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Fear of Falling Creates a Downward Spiral

A sense of balance is key to health, happiness and social connectivity.

A Saint Louis University School of Nursing faculty member named Helen Lach, Ph.D kicked off the first day of “fall” with a simple initiative and timely message to senior adults: “Don’t let fear of falling stand in the way of being active and engaged with the world around you.”

I took a snapshot yesterday of a person balancing on a rock at the end of a jetty. He was taking a picture of the sunset on the first day of this photo illustrates, having a sense of balance is key for being able to get out and explore the world. “While falls can cause problems, we want people to be both cautious and still maintain an active quality of life,” Lach said. “You can’t get rid of all of the risk in your life. But older adults need to maintain their strength, function and activity to the level they are able.”

Helen Lach published an article titled "Impact of Fear of Falling in Long Term Care” that appeared in the August 2013 issue of JAMDA (Journal of the American Medical Directors Association). The review showed that a fear of falling is a significant problem in nursing homes. The cerebellum (down brain) is responsible for balance, rhythm, proprioception ... and needs to be engaged throughout a lifetime to maintain a sound mind in a sound body.

Bulking Up the Cerebellum Improves Your Sense of Balance

When you are sedentary—or confined to a wheelchair or bed rest—the Purkinje cells in the cerebellum atrophy which causes your sense of balance to deteriorate. This is true for people of all ages. To keep the cerebellum bulked up—and your sense of balance finely tuned—you need to engage the cerebellum everyday through physical activities. Inactivity causes your cerebellum to shrink which throws off your equilibrium.

“People in nursing homes tend to be frailer and have more health problems and physical limitations than older adults who are in the community,” Lach said. “The fear of falling can stop some nursing home residents from doing anything, even participating in their own daily care. They become frozen in inactivity, which makes them depressed and bored. They get more out of shape, which creates more health problems that actually increase their risk of falling.”

Lach notes that the fear of falling is part of a cycle that can lead to a frailty and a downward spiral in health and happiness. “As people do less, they become less able to engage in activities. They have difficulty moving around, and their gait and balance deteriorates. This puts them at an increased risk of falling, which unfortunately means the fear of falling actually becomes a self-fulfilling prophesy.”

Falls Among Older Adults: The Statistics from the CDC

Each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. As winter approaches, slipping on the ice presents added challenges for seniors.

  • Among older adults, falls are the leading cause of both fatal and nonfatal injuries.
  • In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments and more than 662,000 of these patients were hospitalized.
  • In 2010, the direct medical costs of falls, adjusted for inflation, was $30 billion.
  • Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas.These injuries can make it hard to get around or live independently, and increase the risk of early death.
  • Falls are the most common cause of traumatic brain injuries (TBI).
  • In 2000, 46% of fatal falls among older adults were due to TBI.
  • Most fractures among older adults are caused by falls. The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.
  • Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling.

Conclusion: Daily Physical Activity Creates an Upward Spiral

“It’s important that nursing home staff members recognize that about half of residents have such a deep fear of falling that they limit their activities, and develop a way to assuage those fears. Exercise programs offered in a safe and supportive environment can be valuable in helping residents feel better—both physically and psychologically," Lach said.

Senior adults who aren’t in long term care facilities also may need to confront their fear of falling, she added. Lach concludes, "Tai Chi, walking, weight training and simple exercises to increase muscle strength—such as practicing sitting and standing to strengthen leg muscles or standing on one foot with a chair at arm’s reach—make a world of difference."

If you'd like to learn more, I have a series of simple exercises designed to bulk up the cerebellum, improve balance, and reduce a fear of falling on page 240 of The Athlete’s Way.