Staying steady, staying positiveA guide to understanding and overcoming anxiety about falls for older people

Visit our website: www.nhsaaa.net

All our publications are available in other formats

Find us on Facebook at www.facebook.com/nhsaaa

Follow us on Twitter @NHSaaa

2

About this booklet

Having fears about falling in later life is very common and often distressing. It can limit life in so many ways.

This booklet is for anyone who has fears and anxieties about falling. It may also be used for family, carers and friends.

This booklet also provides information on falls prevention services and activities in Ayrshire.

This booklet contains information on:

• How fear of falling can affect us emotionally page 3

• What it feels like to be anxious page 4

• How anxiety can affect mobility page 7

• Managing anxiety about falling page 9

• Helping yourself with relaxation page 14

• How staying active can help page 18

• When should I ask for more help? page 20

• Local sources of help page 20

3

How fear of falling can affect us emotionally

Anyone can have a trip or fall. As we age, fear of falling can become a serious concern. Some people worry about falling even if they have not had a fall. This may be because they worry about what might happen should they do so.

If we have had a fall, it can leave us feeling shaken up. We can become more cautious, stop doing things and lose confidence in our abilities. This is a common reaction and very understandable. However, if we find ourselves constantly worrying about falling, it can prevent us from having an active and fulfilling life.

Having anxiety about falling is a very common problem – we all have worries and fears. Anxiety can make us feel like we don’t have any control in how we feel and that there is nothing that can be done to change our situation. This can leave us feeling low in mood, frustrated and lonely.

“I have a fear about falling. I’m always worried about it.”

4

We may be embarrassed about having these worries or fear losing our independence if we tell someone our concerns. Many people carry on living with anxiety when they don’t have to. It is not a sign of weakness or something to be ashamed about.

Help is available and you can get over your fears. This booklet will show you how.

What it feels like to be anxious

We all feel anxious at times in our lives. Anxiety is our body’s normal reaction to a real or imagined threat or danger. Anxiety can develop after any stressful life event such as having a fall. A mild level of anxiety is very common and can often be seen as normal part of life. Some people however, have very strong and constant anxiety and panicky feelings about falling. If this is affecting your life, it has become a problem.

Anxiety can be felt in the body. It can also affect how we think, feel and what we do.

Some examples of bodily symptoms of anxiety that we may notice include:

• rapid, pounding heart beat;

• headaches;

• chest, shoulder or neck pain;

• feeling dizzy or lightheaded;

• shortness of breath;

• shaky legs;

• nausea;

• loss of appetite;

• butterflies in stomach; and

• tightness in muscles.

5

These sensations can be unpleasant but are not harmful. It is nature’s way of protecting us from danger. These feelings will go away when our anxiety reduces and we feel calmer.

If you have any of these symptoms, you should see your family doctor (GP) who will check your physical health first to rule out any health problems. If there are no problems, then it is likely to be anxiety.

Anxious thoughts and feelingsYou may find that you:

• feel irritable and on edge;

• have frequent worrying thoughts – for example, have a constant fear of falling;

• always think the worst will happen - for example, “I will fall and injure myself”; or

• focus on just the negative rather than having a positive mental attitude – for example, “I can’t walk far because I will fall” rather than “I will try to walk as far as I can. I am going to do the best I can.”

Negative thoughts can make things seem worse. For example, anxiety can sometimes lead you to overestimate the risk of falling. Learning to challenge these negative thoughts with more balanced ones can help reduce any worries. It just takes practice.

6

What we may do when feeling anxious

The more worried you become of falling the less likely you are to keep active.

Anxiety can make you act in ways that help you feel safer - for example, holding onto things because you think you will fall or not going out. Avoiding or stopping doing things can make life difficult and less enjoyable. This can lead to low mood and depression. We lose a lot of confidence by avoiding walking. This will affect how you feel about yourself and keep fears going.

“It’s the constant fear that I have of falling that stops me from moving around. I know I should be active but I have decided that the less I move around, the less chance I have of falling.”

7

How anxiety can affect mobility

A cycle of anxiety can develop which keeps fears about falling going. Worrying thoughts can affect how we feel and what we do.

Dealing with anxiety can help improve your mobility, confidence and quality of life.

“I am afraid of hurting myself if I fall so I don’t go out as much as I used to. I don’t walk that far anymore. It’s not much of a life.”

8

Cycle of anxiety

Worrying thought

“What if I fall? I will hurt myself”

Loss of confidence

“I can’t do it”

Physical symptoms of anxiety

- for example, legs shaking

Avoidance

Stop going out

More worry

“I feel unsteady. I am going to fall”

9

Managing anxiety about falling – how you can help yourself

Falls can be more common as we get older but falling is not a normal part of ageing so if you have a fall don’t just ignore it. You should let your GP know. You may need a medical check up to look at why it happened.

Ask yourself these questions• Were you in a hurry?

• Was the floor cluttered or slippery?

• Were you using the correct walking aid if you use one?

• Were you feeling dizzy? It could be side effects of medication. If you are on many different medications make sure you get these reviewed at least once a year. If you have been on sleeping tablets for some time, you might want to see your doctor about options for coming off these. Your GP can also give you advice on how to get a good night’s sleep naturally. It is important that you do not stop taking your medication without speaking to your GP.

There are some things you can do to prevent falls happening which should help to reduce your fears. For further information you can visit NHS inform’s Preventing Falls section at www.nhsinform.scot/aboutfalls.

Self assess your risk of falls and create your own plan using Falls Assistant tool at http://fallsassistant.org.uk/.

To receive a free copy of a falls prevention information booklet call the Age Scotland Helpline on 0800 12 44 222.

10

• If you have had a fall try not to dwell on it, even though it is understandable that you may feel worried for a short time afterwards.

• If your worries are not going away - take control and take action. Talk to someone about your anxiety. It can make problems seem more manageable. Recognising there is a problem can be the first step to getting the help you need and your life back.

• When getting up from a chair, don’t rush. Stand, turn and move off slowly. Concentrate on one thing at a time, getting to where you need to be safely.

• Set yourself small achievable targets: walk for a short distance first (even if it is several steps in the safety of your own home) and build on this. If you feel you would benefit from a walking aid, discuss this with your doctor. Small goals will help you feel more confident again.

• Try to think positive and keep things in perspective. Remember all the times you haven’t fallen and keep walking and moving.

“I keep telling myself that I can do this if I take my time and don’t rush.”

11

Reducing your fear by challenging your thoughts

Thinking positive about walking

Less anxiety and physical symptoms

Success/sense of achievement

Walking with confidence

“I try not to say what if I fall? What if I don’t? I will have spent all that time worrying about something that probably will not happen. It’s my negative thoughts that hold me back”

12

• You may feel more anxious or panicky when you begin walking. You may find yourself breathing faster than normal. If you do, take some regular breaths and tell yourself that these feelings will go away. You can reduce your anxiety by slowing down your breathing and using relaxation techniques. There are some helpful relaxation exercises in this booklet, see pages 14 to 17.

• Learn more about anxiety. Ask your GP for any self help guides or information leaflets or check out visit NHS inform’s Preventing Falls section at www.nhsinform.scot/aboutfalls

Helpful tips

• Cut down on tea and coffee. These contain caffeine which can make anxiety worse and interfere with sleep.

• Make sure you have a well balanced diet. Eat regularly - going too long without eating can make us feel irritable and anxious.

• Get enough sleep – when you are well rested, it is much easier to cope with worries.

• Avoid too much alcohol – alcohol can make you feel better for a short time but it can make anxiety worse in the long term. It can also increase your risk of falling.

• Keep active and do things you enjoy – this can help to take your mind off worrying thoughts. It can also improve our sleep and fitness.

• Think about your posture, the way you hold your body. If you hold yourself up tall when you walk, this can help your balance. We also need good posture in order to do daily activities well.

13

A few tips that can help you to have good posture:

• Think tall!

• Looking straight ahead and lengthen your neck by tucking your chin in.

• Relax your shoulders down and away from your ears.

• Lift your chest up.

• Hold in your tummy muscles and lengthen your back.

• Have a straight body with your knees in line with your ankles.

• Reward yourself for your achievements. Tell yourself how well you have done. This will help build your confidence for next time.

14

Helping yourself with relaxation

This is a way of helping to calm your mind and reduce the muscle tension anxiety can cause. Try the exercises that follow. There are many different relaxation techniques, try a few and see what works for you.

Don’t give up if you don’t feel better straightaway – it is a skill which takes time and regular practice to get the full benefits.

In order to get the most benefit from relaxation, it must become an everyday part of life. We can’t always get rid of what causes us worry completely, but we can learn some skills which can help us get it under some control.

Before you start relaxing make sure your mind, body and surroundings are just right.

Prepare yourself:• Lie down on your bed or sit in a comfortable chair in a quiet, not

too warm room where you will not be disturbed. Wear comfortable clothes, make sure your legs are uncrossed and take off your shoes.

• Don’t try the exercises if you have just eaten or are hungry.

• Don’t worry if you can’t relax immediately. Don’t think about how you are doing – just let it happen.

• Thoughts may pop into your mind. Don’t focus on them just let them pass through.

• Initially try to set aside 30 minutes two or three times each day. The more you practice the more you will train your body to relax as soon as you feel worried or panicky anytime, anywhere.

If you have any medical conditions - for example, breathing problems - see your GP before trying any relaxation exercises.

15

Breathing to relaxBreathing too quickly and deeply can make us feel dizzy, faint or even more anxious. Breathing correctly can help control anxious thoughts and feelings. A few slow regular breaths can make us feel calmer.

Place one hand on your chest and the other over your stomach. Take a slow normal breath in (through your nose if you can).

You want your stomach to move more than your chest. Encourage your stomach to move out as you breathe in. “Relax”

Breathe out slowly through pursed lips. Watch your hands as you breathe out. The hand on your stomach should move and your chest should not. “Relax”

Repeat this 10 times, twice a day.

It might take time to master this. Once you have you won’t need to put your hands on your stomach or watch your hands.

Simple visualisation exerciseThis exercise involves using an image as a focus.

In your mind, create an ideal spot to relax. It can be real or imaginary, somewhere you will find restful, calming safe and happy. Imagine it in as much detail as you can – use your senses to make it as real as possible (what can you smell, hear and so on). See yourself comfortably enjoying this place.

Close your eyes and take a regular breath in through your nose. Become aware of your breathing. Focus on your relaxation place in all its detail and breathe out through your mouth.

Remember you can return to this place whenever you feel the need to relax.

Do this exercise for 10-20 minutes.

16

Quick muscle relaxationHere you can learn to recognise and reduce muscle tension:

• Sit in a chair and close your eyes.

• Concentrate on your breathing. Take a breath in through your nose and breathe out slowly through your mouth.

• Make a fist, squeeze your hand tightly. Hold this for a few seconds, noticing the tension. Slowly open your fingers and feel the difference – notice the tension leaving. Your hand is much lighter and relaxed. Enjoy this feeling.

• You can relieve tension in any part of your body just by tensing and relaxing each muscle in turn.

If you have any physical injuries or conditions that may cause muscle pain don’t tense the muscle in that area.

Cued relaxationOnce you have mastered some relaxation exercises you can use them whenever and wherever you need to throughout the day.

To do this you can use a ‘cue’ - something to catch your eye and remind you to:

• drop your shoulders;

• check your breathing;

• relax the muscles in your body; and

• relax.

17

Find ways of reminding yourself to relax. For example, you could put a small coloured dot on your watch or somewhere else in your home which will act as your reminder.

Make a note of how relaxed you were before and after the exercises to see if it has helped.

Don’t rush to get up after relaxation exercises. Sit with your eyes closed for a few minutes afterwards to avoid the possibility of feeling dizzy. Open your eyes and make sure you feel all right before standing up.

“I practice my relaxation exercises every day. I feel more in control now”

18

How staying active can help

• Getting older can have an impact on our steadiness. Without regular physical activity, it is difficult to maintain strong bones, strength and balance. It is therefore important for us as we age to work at improving our balance through exercise.

• Regular exercises such as Tai Chi and strength and balance training can improve our stability.

• Activity also has a positive effect on how we feel. When we exercise, the brain releases feel good chemicals, which are known to help improve our mood, reduce anxiety and tension.

If you have not exercised for a long time, you may be fearful of falling or hurting yourself. Please don’t be put off! Remember, regular exercise can help to reduce risk of falls.

“I’ve been attending an exercise class for the past 12 months. I know that the strength in my legs has improved because I can walk quite a distance without getting tired and wobbly. I feel I’m getting my independence back and don’t worry as much about falling.”

19

Local activity opportunities

Invigor8 is a programme of exercise classes for people over the age of 65. It supports people at risk of falls to exercise at a level suited to their ability. The classes are led by highly trained and experienced instructors. Invigor8 is suitable if you are fearful of falling, feeling unsteady on your feet, have had a previous fall or if you have osteoporosis. Classes are designed to help build and maintain eight core components: balance, strength, flexibility, endurance, how to get down on the floor and back up, floor work, tai chi and confidence building. You can refer yourself to the scheme or a healthcare or social care professional can refer you.

For more information on Invigor8 contact:South Ayrshire 01292 269793

East Ayrshire 01563 576972

North Ayrshire 01294 605128

“I’m so glad I asked for help. I feel more in control now. There is no guarantee that I won’t fall but I can deal with it. Fear isn’t ruling my life anymore.”

20

When should I ask for more help?You should get more help if:

• you have tried some of the suggestions in this booklet to make yourself feel better and this has not made any difference;

• your anxiety has been going on for some time and not getting any better;

• your anxiety is stopping you from doing things you usually do or want to do;

• your anxiety is strong and unpleasant. If you experience intense anxiety / panic feelings frequently, this can be seriously distressing and disabling. Don’t just put up with it; or

• your anxiety is causing you emotional distress and making you feel fed up. Depression and anxiety often go hand in hand. If you have lost interest in things once enjoyed and/or always feel low in mood it could be a sign of depression.

When should I ask for more help?Remember having anxiety about falling is common.

Please do not suffer in silence – talk to someone you trust about it. There are options and services available that can help you overcome these difficulties. Some of these are listed in this booklet.

Local sources of helpActive Scotland – www.activescotland.org.ukSearch for local activities in your area

South Ayrshire Life 0800 432 0510 www.southayrshirelife.org

My East Ayrshire www.my-east-ayrshire.co.uk

Carena (North Ayrshire) www.carena.org.uk

21

Voluntary organisations often provide details of local health and wellbeing opportunities in your area.Voluntary Action South Ayrshire (VASA)01292 432661

The Ayrshire Community Trust (North Ayrshire)01294 443044

Arran Community and Voluntary service01770 600611

Council Volunteer Organisation (CVO)01563 574000

Vibrant Communities (East Ayrshire)01563 576354

Your GP can also recommend options and treatments available to you if required.

Falls Screening ServiceA falls screen takes place in your home and helps to identify any personal or environmental risks that could contribute to slips or trips. For more information contact your local Intermediate Care Service on:

East Ayrshire 01563 507955

North Ayrshire 01294 400616

South Ayrshire 01292 66044

All of our publications are available in different languages, larger print, braille (English only), audio tape or another format of your choice.

0800 169 1441Tell us what you think...If you would like to comment on any issues raised by this document, please complete this form and return it to: Communications Department, 28 Lister Street, Crosshouse Hospital, Crosshouse KA2 0BB. You can also email us at: comms@aaaht.scot.nhs.uk or comms@aapct.scot.nhs.uk. If you provide your contact details, we will acknowledge your comments and pass them to the appropriate departments for a response.

Name ______________________________________________________

Address ______________________________________________________

______________________________________________________

Comment ______________________________________________________

______________________________________________________ ______________________________________________________

Tha gach sgrìobhainn againn rim faotainn ann an diofar chànanan, clò nas motha, Braille (Beurla a-mhàin), teip claistinn no riochd eile a tha sibh airson a thaghadh.

Last reviewed: November 2017Leaflet reference: OT14-005-GD PIL code: PIL17-0411

Reproduced with kind permission from Manchester Health and Wellbeing Service.