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Fear of Falling – Impact on Older Adults Part 1

As we get older, the occurrence of falls and injuries increases. These accidents can lead to injuries which are often very serious and    can restrict elderly people in their daily lives. As more awareness of these falls is required, our Chartered Physiotherapist from Kilkenny Ann Prendergast discusses “the fear of falling” and the impact of these accidents on older adults in the first instalment of this blog post. In part two she outlines what physiotherapists can do to help. 

Definition of Fear of Falling

Fear of falling (FOF) is defined as “low perceived self-efficacy at avoiding falls during essential, non-hazardous activities of daily living” 5. This fear may be due to a history of falls, and its intensity may relate to the circumstances of the fall, recurrent falls, or the severity of any resulting injury. The prevalence of fear of falling is estimated to be between 29% and 92% in community-dwelling older adults who have fallen 2. Fear of falling may also impact people who have never experienced a fall, affecting about 30% of older adults in this category.

Impact of Falls

Fear of falling is one of the main risk factors for falls in the elderly (including muscle weakness, history of falls, poor balance, gait deficits, urinary incontinence, increasing age, cognitive impairment, among other intrinsic and extrinsic factors). One in three persons over the age of 65, and 50% of those over 80 years, will fall at least once per year. A fall is defined as “an unexpected event in which the participant comes to rest on the ground, floor, or lower level”.

10% of falls in the elderly result in fractures, the most common being hip fractures. The cost of fractures resulting from falls in this population is immense, and can lead to disability, hospitalisation, and premature death. The average patient presenting to A&E after a fall will spend 18 days hospitalised and less than 1/3 go directly home. The inpatient cost of treating a hip fracture as a result of a fall is €12,600″…so with approx. 2800 hospital admissions per year, admission averaging 18 days, that’s more than €35m.

Vicious Circle

Fear of falling often leads to avoidance of movement which in turn will lead to reduced fitness, lower confidence in one’s own balance, increased fear, and increased danger of a fall. Therefore, FOF can be as big a problem for older adults as falling itself.

The cause still remains unclear, though the consequences are negative and can be long-term unless tackled. FOF decreases a persons’ willingness to perform daily tasks and can decrease their quality of life. FOF can result in reduced physical function and social interaction. It is an independent predictor of admission to nursing homes.

In Part 2 of the post we will be telling you how physiotherapists can help with the prevention and assistance with falls. Stay tuned!