Fear of falling is likely to lead to future falls among older people, irrespective of their actual fall risk, according to a recent study.
The study indicated that measures of both actual and perceived fall risk should be included in fall risk assessments to help tailor interventions for preventing falls in older people, according to Stephen Lord, senior principal research fellow for the Falls and Balance Research Group at Prince of Wales Medical Research Institute and co-author of the study.
Fear of falling is common in older people and is associated with poor balance, anxiety, depression and falls. But the problem of irrational fear has been neglected in the scientific literature. A team of researchers from Australia and Belgium set out to improve their understanding of fear of falling and its impact on the risk of falls.
Five hundred people, aged 70 to 90 years, living in Sydney, Australia took part in the study and underwent an extensive medical and neuropsychological assessment. Actual and perceived fall risks were then estimated using recognized scoring scales and participants were followed up monthly over a 1 year period.
The researchers found that both actual fall risk and perceived fall risk independently contribute to a person’s future fall risk.
“It appears that fear leads to a restriction of activities and a consequent downward spiral,” Lord told O&P Business News. “That is, fear leads to less activity, then deconditioning, then fall with an injury and then more deconditioning. This can lead in the long term, or sometimes even the short term, to loss of independence and need for nursing home care.”
Further analysis was then used to split the sample into four groups based on the disparity between actual and perceived risk.
Most people had an accurate perception of their fall risk. Those in the “vigorous” group (low actual and low perceived fall risk) were considered at low risk of future significant falls, while those in the “aware” group (high actual and high perceived fall risk) were considered at high risk of future significant falls.
Overall, it seems that high levels of perceived fall risk are likely to result in future falls, irrespective of the actual risk and the disparity between actual and perceived fall risk contributes to risk mainly through psychological pathways, the authors found.
The findings also suggest that reducing fear of falling is not likely to increase the risk of falls by making older people overly confident, they add.
“The most surprising finding was that we did not uncover a group of risk takers that were overly confident and thus suffered more falls than you would expect based on their physical tests,” Lord explained. “We think that through a positive outlook, these people maintained their activity levels and consequently did not increase their risk of falls and also a good quality of life.”
