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I was talking with a friend who shared that she and her brother have a pact when they call one another, they start each conversation with, “Dad is ok.” They do this because, in the past 20 years, their dad has fallen countless times; And those are only the falls of which they are aware. According to their mother they “don’t even want to know” the actual number. She also shared their dad refuses to tell them (or have their mother be the bearer of bad news) because he is embarrassed.
Although she disagrees, she at least understands his feelings. Her dad was always a very independent man. A former executive who traveled around the world, who was an avid exerciser, who, although working full time, paired with her mother to take care of her and her brother. Imagine now, that he is the one needing to be taken care of. The one now, who is dependent…for so many things. He is a proud man, and his pride gets in his way. He comes across as stubborn and somewhat reserved. But she suspected what was behind this personality was a myriad of emotions. If she had to guess, she sensed feelings of embarrassment, helplessness, guilt, boredom, and fear.
Wow.
That’s a lot of feelings to feel…simply due to a fall. But every time he has fallen, and he’s had to go to the hospital; every time he falls and has to call on his wife of 53 years to get help; every time he calls his children to tell us that he fell, but he’s ok. As they breathe a sigh of relief that the fall “wasn’t that bad,” his embarrassment, helplessness, guilt, and fear are magnified. He becomes anxious to do anything that may result in a fall, and so he becomes more reserved, more isolated, increasingly bored, and sad. In other words, he feels the emotional impact far greater than the physical impact of the fall.
Simply stated: Emotions are the unspoken consequences of falls and they are deep-rooted.
The National Council on Aging reports that falls in adults aged 65 and over are the leading cause of head injuries and broken hips, with one in ten falls resulting in serious injuries such as fractures or traumatic brain injury. Preventing falls can be achieved through a combination of interventions including physical and occupational therapy to improve strength, mobility, balance, and endurance, perform home/environment hazard assessment and modifications, and provide education and management to reduce the fear of falling. In addition, physical and occupational therapists work with medical teams to identify medications that may be impacting the patient and allow medical teams to manage more effectively.
Interventions such as those mentioned above are extremely important as there are many factors to account for that contribute to falls including medical conditions, cognitive decline/impairment, visual impairments, being on multiple or certain singular medications as well as external factors such as environmental obstacles such as rugs, electrical cords, uneven walkways, etc. The top contributing factors to fall risks are in order: age, gender (being female), a previous history of falls, and a fear of falling. I’ll say that last one again—the fear of falling contributes to additional falling.
So how can fear of falling contribute to falls? There are several reasons but let’s break down this picture a bit. Back to my friend’s dad who is afraid of falling. His fear causes him to reduce his activity. But by reducing his activity, he has become extremely deconditioned. By being deconditioned, he cannot participate in many activities, and he becomes lonely and bored. The lonelier and more bored he feels, he senses increasing helplessness. Guilt for falling and/or allowing himself to become deconditioned begins to creep in and each time he tries to engage more, his fear becomes magnified. Every time he falls, he becomes embarrassed and he feels more helpless. And the cycle continues.
But let’s examine that same scenario after an intervention. Working on strength training, balance, mobility, and endurance through physical therapy may provide more than just physical improvements for someone. The confidence one can feel after just a few sessions of physical therapy, knowing that they feel stronger, feel more in control of their balance, and can stand or walk longer and farther than before creates situations in which safer mobility can occur. The less deconditioned someone becomes, the easier it is to move and the more confident they may be in their ability to participate in activities. After in-home assessments and modifications completed by occupational therapy, patients can also navigate their surroundings with greater assurance and can identify when barriers may present themselves.
The average cost of treating just one fall can be close to $30,000; the monetary savings that can occur by preventing or reducing risks of falls can be upwards of $60,000,000,000 per year.
But the true question in my mind is, what are the savings in reducing or eliminating the emotional costs of falling?
Well, that’s just priceless.
References
Andersen CU, Lassen PO, Usman HQ, Albertsen N, Nielsen LP, Andersen S. Prevalence of medication-related falls in 200 consecutive elderly patients with hip fractures: a cross-sectional study. BMC Geriatr. 2020;20(1):121. Published 2020 Mar 30. doi:10.1186/s12877-020-01532-9
Centers for Disease Control and Prevention. Falls Among Older Adults: An Overview. http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed July 20, 2020.
Karinkanta S, Piirtola M, Sievänen H, Uusi-Rasi K, Kannus P. Physical therapy approaches to reduce fall and fracture risk among older adults. Nat Rev Endocrinol. 2010;6(7)
National Council on Ageing: Falls Prevention https://www.ncoa.org/healthy-aging/falls-prevention/, retrieved July 22, 2020
National Council for Ageing Care-Falls Fact Sheet https://aging.com/falls-fact-sheet/ retrieved July 20, 2020
Stevens, J.A., Ballesteros, M.F., Mack, K.A., Rudd, R.A., DeCaro E., & Adler, G. (2012). Gender differences in seeking care for falls in the aged Medicare population. American Journal of Preventive Medicine, 59–62
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