Fear of Falling

Can learning how to fall help older adults overcome their fear?

Posted Oct 21, 2011

Falling to the ground is not a pleasant experience. Usually if you are hurtling toward the ground something bad has happened. You've slipped or tripped on or over something and you are no longer able to carry on with what you were trying to do. Like safely moving forward. While it can be a nuisance in a sports context, and a hazard out in real life, falling down is also a real and present danger with huge implications for health in the aging population. The Center for Disease Control reports that 30% of adults 65 years and older fall each year. These falls can result in significant damage including hip fractures and head injuries and can dramatically increase risk of death. Not only that, it's hugely costly. The CDC has estimated that the adjusted cost of fatal and non-fatal falls in the US in 2010 was over $28 billion. Clearly, it's a big problem, but exploring all aspects of what this means isn't the focus of this post. What I want to focus on is an outcome that happens in many people who fall and survive even with little or no injury.

When something unpleasant happens to us, we often develop an aversion to having that unpleasant thing happen again. Not surprisingly, many people who have a fall develop a fear of falling again. A couple of things come out of this. A fear of falling can lead to doing fewer things that might cause falls in the first place. Things like walking around and being active. In other words, things that help support and maintain physical capacity. Since physical capacity declines with age, keeping active is an important way to reduce the impact of this inevitable decline. And you need a good base of strength and balance to help you avoid tripping and slipping but also to avoid falling when something does happen. But not doing as much because you are afraid of falling means you actually can bring about the very thing you are afraid of-falling. Reduced fitness levels make it more likely that someone will fall and the fear of falling winds up driving the actual thing that is at the heart of the fear.

All of which brings us to martial arts. Hey, this is called the "Black Belt Brain" blog, after all. There are considerable and well established health benefits of martial arts training. These include overall effects on such things as strength, flexibility, cardiovascular fitness, and, importantly for our discussion here, balance. These benefits can be gained in differing extents from meaningful practice of many martial arts. This includes the range of practice from more relaxed and flowing activities such as T'ai Chi Chuan to the more expansive physically demanding Judo, Tae Kwon Do, and Karate. Many recent studies have shown clearly, for example, that T'ai Chi Chuan training can improve balance. These improvements in balance may also reduce the risk of falling. But there's another way to reduce the risk of falling-do lots of actual falling practice.

Judo represents a martial art which makes no bones about falling-or being thrown actually-and hitting the mat. Judo founder Jigoro Kano (1860-1938) created his system as a distillation of his training in ju-jutsu. The term judo has been translated as "the way of gentleness" and is based upon Kano's ideas of maximum efficiency with minimum effort. In any case, falling down-or more correctly falling down safely-is a critical part of judo practice. So, why not get older adults who are afraid of falling to learn how to do judo falling techniques?

That was the basic idea of a team of Dutch scientists headed by Jacques Duysens and based in Nijmegen, Amsterdam, and Belgium. With a series of careful studies, they examined the mechanics of falling techniques, the impact forces experienced during falling and breakfalling (particularly at the hip), the ability for people to learn falling techniques, and the amount of training needed. Incredibly, even a 30 minute training session was effective in helping young adults achieve effective and safe falling.

The most interesting part of all this work culminated in a study from 2010. They had older adults between the ages of 60-81 years participate in 5 weekly 45 minute sessions of training in falling techniques. At the end of training, participants improved their falling technique, reduced their hip impact forces, and showed a significant decrease in fear of falling. It seems that martial arts falling techniques can be effectively learned and implemented by previously untrained older adults in as little as 5 weeks.

There remain many details that need clarification in this work. For example, the experimental falls were self-initiated but real falls are usually unexpected and it isn't certain how effective these techniques may be in such real falls. Despite that, the majority of the older adults in the study expressed confidence in their ability to respond to a real fall. While the result of this kind of work is not definitive (and other studies continue) it really is encouraging and represents an outside the box mindset towards dealing with a serious real life issue. It is exciting to think about how this work may continue to unfold and eventually make its way into general practice.

The potential value in reducing the physical toll of falls in the aging population combined with the reduced fear of falling (which can be expected to reduce actual falling) is tantalizing. Overall, it encourages keeping active and providing a concrete management strategy for the fear of falling. And, on the theme of older adults, falling, and judo, we have only to look to 98 year old judo 10th dan black belt holder Keiko Fukuda. Fukuda, who lives in San Francisco, is an original student of Jigoro Kano. She is still active in judo and embodies the principles of the gentle way. She serves as an excellent example of a lifelong active lifestyle and the protective nature of mindful martial arts practice.

© E. Paul Zehr (2011)