Fear of Falling

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (30/August/2019)

Original Editor - Your name will be added here if you created the original content for this page.

Lead Editors  

Definition

A fear of falling (FOF) or post-fall syndrome is a person's anxiety towards usual or normal walking or mobilising, with the perception that a fall will occur. It is common after a fall although it can occur in the absence of a fall. FOF is common in the elderly and experienced by women more than men.

Falls are a significant cause of morbidity and mortality. Please see the Falls page for further detail.

Clinical Presentation

Functional Decline

The person may have had a fall or known someone who had a fall and sustained serious injuries. As a result, the person becomes fearful of moving in case they fall and hurt themselves. As a result, they will reduce their usual activities which can show up in a subjective of the person's recent activities or ADLs compared to what they, or a carer, report they used to do. A longer exposure to FOF has been linked with an increased risk of functional decline.

Reduced Mobility

The result of reduced ADLs leads to muscle weakness and loss of balance reactions which increases the person's actual chance of falling. Hence a FOF can become a "self-fulfilling prophecy" and a cycle of fear, reduced activity, reduced physical function, falls and injuries and so on.

Anxiety and Depression

In regards to anxiety, Harding et al distinguish between anxiety accompanying the activity e.g. nervous whilst walking outside down a steep path, versus anxiety which prevents activity e.g. "I am anxious at the thought of going outside and falling in the garden and breaking a bone so I am not going to do gardening anymore."

The individual may present with depression and low mood and not being able to participate in their usual ADLs and social roles as a result of their FOF.

Risk Factors for FOF

These are the same as those for falls. Gait changes, poor self-perception of physical health, reduced cognitive function and economic resources have been found to be associated with fear of falling.

Diagnostic Procedures

Subjective Assessment

This should include:

• Recent pattern of activity - over days, months, year
• History of falls including incident, any subsequent treatment and rehabilitation, life changes (or not) after fall/s
• Current living situation
• Current mobility both in the home and in the community
• Descriptions of activities that cause the person anxiety
• Medications the person in currently taking
• Previous treatment for anxiety in general and if/how FOF has been treated in the past

Objective Assessment

This should include:

• Mobility in functional tasks e.g. transfers on/off chair and bed, walking indoors, walking outdoors, mobilising on steps, mobilising to and from bathroom, what aids (if any) are used or have been tried in the past
• Balance (see below)
• Strength of trunk and limbs
• Level of anxiety (see below)
  

Management / Interventions

Build Self-efficacy

Recent research suggests that when FOF is viewed in the context of post traumatic stress disorder, that FOF is not just negative but can be either maladaptative (as described above) or adaptive e.g. the individual takes care when navigating challenging balance situations but does not avoid them altogether. As a result, the authors suggest that building the individual's self-efficacy is a valuable tool for addressing a maladaptive FOF.

Building self-efficacy could involve psychological techniques, practising the tasks or activities that cause anxiety, working with the person to find strategies, teaching the person to reflect on their abilities and successes, increasing physical performance e.g. muscle strengthening, balance training.

Resources

add appropriate resources here