Fear of Falling FOF

Claudia Kardaras MAPPPsychologist

What is a Fear of Falling (FOF)

Fear of falling is an emotion and physiological response experienced after a fall or a near miss – becoming more anxious about future falls.

Loss of confidence and experience of anxiety that is distressing to the person. Some symptoms of anxiety: shortness of breath, dizziness, sweating, increased heartbeat, jelly like legs, (fight or flight).

It is usually out of proportion to the situation and impacts on quality of life.

 

Who Develops FOF

Research indicates that around 50% of people who have had one or more falls.

More women than men develop FOF.

Time left unassisted is a significant predictor of FOF.

Who Develops FOF

Underlying anxiety conditions – more prone to develop FOF.

Those with balance or gait abnormalities are more likely to express FOF.

Incidents of FOF increase with age.

Consequences of Developing FOF

Activity restriction due to avoidance. Poor social interaction. Depression – isolation/loneliness. Decreased ability to perform daily tasks: domestic

activities, personal grooming, eating and drinking, mobility.

Anxiety or excessive worry – about future falls. Increased risk of falling. Negative thinking – fearing the consequences of a fall.

Consequences of Developing FOF

Research has found worriers or anxiety prone individuals have an increased risk of falling despite low actual risk.

FOF leads to falls independent of physiological falls risk factors.

Consequences of Developing FOF

FOF induces gait adaptations: gait speed and step length decrease in people with fof.

Walking stability decreases therefore increasing risk of falls rather than protecting from falls as participant intends with gait adaptation.

Assessment of FOF

Obtain a history and cause of falls. What other medical conditions does the patient

have that can contribute to falls. What is the patient’s appraisal of their fall, how

did they cope? Anxiety/depression levels both descriptive and

using the HADS instrument.

Assessment of FOF

Awareness of what contributed to their fall ie; poor balance, inadequate shoes, tripping hazards, rushing, etc.

Realistic appraisal of balance ability and their falls risk – research indicates elderly people can underestimate or overestimate their risk of falls

Treatment for FOFCognitive Behaviour Therapy

Cognitive Behaviour Therapy (CBT) has the strongest empirical evidence in success of treatment.

CBT targets our thoughts and behaviour by providing strategies and skills to overcome any difficulties that we are faced with.

CBT Treatment

It is active, structured and collaborative – both the therapist and client work together. It is relatively short term (3 – 12 sessions).

Formulating goals of therapy sessions, together with client – what do they want to achieve.

 

CBT Treatment

  Psychoeducation – general falls prevention,

what FOF is, and what anxiety consists of, such as the relationship between thoughts and feelings, physiological symptoms of anxiety and the fight or flight response. Clients are often relieved to find out that they are not having a heart attack when experiencing the fight or flight symptoms.

CBT Treatment

Identifying, challenging and modifying unhelpful thoughts, for example:

 Thought 1: “I’m going to fall” Challenge: Is this really very likely, am I expecting the

worst to happen? Helpful thoughts: There are things I can do to reduce

my risk, I am fairly safe with my frame, I have done this many times before without having fallen, I know the more often I do it, the easier it will get, doing things improves my confidence, strength and mood.

CBT Treatment

Thought 2: “I will look foolish if I fall/walk with a frame” etc.  Challenge: What would you think if you saw someone

fall/use a walking frame? Helpful thoughts: I would be concerned and want to

help them up. It would not enter my mind to laugh or think badly of them.

Encouragement and support to engage in pleasant activities – this also helps to lift mood and decrease depression.

CBT Treatment

Goal setting for increased activity – planning and setting strategies in place to increase domestic and social activities.

Reframing thought patterns to focus on what they can do instead of what they cannot do.

Reducing anxiety by relaxation (Bensons, PMR, pleasant imagery), graded exposure (create hierarchy – practice with least anxiety provoking situations to reduce anxiety to a level where activity is undertaken – practice first at home, then gradually outside the home).

CBT Treatment

Sleep hygiene – strategies to increase quality and quantity of sleep without the use of sleeping tablets, which may contribute to dizziness and daytime drowsiness

Assertiveness training.

Stress management.

CBT Treatment

Increasing Motivation - Motivational Interviewing Techniques.

How important is it that you make that change? What sort of impact is it having on you and

your life? What are the cost and benefits of staying the

same or making changes? Do you believe you can make the change?

New kid on the block:Positive Psychology

Various theoretical concepts from the field of positive psychology can be used in treatment.

Emphasising grit – grit is defined as perseverance and passion for long term goals.

Increase in grit is linked to increased motivation to achieve long term goals.

Eliciting strengths – optimism, hope, perspective, gratitude and others.

Treatment with Positive Psychology Concepts

Gratitude: research indicates that those individuals who focus on good things in their life cope better with the bad.

PERMA THEORY – Positive emotions, engagement, positive relationships, meaning and accomplishment.

Treatment with Positive Psychology Concepts

Positive emotions – taking attention away from anxiety and building on positive emotions.

Engagement: participating in activities that increase wellbeing.

Positive Relationships – encouraging people to keep contact with friends and family.

Treatment with Positive Psychology Concepts

Meaning: setting goals that have meaning to the individual, for example, overcoming FOF to visit grandchildren.

Accomplishment: recognising achievements no matter how small.

Questions……

Email: claudia.kardaras@nh.org.au Email: oceanblue_05@hotmail.com Mobile: 0414 725 201 Master of Health Psychology. Master of Applied Positive Psychology.