For Elderly, Fear of Falling Is a Risk in Itself
By N. R. KLEINFIELD,
NY Times
March 5, 2003
Sarah
Goldberg has used a motorized scooter since a fall several months ago. But
she does body conditioning and refuses to cut back on her activities.
"I worry about falling," she says, but adds, "I don't
restrict my life."
Who wanted to start? Ideas, anyone? What might make you fall?
As suggestions came flying back, two occupational therapy students
scribbled them furiously on a board. Throw rugs. Wet floors. Cracked
sidewalks. Ice. Toys. Steps. Ladders. Shoes. Poor circulation.
Lightheadedness. The list grew beyond the borders of the easel.
Debra Mlotek, one of the student interns from Columbia University,
said: "So there are a lot of risk factors. Things in our environment.
Things happening in our body."
Then she introduced an unmentioned force into the mix: fear of falling,
a phenomenon now interpreted as a significant risk factor of its own for
the elderly.
Shira Dworetsky, the other student, said: "I think it's very
important that we all talk about it. Talk about that fear."
One grim-faced woman in the audience cleared her throat: "Yes, you
develop an awful fear. You don't know when it's going to happen. It starts
affecting you emotionally, mentally and everything else. Eventually you
get paranoid. You're afraid to do anything. So I'm living with this
terrible fear of walking. If you stay home, you go crazy. If you go out,
you're in fear. Where's your life?"
Nods all around. The subject was dear to the small but intent audience,
13 elderly people seated in a circle at the Riverdale Senior Center in the
Bronx. There might have been more, but hard-fought bridge games at nearby
tables proved powerful competition.
Of the nagging, minute-by-minute worries of old age, none seems to
eclipse the fear of falling. Every mundane act — taking a bath,
scrubbing the floor, shopping for groceries — appears fraught with
peril. If you go down, what then? A bruise? A fracture? Or could this be
the big one, the one that sends you to the nursing home with no return
passage?
Falling has long been considered an inevitable byproduct of later life,
an unwelcome companion to white hair and bifocals. Studies suggest that a
third of people 65 or older fall each year. Health professionals, however,
increasingly are recognizing that falls are not a normal part of aging and
that many falls do not need to happen. In recent years, particular
attention has been paid to the fear of falling.
And so more clinicians are urging elderly people to talk about that
fear as well as to take precautions that might muffle it. Hence balance
courses. Hence fall videos. Hence products like dressing sticks, elongated
shoehorns, underpants with hip padding.
Hence this seminar.
They were meeting in the Green Room. Afterward, the area was reserved
for an exercise class. Made sense. Deal with fear of falling and then
exercise to strengthen the muscles and reduce the risk of falling.
The two students, Ms. Mlotek and Ms. Dworetsky, were doing fieldwork as
part of their graduate course "Prevention and Rehabilitation With
Older Adults," taught by Patricia A. Miller, an occupational
therapist and assistant professor of occupational therapy at Columbia. In
the last few years she has dispatched students to senior centers and adult
day care centers, and one of the more popular subjects they address is
fall prevention.
Ms. Miller talks about the inactivity cycle. People are scared of
falling, so they stop doing things. Some all but withdraw from life,
prematurely imposing immobility on themselves. As they do less, their
physical condition deteriorates, making them more susceptible to falling.
What they fear becomes more likely.
Jonathan Howland, a professor of social and behavioral science at
Boston University's School of Public Health who studies the fear of
falling, says that inactivity often leads to depression. That can require
medication, which can make someone more liable to fall. It can lead to
drinking, which can make someone more liable to fall. It can lead to
medication combined with drinking, which can really make someone more
liable to fall.
Studies indicate that 30 to 50 percent of elderly people fear falling.
Mr. Howland said that research he engaged in found that fear of falling
exceeded other commonplace anxieties like fear of being robbed in the
street, fear of forgetting an appointment and fear of financial problems.
Stimulus for this primal fear is everywhere. The elderly not only fall
themselves. In their world, they are witnesses to a montage of friends
falling, neighbors falling, strangers falling — last week, yesterday, 10
minutes ago.
Flora Cherot, in her 70's, lives alone in the Bronx, and had a fall two
years ago. Walked into her apartment, no warning, no nothing, and she was
on the floor, sliding seven or eight feet from the door. It took her a
half-hour to right herself. Nothing was broken, but the soreness persisted
for months. The moment is etched in her memory.
"In a senior center I used to go to, I'd see people coming in with
their arms in casts, wrists broken, legs bandaged," she said. "A
neighbor lady fell out of the bed several times lately. A man in my
building fell and broke his hip and was in rehab for several months. He
was back a couple of days and fell getting into bed and broke the other
hip. He still isn't back. You hear those things, and they make you
think."
Nancy Newman, 93, who lives in the same building, has had knee surgery
and suffered four fractured ribs as a result of falls. She keeps going,
her personal concern muted by other discomforts. "Actually my worst
fear is going to the dentist," she said.
With an aging population, treating the fear is an intensifying issue.
It involves lifestyle and life itself. An estimated 10,000 people 65 and
older die each year from injuries related to falls. And it involves money,
in the ever-deepening well of health-care spending. The entire cost of
falls is hard to calculate, but health care professionals agree it is in
the tens of billions of dollars a year, and rising.
Dr. Mary Tinetti, a professor of medicine and public health at the Yale
University School of Medicine and an expert on falling and the elderly,
feels much progress has been made in investigating the subject, but
believes that falling still doesn't get broad enough respect from many
health care professionals. "They need to try to prevent falls in the
way that they try to prevent heart attacks and strokes," she said.
She emphasizes conditioning the person rather than modifying the home
by eliminating scatter rugs and adding handrails, for example, though she
supports these measures.
Mr. Howland said that people needed to learn about the trade-off
between the risk of immobility and the risk of mobility, and then find the
right balance for themselves.
Ruth Schaefer, 89, took in the Riverdale seminar, and for good reason.
She admitted to poor balance, to more falls than she could easily tote up.
She has twice fractured a hip.
"I fear falling," she said. "You betcha. I'm always
worried about it. My husband is dead five years. We had the car and he was
always holding my hand and all that nonsense. Now it's just me and my
feet."
She has cut back on using them. "I don't go out as much as I used
to," she said. "I don't walk that much. I'm afraid of getting
hurt. I try not to think about a nursing home, but it's there."
She is exceptionally attentive to the wind. "I think the wind is
the biggest factor for someone who's old," she said. Before she
ventures out, Ms. Schaefer listens to the radio to catch the wind speed.
"Anything over 15 miles per hour, I don't move," she said.
"I'm not very happy even with 15. I like it about 10. Then it's not
too bad."
She was asked about padded underwear. It is a product — pads attached
to underwear to protect the hips if you go down — that a lot of health
professionals endorse. A French company makes some frilly ones. "I
wouldn't do that," she said. "I've got no clothes to wear over
something like that."
Who would go fearless against falling? Sarah Goldberg, 69, attracted
rapt interest from the Riverdale audience when she shared her story. She
has an ongoing relationship with the floor. She figures she averages two
or three falls a year. Once, she fell in the shower and lay there for 17
hours until she was discovered. "You name the place," she said,
"and I've fallen there."
She was riding in a motorized scooter today. She had fallen just a few
months ago. Nonetheless, she carries on undeterred. She has an
invulnerable core. She stares fear of falling in the face and makes it
quake.
"I worry about falling," she said. "But I don't fear it.
I don't restrict my life."
A couple of years ago, she had an occupational therapist visit her
apartment to try to make it as fall-proof as possible. Two months ago,
after her most recent fall, she again invited a professional in for an
update. "You always have to upgrade," Ms. Goldberg said.
The toilet was raised, some additional handrails installed. She got a
dressing stick, a rod with a hook at the end to help her pull on pants.
She got an elongated shoehorn. She got a reacher so she can grab things
she drops without bending over and risking a fall. She also uses it to
shut the door behind her.
She makes a point of doing weight lifting and tai chi at the senior
center to stay in shape.
And so she lives. "You shouldn't stop going on living because you
have a fear of falling," she said. "Once you restrict your life,
you're finished. Everything goes. I love life too much for that."
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