Silver Linings: How To Approach Your Fear Of Falling

Children at playgrounds take tumbles. It almost seems to go with the territory. Whether going down a slide or racing after each other, they make a habit out of slips, trips and falls. For them, it’s no big deal. They get up, dust themselves off, and go again.

But as we get older, there are no fun and games when we fall.

Injuries abound. Falling can be painful, even fatal.

Ivana Trump, former wife of the president, died at only 73 years old following a fall down the stairs in her Manhattan home. LaVell Edwards, former BYU football coach, and Stephen Covey, former author and management consultant, both died from complications after a fall.

The rich and famous are not spared from such accidents. Nor are ordinary people overlooked, either. Accidents from falls can happen to anyone.

According to the U.S. Centers for Disease Control and Prevention, one of every three adults age 65 and over falls each year, leading to nearly 20,000 deaths. Even when falls don’t cause injury, they may cause older people to develop a fear of falling that can limit their activities and reduce their mobility.

In fact, falls are the leading cause of injury for those over the age of 65. More than 14 million adults in the United States report falling each year — and the risk increases with age.

Falls among older adults are common, costly and often preventable, says my middle son who is a practicing emergency room physician. “I see patients in the ER almost every month who have fallen from a questionable ladder or shaky chair propped up against a wall. They overestimate how far they can reach or how secure their footing might be, and the result is often a serious injury,” he says. “While older people may not think they are superman, yet they still think they can leap tall buildings in a single bound. But they can’t.”

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While falls result from other conditions besides climbing questionable ladders or standing on shaky chairs, many falls are clearly preventable. The American Public Health Association even estimates that as many as one third of all falls among older Americans can be easily prevented.

Proper shoes, well-lit rooms, and non-slip rugs all help. So does getting enough sleep, understanding the effects of medication and staging furniture and cords to minimize tripping hazards.

While older people typically know about household hazards and how to prevent them, they are also highly attuned to the impact of falls that result in injuries.

In my neighborhood in St. George, Utah, I often hear about someone who has fallen, broken a hip and is having difficulty recovering. In fact, research shows that between 40 and 60% of those who break a hip after a fall do not recover to their pre-fracture level of mobility and independence.

People stumble all the time, not just older people but all of us. Mostly, we catch ourselves and quickly recover. Yet, when older people stumble— like both President Biden and President Trump while climbing the stairs to board Air Force One — it can raise eyebrows.

Such incidents as well as various statistics have created a widespread fear of falling or basophobia, as well as ambulophobia, the fear of walking, among many older adults.

If someone has fallen unexpectedly or feels unstable walking across a room, this sometimes debilitating fear can make matters worse when we avoid physical movement, stiffen when walking or minimize activities. In many cases, ambulophobia changes walking from an automatic habit to a deliberate, controlled method which makes our movements rigid and further increases our fall risk.

So, what helps?

While quick reflexes and a strong core can help maintain balance and minimize falls, it turns out that our minds play just as important a role as our physical bodies in fall prevention.

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To avoid falling, it appears we may just need to pay attention more and multitask less. Our brains need to adjust our body’s position in daily activities, say researchers at the Albert Einstein College of Medicine, so overloading our brains by listening to music, thinking about other tasks, or even talking can put us more at risk of falling while either walking or performing other daily tasks. Ordinary tasks require more cognitive effort as we grow older. Multitasking not only creates cognitive overload but also reduces our ability to reflexively catch ourselves when we stumble or trip over uneven surfaces or walkways.

A related factor in fall prevention is “self-efficacy,” which is essentially a person’s confidence in their own skills and capabilities — like walking unassisted without stumbling or falling. A person with high self-efficacy is more likely to persist in the face of challenges and believe they can overcome obstacles. The benefits of self-efficacy in preventing falls have been extensively studied, though they are not frequently discussed in non-clinical books or magazines.

Self-efficacy reduces the fear of falling and enables older people to confidently engage in social activities that have their own inherent benefits. People with higher confidence in their mobility engage in more physical and social activities which leads both to improved physical balance and social involvement.

They don’t stay home; they get out and mingle. Such confidence similarly helps reduce anxiety about falling and the negative self-fulfilling expectation that can result when focusing too much on it.

My friend Charles Tatum, 85, has occasionally used a walker both at church and at neighborhood socials. “At first, it gave me some confidence and stability,” he said. “Then, I found myself depending on the walker more and more. So, now I am intentionally more selective about using it. I look for times and places to walk unassisted. But if I’m in a crowd, it helps me get others to move out of the way.

“That’s an unanticipated benefit,“ he says smilingly.

While canes and walkers can assist older people with both their stability and their confidence, many experts warn against letting shuffling become a habit if there are no other underlying medical condition since shuffling has physical consequences and takes a toll on the shufflers themselves. While there may be underlying medical reasons why someone shuffles, often shuffling results from a declining sense of possibilities. A shuffling gait is like a billboard advertising “old age.” No one wants it. No one wants to be associated with it.

Physical exercises can improve a shuffling gait when supplemented by a confident outlook. Engaging the mind is as vital as exercising the body. After all, we are only as old as we think we are. As my wife likes to say, “Age is just a number and mine is unlisted.”

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