I had a workers compensation case not long ago in which an older lady (Ms. “S”) fell at her job as a waitress and suffered a tibial plateau fracture.  The fracture healed, but she required a very lengthy healing period primarily because she was fearful of falling again.  Ms. “S” continued to use a walker long after she was told to discontinue this.  She even took it upon herself to move to a cane before discontinuing the walker as directed.  Returning her to the work environment was nearly impossible due to self restrictions due to this fear of falling.  Case management, the physician, and the therapist all worked diligently to improve her functioning while eliminating her fear.  This proved difficult at best.

Falling and fear of falling have been identified as common problems among older adults.  This fear of falling may reduce physical activity and decrease ability to perform activities of daily living thereby increasing the likelihood of future falls.  It is a vicious cycle.

A recent study estimated the frequency of falls and the prevalence of the fear of falling among a sample of community-living older adults aged 65 and older.  The CDC conducted a telephone survey and asked respondents if they had fallen recently (within three months).  If so they were then asked to rate their fear of falling.  Several questions were posed about beliefs and behaviors for preventing calls such as, “In the past twelve months, has your doctor or pharmacist reviewed with you each bottle of medication you are taking?” and “How important do you believe it is to be physically active in order to keep from falling?”.

The study found that 10% of the US adults questioned had fallen in the past three months.  About 1.7 million of those were injury and 875,000 sought medical treatment.  More than one-third of US older adults were moderately or very afraid of falling.  Those who were moderately or very afraid of falling were more likely to be women, single, have lower incomes and aged 75 or older.  My patient mentioned above met all of these criteria with the exception of age.  Ms. “S” was in her late 60′s.

The study also revealed that while many older adults believed that physical activity and medication review could prevent falls, the majority of the people who had falling did not change their behavior in order to prevent future falls.  65% reported no change in the physical activity and almost 22% had actually decreased their physical activity.
Healthcare providers should ask senior adults about falls, address risk factors for falling and implement interventions to reduce those risks.  Home exercise plans, multi-factorial fall-related programming and community-based Tai Chi provided in a group format have been proven to be effective in reducing fear of falling and therefore should be encouraged.  What do you do to encourage your patients after a fall?  Do you find fear of falling a significant problem in your practice?

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Tagged as: fall, fall assessment, fall prevention, fear of falling