June 15, 1999 Most people reach a point in life when they think twice about bounding up stairs, buying high-heels, or climbing onto roofs to clean gutters. The fear of falling gradually creeps into the consciousness of aging adults and can become a daily worry, said Elizabeth Peterson, clinical assistant professor of occupational therapy at the University of Illinois at Chicago.
Peterson is among a group of researchers who have identified fear of falling as a disability that can effectively be treated by health care providers. She and her colleagues designed and tested a program to help older adults overcome their fear of falling and proved its effectiveness in a five-year study of 434 older adults from four senior housing sites. The fear of falling is common among older adults and often results in their limiting a wide range of activities, which not only diminishes their quality of life, but also may increase their risk of falling, Peterson said.
Previous falling research focused on environmental changes, such as handrails, and was largely ineffectual, according to Peterson. Her team's successful program focuses on encouraging older adults to be realistically concerned about falling and developing a wide range of fall-prevention skills. The program, titled "A Matter of Balance," aims to instill adaptive beliefs such as greater perceived control, greater confidence in one's abilities and greater assessment of failures.
The first step is making seniors aware of their own beliefs and attitudes about falling, Peterson said. Many older adults think that falls are an inevitable part of aging and that being sedentary is the only way to reduce the risk of falling. The researchers help older adults understand that there are many actions they can take to reduce their risk. Exercising regularly, communicating assertively, and finding alternatives to potentially risky behaviors are among the actions the researchers recommend.
"We don't just tell them what to do," said Peterson. "We want them to come up with solutions on their own." When participants in the study, for instance, imparted their fear of falling while alone in their apartments and not being able to get up, their counselor encouraged them to come up with an idea that would address this concern. The seniors devised a system to help ensure that no one would be left immobilized in their apartment overnight. They created cards, one side blue and the other side yellow, to hang outside their doors, and agreed to turn the blue side out just before going to bed.
Each night someone would survey the hallways to make sure that all the cards had been turned. If a card had not been turned, the monitor would check on the person in that residence. "We try to give participants ownership of the solution, which helps them maintain their independence and sense of control over their lives," Peterson explained.
"Falls are an emotionally-laden issue that represent loss of independence," said Peterson. "Seniors are loath to divulge falls to children or health care providers for fear that they will be sent to a nursing home."
Peterson and her colleagues now are testing a modified version of their program among older adults who have experienced a fall-related injury and are living independently. She said the next step is to train health care providers throughout the country in the model program.
With 25,000 students, the University of Illinois at Chicago is the largest and most diverse university in the Chicago area. UIC is home to the largest medical school in the United States and is one of the 88 leading research universities in the country. Located just west of Chicago's Loop, UIC is a vital part of the educational, technological and cultural fabric of the area.
UIC RESEARCHER PROVIDES FALL PREVENTION TIPS FOR OLDER ADULTS
Compiled by Elizabeth Peterson, clinical assistant professor of occupational therapy at the University of Illinois at Chicago and expert on falling and fear of falling among older adults
How to Reduce the Risk of Falls
· Take charge Talk to your health care providers to identify your risk factors for falls.
· Get involved Take an active role in creating fall prevention strategies that fit your needs, lifestyle and goals.
If, for instance, you still are storing food and other items on high shelves, you may want to consider asking someone to help you bring everything down so that you aren't reaching up for things even infrequently.
Remember, unless you are satisfied with a plan to reduce the risk of falling, it is unlikely that you will follow through with it.
· Prioritize Falls often are caused by many factors and may require a variety of prevention efforts such as reducing the number of prescription medications, changing positions slowly to avoid a drop in blood pressure, and installing grab bars by the toilet.
Once you've learned what your fall risk factors are, decide which one you want to address first. Take into consideration which change is the easiest to make and which will have the greatest positive impact on your health.
Success in eliminating one risk factor likely will motivate you to continue your efforts.
· Exercise Exercises that improve balance, such as Tai Chi, have been shown to reduce fall risk.
Talk to your doctor and explore community resources to find an exercise program that will work for you.
You can gain the support needed to stick with an exercise program by exercising with a friend.
· Be assertive Making requests, for example, to have a dangerous throw rug removed or for a seat on a crowded bus, is not a sign of dependence.
We all need advice and assistance from time to time. Such requests are a way to help you avoid a fall and maintain independence.
· Have a contingency plan Know what you will do should you fall when you are alone.
Find out from your health care provider about the best way to get up after a fall.
Have a plan for reaching help.
Ask someone to routinely check on you to ensure your safety.
How to Reduce Concerns about Falls
· Acknowledge the concern Your concern about falling is a rational response to a real threat to your independence -- many older adults share this concern.
Being aware of your concerns about falls and how they impact your physical or emotional health is the first step in managing the fear of falling.
· Explore your attitudes Negative attitudes about aging and fall prevention, such as "exercise is dangerous at my age," block your desire and ability to take positive stops to prevent falls.
Positive thoughts, on the other hand, inspire action.
· Practice, practice, practice To gain confidence in your abilities to reduce fall risks, you will need to prove to yourself that you have the necessary skills. These skills vary depending on your unique fall risk factors.
Common skills used to prevent falls include exercising regularly, communicating assertively and finding alternatives to potentially risky behaviors.
· Be a problem solver Set goals and create action plans.
Identify potential barriers upfront to accomplishing goals and address these threats to your success.
Remember that needs change over time, so re-evaluate your fall risk factors, goals and action plans.
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