The number of older people who have died from a fall in the UK has increased in recent years. It therefore comes as no surprise that the fear of falling can be a very serious concern for older people, even before they fall. The problem is, research shows that fearing a fall actually increases the chances of falling. This cycle begins with a reluctance to participate in physical activities, leading to reduced mobility and decline in physical fitness, which then increases the chances of falling.

While fear and anxiety do nothing to help those who are at a high risk of having a fall, the natural tendency to become fearful (especially where there has been a previous fall) can be understood. Anxiety is a common problem which can affect anyone at any point, and it can come as the body’s natural reactions after perceiving a threat, whether real or imagined. A person can develop anxiety after going through a traumatic experience (such as having a fall), and in small doses, anxiety is very common. If anxiety begins to affect a person’s thoughts, actions and feelings, it can begin to cause physical problems such as a rapid heartbeat, headaches or a loss of appetite. These symptoms while unpleasant, are part of the body’s defence mechanism from danger, and they tend to reduce if the person gets calmer. If however, you find that these symptoms persist, please visit your GP.

So how can I break this cycle of fear of falling?

The danger of medication

When feelings of anxiety persist, one common course of action that doctors might take is to prescribe anti-anxiety medication such as benzodiazepines. However, researchers at the University of Utrecht in The Netherlands have shown that these drugs do not just increase the risk of falling, but they also increase the risk of getting dementia. The study showed that in a group of 404 elderly patients, patients taking psychotropic drug classes including short-acting benzodiazepines were 3.5 times more likely to fall than other patients.

The study highlighted the strong correlation between the 59% of patients who had experienced one or more falls in the year prior, and their use of psychotropic medication. It concluded with a recommendation that the relationship between falls and the use of psychotropic medication should be recognised by doctors prescribing for older people, as well as older people themselves. Where possible, these psychotropics should be avoided by elderly patients, especially those at risk for falling.

Tackling your fear of falling without medication

The first step to overcoming fear or anxiety regarding falling is by recognising the feelings of anxiety when they come and learning to cope with them. This can be achieved by understanding the realities of ageing in the modern world and allowing your limitations to evolve as you age. By listening to your body and considering alternatives to prescription medication, you will develop a healthier mechanism for coping with stress and anxiety.

Actions you can take to achieve this include:

Identifying risks and creating a plan for the future

To be able to tackle a problem, it is important to first identify and define it. There are a number of things that could increase your risk of having a fall, which can range from personal reasons relating to your health, to environmental reasons such as lighting or trip hazards.

If you have already had a fall, you can start by reevaluating the reasons for the fall by asking questions such as:

• Was I in a hurry?
• Did I feel dizzy at the time?
• Was the environment cluttered?

The aim of these questions is not to victim-blame, but rather to establish the cause(s) of the fall and eliminate them if possible.

Once the cause has been identified, you can go on to create a plan to get help in the event of a fall. This is especially important if you live alone, or are alone for long periods of time. Your plan should include what to do, who to contact and how they can reach you. The quicker you get help after a fall, the less likely you are to experience unnecessary fear and distress.

This concludes our series on post-surgical care and ushers us into a new series focusing on conditions in the elderly, and how to manage them. Our next article will discuss the management of patients with Parkinson’s disease.