For a senior, a fear of falling can create a downward spiral. It can lead refusal to participate in activities, which can results in muscle weakening and loss of strength and balance, which increases the risk of falling.
"Excessive fear of falling can lead to needless restriction in participation in physical and social activities, resulting in physical deconditioning, poor quality of life, social isolation, depression, and psychological distress," wrote Stephen Lord and other researchers from Australia and Belgium in the Aug. 19 issue of the British Medical Journal.
The researchers concluded that their findings suggest providers should be more attentive to asking their patients how afraid they might be of falling, because the answers to that self-evaluation might be helpful in designing fall prevention efforts, such as ways to build confidence, provide better balance perception or specific strength building exercises.
The Australian researchers did not indicate the cost of caring for fall injuries in their study participants. But in the U.S., federal research last October revealed that 30% of elderly patients who went to the emergency room because of a fall had to be admitted, which incurred $6.8 billion in hospital costs in 2006.
The report, from the Agency for Healthcare Research and Quality, said falls sent 2.1 million people to the emergency room in 2006, the reason why one in 10 people over age 65 needed emergency room care.
The current study, which enrolled 500 people between the ages of 70 and 90 from Sydney Australia, compared the seniors' perceived risk of falling with their actual physiological condition as well as whether they actually had fallen and incurred injuries from that fall serious enough to be disabling in the next 12 months.
They were divided into four groups, vigorous, anxious, stoic, and aware, based on the disparity between their physiological and perceived risk of falling.
Although most of those participating in the project had an accurate perception of their fall risk, one third of the participants "had disparities between their perceived and physiological fall risk," the researchers wrote.
For example, of the 198 who had a low physiological risk of falls based on their physical condition, history of prior falls, medication use, and other factors, 54 perceived that they would fall (the "anxious" group). And of those, 21 (39%) actually did, indicating that their fear may have played a part in that occurrence.
"Despite their low physiological fall risk, almost 40% of the anxious group experienced multiple or injurious falls during the one-year follow-up," the researchers wrote. "The disparity between physiological and perceived fall risk in the anxious group seemed to be strongly related to psychological factors."
And, the researchers wrote, the group's psychological profile indicated "a higher prevalence of irrational fears (higher levels of neuroticism) possibly leading them to interpret small balance impairments as major deteriorations in balance control.)
Likewise, of the 302 with a high physiological fall risk, 100 (the stoic group) didn't think they were at risk of falling, and of that group, 34 (20%) actually fell. The researchers acknowledged that they "initially hypothesized that an inaccurately low perception of fall risk would lead to a higher rate of injurious and multiple falls through risk-taking behavior or poor insight." But these participants' psychological profile did not indicate excessive risk-taking, "but rather a positive attitude to life, emotional stability, and low reactivity to stress."
And the researchers wrote, the low perception of fall risk in the stoic group "seemed to be protective towards future falls compared with the aware group," perhaps because they were more active and thus had better muscle strength, used fewer psychotropic medication, or had not had a prior fall.
The Australian researchers had several limitations in their report. For starters, they followed the patients for one year, so falls in any of the groups that occurred after that period would not have been reflected. Also, all psychological profile information was by self-report from the seniors, and the physiological profile assessment, they acknowledged, was only an estimate.
The authors received funding from the Australian National Health and Medical Research Council.
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