Fear of Falling

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Fear of Falling
Steve Malkin Psychology Department MECRS
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Homework
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Introduction - Why talk about Fear of Falling?

• Fear of Falling (FOF) is common
• Severe forms are distressing limiting
• Can be a risk factor for further falls
• Can be addressed
• awareness versus expertise.

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Magnitude of the Problem

• 25-50 of fallers will become anxious about
  future falls
• About 25 of fallers will restrict activities due
  to fear of falling
• Up to 15 of elderly non-fallers (near-misses,
  vicarious experience) develop fear

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Falls Efficacy

• Confidence in ability to complete certain tasks
  without falling
• A better predictor of poor functional and social
  outcomes than fear of falling per se although
  they are correlated (Tinetti 1994).

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Assessment - some things to remember

• Increasing observational/behavioural focus with
  increasing cognitive deficits
• Some level of apprehension is often reasonable
  and understandable i.e. who not to treat.
• Phobic Criteria - marked, persistent fear
  recognised as out of proportion with actual
  abilities and/or a problem in itself?

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Assessment - Interview

• Interview
• direct questions about fear, anxiety or nerves
  in situations where falls are a possibility
• consider asking questions about levels of
  confidence in completing certain tasks without
  falling
• questions about activities avoided for fear of
  falling
• questions about feelings/bodily sensations (e.g.
  racing heart) - often useful in vivo

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Assessment - Observations

• In therapy/on ward
• Patient recorded
• Staff recorded

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Assessment - Inventories

• e.g. Modified Falls Efficacy Scale (Hill et al
  1996)
• More precise measurement of degree of problem and
  change
• encourages disciplined approach
• More time consuming

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Options for Management

• Theory from other anxiety disorders -
  cognitive-behavioural approach
• Research
• large scale community-based study (Tennstedt et
  al, 1998). Benefits for regular attendees
• nothing in inpatient setting
• anecdotal evidence - its difficult

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Considerations When Planning to Intervene

• Safety First
• Factoring in cognitive status
• Group versus individual
• meshing with existing routine
• understanding the patients point of view

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Communication

• Respect
• Empathy
• Reflective Listening
• Rationales for and agreement to interventions

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Suggested Components of Intervention

• Education re anxiety and falls prevention
• Relaxation
• Exposure Hierarchies
• meshing with ward, physio, OT tasks - esp. when
  anxiety is the main barrier
• Identifying and challenging maladaptive thinking
• Specialist referral

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Organisational Challenges

• selling the idea
• Who coordinates?
• Who does what when? - clear responsibilities and
  incorporation into the routine
• Access to Psychological supervision/training/speci
  alist assessment and input