My mother started to express a fear of falling 10 years before she had her first fall. She and my father were active people, playing golf 3 times a week right up until she was 79 and he was 81. They have lots of friends and were always out doing things; popcorn night, Elks Club dinners, a cruise to the islands once a year, evening rides on their pontoon boat at our summer home in Maine. But her steps started to look different. Her gait pattern was changing and before my eyes, her daughter and also a physical therapist saw that the future could easily be a fractured hip.
Fear of falling in seniors is the number one risk factor leading to a fall. As we begin to worry about falling and all of the complications that go along with a fall in our 70s and 80s, we change the way we move. People with a high level of anxiety about falling are most likely to suffer a fall, as noted in a 2010 study conducted in Sydney Australia. http://health.usnews.com/health-news/family-health/bones-joints-and-muscles/articles/2010/08/20/in-seniors-fear-of-falling-risky-in-itself
About one third of the elder population over the age of 65 falls each year, and the risk of falls increases proportionately with age. At 80 years, over half of seniors fall annually. Those who fall are two to three times more likely to fall again. Fear of falling leads to a restriction in activity which leads to weakness, which leads to a justifiable reason to be afraid of falling. The cycle has to be stopped early.
My mother continued with her social activities but took the golf cart more often. She shortened her steps and changed the way she went up and down stairs. In essence she created what she feared. Talking to her about her fear did not help much. What she heard when we talked about fear of falling leading to falls was a prophecy of her future. She heard “you are afraid of falling so you are going to fall.” What was meant was “you are afraid of falling so let’s change the way you move to better prevent a fall.”
To be fair, my mother has had rheumatoid arthritis for 35 years, she had back surgery, a laminectomy at 69 followed by a small stroke from both of which she had an excellent recovery. My mother did begin a home exercise program that I taught her, modified somewhat for her arthritis, but once up and about for the day she stopped pushing herself physically. Walks were shortened and then became absent. Her gait pattern changed with her feet closer together and her stride length shorter. And then the fall came.
My mother had a larger stroke at 79, leaving her slightly weak on the left side. 8 months later she dropped her toothbrush on the floor and bent to pick it up and just kept going forward until her face and hands hit, followed by the rest of her. An ambulance ride, x-rays, and consultation with orthopedics revealed broken fingers and very bruised facial bones. No fractured hip. One blessing. Once home the response? Increased use of the wheelchair, decreased walking, increased immobility, increased muscle weakness. All out of fear that now was a reality for both my mother and my father. He was happy to have her in the wheelchair. It broke his heart to see her bruised and hurting.
In retrospect I should have done more education earlier. I should have been a meddling daughter after the back surgery and called her doctor, insisted on physical therapy for her then. I should have recommended regular exercise class. She needed more than the 10 minutes a day of exercises I gave her. Granted 10 minutes of targeted exercises are better than nothing but they need to be combined with the consistency of walking, swimming, tai chi, or any other senior modified exercise program. I lived too far away in New Hampshire so each year that summer arrived and my parents traveled north from Florida for a summer in Maine I grew more and more alarmed. I made gentle recommendations but now I wish I had raised a loud red flag of concern and asserted myself as a physical therapist first and daughter second.
What does this mean to you? Learn from our journey. Start early and do not let up. Recognize that you have to stay mobile to stay mobile. Yes, do some home exercises, a good start was recommended in earlier blogs. Look for a class conducted by a professional with experience with seniors. This could be a physical therapist, an athletic trainer, a tai chi expert, a yoga instructor but be sure that the professional knows how to safely modify each exercise for seniors or for an underlying condition like arthritis. If you have a fear of falling ask your doctor for a referral to physical therapy. Chances are you have some underlying weakness and in 4 to 6 visits you will have greater confidence and an individualized home exercise program to keep you going. They may also know of a good group program to continue with once discharged from PT. Even finding a walking partner in your community helps as you will both keep each other motivated even in cold New England winters. Overcome your fear of falling and decrease your risk; step out in confidence.
