You’re watering your plants or retrieving the newspaper from the front step when you suddenly find yourself flat on the ground. This unexpected turn of events can leave you with more than just bruises. A fall can also have lasting psychological effects, manifesting into a fear of falling again.
For Canadian seniors, falls remain the leading cause of injury-related hospitalizations (1), so a fear of falling is not unfounded. In Canada, 34% of older adults report being concerned about falling (2), and this fear is most common in those who have hit the ground recently (3).
A fear of falling can lead people to play it safe – older adults will often go out less often and participate in fewer activities (3), leading to less social interaction and a lower quality of life (4;5). A fear of falling can also lead to poor balance (5), and may even change the way a person walks (6). The irony is that playing it safe creates a circular problem in which a fear of falling becomes a risk factor for future falls (4).
Many studies have examined ways to ease the fear of falling, with interventions such as fall-related programs that focus on multiple components and risk factors, tai chi, and exercise, in particular, showing promise (7).
More recently, studies have examined whether cognitive behavioural therapy (CBT) reduces fear of falling in older adults. CBT aims to change how a person thinks (“cognitive”) and acts (“behavior”), which can markedly improve how they feel. This approach can help people overcome their fear of falling by shifting their focus from pessimistic thoughts to things they can do – such as exercise – to lower their risk of falling. This shift in focus encourages people to safely increase their daily activity level (8).
What the research tells us
A recent systematic review and meta analysis looked at CBT delivered in groups or privately, either in person or over the phone. CBT sessions lasted between 4 and 20 weeks and included goal-setting and promoting physical activity.
This review found that CBT may lower the risk of falling and improve balance by small amounts in people 60 years of age or over who live at home. For risk of falling, effects began immediately after therapy ended and lasted for 6-12 months, while for balance effects were not immediate and only seen within 6 months of treatment ending. It also appears that individual CBT may produce stronger effects than CBT done in groups. These findings suggest that CBT is a promising strategy for addressing fear of falling among older adults. But despite the positive results, more research is needed owing to the small number of studies included, exclusion of older adults with certain health conditions, and variability among the CBTs used in the different studies (8).
If past falls have filled your mind with worries, CBT may be a useful technique to help you quell these doubts, and encourage you to move around with confidence once again!
