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Fear of Falling
Written By : Bruce Kaler, MD 
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Are you aware of the severity and fear related to falling? As aging and loss of physical independence narrow one's boundaries many people have increasing anxiety and depression related to their loss of control. Their everyday environment becomes a minefield with which they have difficulty navigating. Since the most common injuries to people over 65 are falls and most of these happen at home there is good reason for people to be fearful. It is not just cultural hype or myth. People see other friends or family suffer miserable slow healing injuries or even death as direct result of a fall. Head injuries and traumatic brain injuries due to falling are not unusual.

The diminished physical skills people feel every day only serve to reinforce their anxiety. Their fear becomes an obstacle and reason for even more inactivity. A client fell while living in senior housing during the night returning from the bathroom. She was stuck, wedged between the bed and wall in a very awkward position. She was too weak to right herself and remained there for 14 hours till she was discovered by the staff. The dehydration, severe injury to shoulder and muscles caused complications while in the hospital from which she barely survived. She spent the next year in a rehab facility with a lot of intensive physical therapy to regain her strength so she could perform simple tasks of personal care and transfer from bed to chair and ambulate with a walker.

She developed a great deal of depression because of her physical predicament and the long challenge in front of her. She was very anxious with every change of position from sitting to standing to walking. Each change of position provided another opportunity on the "high wire" from which she may take another dive due to her weakness, poor coordination, and debilitated condition. The only time she felt safe was flat on her back in bed. She had suffered no stroke or cardiovascular events and her mental status was as sharp, witty, and intelligent as anyone. She was almost consumed for months by her dread and hopelessness. With intensive physical and occupational therapy, lots of encouragement from staff and family she was able to persevere. She has been able to move into an assisted living facility where she motors around on her own with a walker in very small increments and with great caution always wary of her surroundings. She needs assistance only with bathing and housekeeping of her small apartment. She remains fearful of going out with family on any special occasion because of the potential hazards from no longer being in control of her environment and rather loose grip on maneuvering her own body.

Her story is unfortunately very common. Prevention is the ticket. Encouraging healthy lifestyles and activities to maintain strength, coordination and conditioning are important. Work-outs even for the most sedentary have proven to increase strength, coordination and decreased incidence of falls. It is never too late. Surveying living areas to remove obstacles or items that could cause a slip or trip can help. Handrails or hand-hold bars in strategic areas can help in both practical and emotional ways to facilitate greater mobility. Mental strategies that are supportive can go a long way to encourage and motivate someone who is tentative in this area. For that matter it's a great recipe for all of us. "All ya need is love..."

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