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Fear of Falling Assessments and Interventions

woman with elder Fear of falling puts older adults at higher risk of falls and is an important risk factor to address. As many as half of all community-dwelling older adults experience fear of falling. When older adults curtail activities that they are safely able to do because of concerns about falls, this can lead to deconditioning and functional decline, which increases falls risk. Fear of falling can also increase social isolation, depression or anxiety.

Health care providers can assess the extent to which an older adult’s perceived fall risk matches his or her actual fall risk, and can recommend interventions accordingly.

Providers should screen all older adult patients and clients for fear of falling using these questions:

    1 - Apart from being in a high place, in the past 12 months, have you been worried or afraid that you might fall?

    If the patient responds positively, follow up by asking:

    2 - Do you ever limit your activities, for example, what you do or where you go, because you are afraid of falling?

    If the patient responds positively, follow up with a detailed Fear of Falling assessment.

 

Fear of Falling Assessment Tools:
The Falls Efficacy Scale International (FES-I) is a validated 16-item questionnaire of fear of falling, available for use in different languages. The Short FES-I is a 7-item questionnaire that is reliable and feasible in clinical practice. For more information and additional translations, refer to the Prevention of Falls Network Europe (ProFaNE).

 

How Providers can Address Fear of Falling:
  • Communicate - Talk with older adult patients to learn about their activity levels and concerns about falling.

    - Discuss these key points:
    • Concerns about falling are common. Even those who have not fallen can have a fear of falling.
    • Cutting back on activities they are capable of doing because of concerns about falls increases fall risk.


  • Educate - Provide your patients with materials and resources to reduce their risk of falling by addressing home hazards, improving medication management and adherence and increasing physical activity.

    Remember to:
    • Discuss the benefits of physical activity, especially exercise that improves balance, strength and coordination, such as Tai Chi, which is available for free at many local senior centers.
    • Discuss options for occupational or physical therapy for tailored programs to increase daily functioning.
    • Remind your older adult client that their pharmacist can also help with medication management.


  • Emphasize the importance of social networks - People who are afraid of falling often have limited social networks. Talk with your patients or clients about their community and family resources to better understand their level of social support. Point out that both formal and informal support networks are important.

    Recommend:
    • Group exercise classes available for free through BeFitNYC;
    • Getting involved with a local senior center. Go to the Department for the Aging’s “Senior Services” locator to search for senior centers by zip code or borough; or
    • Taking part in the Department for the Aging’s “Partner to Partner” program, which connects older adults to peer volunteers who are trained to be receptive listeners who can offer support.


  • Address anxiety and depression - Ask about sources of anxiety and behaviors leading to anxiety or depression. Consider administering a screening tool, such as the K-6 (see scoring and other information about the K-6). Refer patients for cognitive behavioral therapy if necessary. Try to avoid medications that are known to increase fall risk. Remind your patients or clients that:
    • Exercise can improve mood; and
    • Increasing social networks can help address anxiety and depression.

 

Last Updated: February 21, 2012