription regularly. Click here, for an infographic on preventing vision related falls in older adults.

4. Be physically active. Being active will promote muscle strength, balance and flexibility. That might include home exercises through online programs, walking around community spaces such as the local arena/mall. If you're uncertain of where to start, getting in touch with a health care provider can point you in the right direction. If you want some help with a unique and personalized program, I would love to work with you. Click here to book an appointment.

5. Consider Cognitive behaviour therapy. This can help to address fears. The McMaster optimal aging portal article describes how cognitive behaviour therapy is a useful technique to address fears of falling.

6. Avoid letting fear lead to social isolation. Having a good support system and the company of others is a large aspect to maintaining a good quality of life.

7. Consider a medical alert button. This option can help to provide some reassurance that should a fall occur, appropriate help is readily available.

8. Learn how to get up from a fall. This is a skill I teach all my patients who have recently had a fall or have a fear of falling. It will help to increase your confidence that should a fall occur there is no fear that you will be stranded. Click here for a poster on what to do if you can or cannot get up from a fall, or if you are a witness to someone who has fallen.

November is Fall Prevention Month. If you or someone you know is at an increased risk of falling make sure to try out these tips. If you know what to look for or how best to be prepared, you can help reduce the risk of falling for your aging parent, other family members and friends or even yourself.

Signs to Look For if You Think Someone is at an Increased Risk of Falling

1. Trouble entering or exiting their home. Whether they are distracted by another task such as carrying their groceries in, or their porch is poorly lit, or they require a sturdy handrail, or in my case my curious dog.

2. Poor cardiovascular fitness. Cardiovascular health is extremely important as you age. A quick test is to see if they can walk for 15-20min continuously. If not, they may be at an increased risk of falling. Ways to improve include daily walks, for as long as they can tolerate. Try increasing by 15% each week as tolerated.

3. Poor Balance. A common sign we see in individuals with poor balance is known as "furniture walking". Do they reach for the wall, the chair or the counter to get from point A to point B? Poor balance can increase your risk for falling as it can be challenging to recover from a near miss. A quick test to see if someone is at an increased risk of falling is testing their single-leg balance. Stand close to support if needed, ask them to try standing on one leg at a time. If they are NOT able to stand on one leg for greater than 10 seconds then they are at an increased risk of falling. This may also help to indicate that they may require a gait aid when walking.

4. Taking certain medications. Did you know, different types of medications can increase your risk of falling? The Canadian Deprescribing Network has a webpage with information on which medications may increase your risk for falling. Always consult your doctor about your risk for falling when you are being prescribed new medication, or if you think your current medication will increase your risk for falling.

If you found this article to be a helpful read stay tuned for the falls prevention blog series coming this November, where we'll dive a little deeper into some of the topics mentioned above!

Also, I'd love to hear your thoughts in the comment section below!

Resources

1. Safer bath, safer bathing

2. Preventing falls on stairs

3. Maintaining senior's independence through home adaptations

4. Community care Durham; exercise and falls prevention classes

5. Fall Prevention Month

References

1. Public Health Agency of Canada. (2022). Surveillance report on falls among older adults in Canada

2. CIHI. (2019). Slips, trips and falls: Our newest data reveals causes of injury hospitalizations and ER visits in Canada

3. Parachute. (2018). Ontario Injury Data Report 2018

4. Kozinc, Ž., Löfler, S., Hofer, C., Carraro, U., & Šarabon, N. (2020). Diagnostic balance tests for assessing risk of falls and distinguishing older adult fallers and non-fallers: A systematic review with meta-analysis. Diagnostics, 10(9), 667.