Fear of Falling

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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 Vellas et al.

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.

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.

Diagnostic Procedures

Subjective Assessment

This should include:

• Recent pattern of activity - 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
• Balance (see below)
• Strength of trunk and limbs
• Level of anxiety (see below)
  

Resources

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