| Tampa Tribune article on Fall Prevention: Fear Of Falling Haunts Elderly By DONNA KOEHN dkoehn@tampatrib.com Published: Sep 8, 2003 TAMPA TRIBUNE TAMPA - It's a fear that can drive older adults to retreat into their homes, locked inside and withdrawn from the world. They tell no one - not their grown children, certainly not their doctors. And, in an ironic twist, their self- protective behavior can make what they dread more likely to come true. For an estimated one-third to one- half of elderly people, the boogeyman is a fear of falling. ``It's a huge concern to older people,'' says Pat Quigley, a faculty member of the University of South Florida's College of Nursing who has researched the phenomenon. ``They are afraid of it. But they won't tell anyone.'' To a younger person, a fall can be embarrassing and painful, maybe resulting in a few bruises or sore muscles. But to an elder, a slip in the bathtub or a missed step off the curb can mean fractures to fragile bones, a rapid decline in health, a loss of independence, even a permanent trip to a nursing home. Falls are the leading cause of injury deaths for people 65 and older. Elders have seen it happen to relatives and friends. They cringe as they read newspaper stories, such as last week's report about a 91-year-old Florida man who became weak cleaning his roof and lay there for two days, calling for help, before he rolled to the ground and eventually was found. And one of the longest-running punch lines ever - ``I've fallen, and I can't get up!'' - carries no humor at all. So if they fall, they tell no one. Even if they don't, they worry. When eyes and ears are beginning to fail and aging bones and muscles make getting around more of a challenge, a healthy dose of caution is a good thing, experts say. But too much fear can lead to a shuffling gait and a withdrawal from activities, causing muscles to stiffen and atrophy - leading to an even greater likelihood of a fall. ``It's one thing to be careful, but it's another to stand in front of two steps and be afraid to move,'' says Celinda Evitt, patient education coordinator with the Veterans Health Administration in Tampa. Judy Stevens, an epidemiologist with the Centers for Disease Control and Prevention in Atlanta, is conducting a national survey of the fear of falling. She believes there are psychological ramifications as well. ``If people are withdrawing because of the fear, that can lead to depression,'' she says. ``And people believe a fall is the beginning of the end.'' Had his wife not watched it happen, Harold Osborne, 73, admits he probably would have told no one about his spill outside his doctor's office. ``I worry all the time about falling,'' he says. ``It does bother me. I don't do long walks anymore. I don't drive.'' Margaret Osborne, his wife of 50 years, thinks he's more afraid. ``I know he wouldn't have told the doctor if I hadn't been there,'' she says. As a veteran, Harold Osborne is entitled to evaluation and treatment at the Veterans Affairs Patient Safety Center at 11605 N. Nebraska Ave. in Tampa, a facility its directors say is unique. Its interdisciplinary team helps patients improve balance and mobility to prevent falls. It also works to lessen their fears. Bill Herman of Brooksville, 77, attends a functional balance class at the center. He isn't all that afraid of falling, he says, although a stroke, hearing and vision loss, and equilibrium problems have sent him tumbling twice. ``I can catch myself,'' he says. ``But it's scary, especially for elderly people, especially when they're alone.'' Fear Is A Delicate Question Getting elders to admit to the fear is difficult, says USF's Quigley, who also is associate director of the safety center. ``We received a $3.2 million grant to look at the issue, and we had planned to start a fear of falling support group,'' she says. But the veterans she serves, almost all of them men, wouldn't participate. ``We have to get at the fear by asking certain questions of the patients who come to us who've already fallen,'' she says. ``We ask, `Do you have concerns?' `Do you restrict what you're doing because of it?' '' Tatjana Bulat, a USF medical school geriatrician and medical director of the safety center, tries to persuade patients to wear a special underwear with hip protectors to reduce the risk of broken hips. Fifty percent of people who fracture their hips never regain their previous mobility, and broken hips can precipitate a perilous decline in health for elders. The problem is, no one wants to wear the protectors, which add about a half-inch to each hip. ``Our major issue is compliance,'' Bulat says, even though the center provides the $50 garments free to its patients. ``We did a survey of our outpatients who are at risk for falling, and 60 percent didn't even bother to try them on. ... Those who did said they did feel more secure.'' Increasing the confidence of patients is one of the goals of Stephanie Hart-Hughes, physical therapist and director of the center's gait and balance laboratory. Gripping them by their waistbands or hovering nearby, she leads patients through activities designed to challenge their equilibrium, sharpening some senses to compensate for others that are failing. ``It would be nice if we lived in a world of flat surfaces,'' she says. ``They need to learn to balance in different conditions. We do a lot of work here with our eyes closed. You really depend on your eyes for balance, so when they're in the shower and they close their eyes to wash their hair - boom! - they fall over.'' Although groups such as this one are rare, Hart-Hughes says many physical therapists do similar work one-on-one with patients. Sometimes the cost is covered by Medicare. Some Choose Tai Chi Another possibility is tai chi, a discipline developed hundreds of years ago in China that features slow movements and relaxation to enhance strength and balance. Research has confirmed its benefits; an injury prevention program of the state's Department of Elder Affairs even publishes a pamphlet, ``Are You Afraid of Falling Down? Let's Try Tai Chi.'' ``I work closely with older people who are scared to death of falls,'' says volunteer Becky Clemments, who teaches at the nonprofit Taoist Tai Chi Society's Brandon site. ``I've seen people who have started out in wheelchairs graduate to walking with a cane to walking holding on to my finger.'' Tai chi student Allison Elrod of Brandon, 64, fell while planting a small palm tree in her garden, breaking her foot in four places. ``I had really lost confidence,'' she says, ``and I'm still afraid of falling. But tai chi has helped me learn the position of my body to be sure of my balance.'' Experts stress that although falling is a legitimate concern, it isn't necessarily a one-way pass to a nursing home. They urge seniors - and their grown children - to bring up the fears and seek medical advice. They also encourage physicians to ask about falls. ``There are things doctors can do to help,'' says the CDC's Stevens. ``Just don't freeze up and do nothing. That's the worst possible way to go.'' Reporter Donna Koehn can be reached at (813) 259-8264. |
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