Help patients recover from the fear of falling

It can hinder independence, recovery

Sometimes therapists find it difficult to motivate elderly patients to regain their strength and mobility after an accident or surgery. Patient recovery may lag behind for many reasons, but one potential cause might surprise clinicians: Patients may be afraid they will fall.

Elizabeth Walker Peterson, MPH, OTR/L, first became intrigued with the idea that a fear of falling is a disability after observing older people who had taken serious falls. "I noticed it was difficult to motivate people to participate in therapy in the hospital because they were very concerned about falling again," says Peterson, who is a clinical assistant professor at the University of Illinois at Chicago. "Fear of falling is a rational response to an event that could conceivably happen to them, and even people who haven’t had a fall have a fear of falling," she says. "If the fear is intense enough, it can lead to activity restriction, and then you get into the vicious cycle of activity curtailment and deconditioning caused by the fear of falling."

Peterson was among researchers at Boston Uni versity School of Public Health, the University of Illinois at Chicago, and several other universities who participated in a randomized, controlled trial that sought to reduce the fear of falling among older adults.

The research led to the development of a program called "A Matter of Balance," which teaches patients greater control and instills confidence in their abilities with the purpose of eliminating their fears of falling. The program provides a group intervention in which participants are taught better communication skills and physical exercises and are given an opportunity to gain insight into their own fear and the actual risk factors of falling. Here’s an outline of how the fear of falling program works:

Create a structured group intervention. Older adults meet as a group partly because some parts of the education are interactive and work better in a group setting and partly because the participants give each other support, which has a therapeutic effect.

Focus on cognitive restructuring. Program leaders try to change attitudes about falling, partly through the use of skills training in fall prevention and presenting facts about the incidence of falls and what to do if one falls.

Provide exercise training. The program emphasizes how exercise and strength-building help reduce the risk of falling.

Use a group to build social support. By providing a group setting, facilitators give participants an opportunity to share their concerns with others who have had the same experiences, serving as a support network.

• Teach assertive communication skills. Older adults often do not know the difference between assertive, aggressive, and passive behaviors, Peterson says. "This is relevant to fall prevention because older adults may be placing themselves at risk when they’re not assertive."

• Educate about environmental hazards. The program teaches participants who live in their own homes within an assisted-living facility or on their own about physical hazards in the home, such as living room extension cords or phone cords that trail across a floor.

For more information, contact Elizabeth Walker Peterson, MPH, OTR/L, Clinical Assistant Professor, University of Illinois at Chicago, Department of Occupational Therapy, 1919 W. Taylor St., Chicago, IL 60612. Telephone: (312) 996-4506.