Fear of Falling
Preventing Falls and Fear

By Sharon Roth Maguire, MS, APRN-BC, GNP, APNP

Most caregivers are aware of the importance of preventing falls. When a fall occurs, the results can be life-changing. While we all realize the significance of a broken bone that may result from a fall, what we sometimes fail to acknowledge is the broken spirit that may occur after a fall. Many elders who fall never fully regain the confidence in their ability to navigate around their home or near steps. They may experience a fear of falling again that may cause them to limit their activity. They may have a permanent disability—not only from the physical consequences of the fall, but from the emotional consequences as well. What then can be done to reduce the likelihood of falling? There are four major risk areas to target when you think of fall reduction: Environmental Risk, Age-Related Risk, Health- Related Risk, and Medication Risk.

Minimizing environmental risk would include things like providing for hand rails near the toilet and tub to make it easier for the individual to get up or get balanced; using non-skid throw rugs, or better yet, no throw rugs at all; keeping pathways to and from the bathroom, bedroom, and kitchen free of clutter.

Reducing age-related risk would include things like accommodating for vision and hearing changes that make it more difficult for the older adult to interpret their environment and to see or hear clearly. Eyeglasses should be of the correct strength, in good repair, and clean. Lighting needs to be increased, but not to the extent that it produces glare. A night light will help reduce the dramatic and often times blinding changes in light when going from a darkened bedroom to a brightly lit bathroom. Hearing aids should be cleaned regularly as wax may accumulate and prevent them from working properly. Hearing aid batteries should be replaced regularly to ensure good function.

Reducing health-related risk requires a good healthcare partner and a motivated patient. Osteoporosis is primarily a disease that affects older women and those who have taken medications known as long-term steroids (often used for the treatment of severe arthritis and asthma). These medications cause bones to become increasingly fragile and break even without trauma. Older adult women should be screened for osteoporosis to determine the density of their bones and if medication management is required. All older adults should get regular weight bearing exercise and eat a well-balanced diet to maintain their bone health. Older adults need as much calcium as pregnant women (1200 mg/day)! Vitamin D requirements also increase with age (400-600 IU/day) and are essential for healthy bones as well.

The last category for risk reduction is medication awareness. As we age, we are at risk of taking many medications for many ailments prescribed by many providers; a situation known as polypharmacy. There is much research and increasing awareness of the potentially hazardous effects of polypharmacy. It is well documented that the more medications an individual takes, the greater their risk of side-effects, drug interactions, and falls. Certain medications are particularly dangerous. Anti-anxiety medications like Valium, Xanax and Ativan; sleeping pills like Ambien, Restoril, and even Tylenol PM have been implicated in increasing fall risk. Discuss your loved one’s medication regimen with the prescriber and focus on reducing or eliminating those drugs that increase the risk of falling. Should your loved one require extended care somewhere other than home, be sure to ask what their fall reduction program has to offer.

Fear of falling is a very real phenomenon that is as important to reduce as the physical consequences of a fall. Both can be life changing and demand our attention to reduce the likelihood of a fall occurring.

Sharon Roth Maguire MS, APRN-BC, GNP, APNP is the Senior Director for Healthcare and Resident Services at Alterra Health Care Corporation and a Clinical Assistant Professor (Adjunct) at Marquette University College of Nursing in Milwaukee, WI.

 

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