In his 1933 inaugural address, President Franklin Delanor Roosevelt said “The greatest thing we have to fear is fear itself…”. Although this quote was aimed to inspire a nation of people to march forth in the face of a great depression, FDR spoke it from the heart, inspired by his own personal fear of falling as a result of his impairments from polio. He feared both the ridicule and the physical consequences of falling could alter his ability to lead. However, with inspiration from a physical therapist, he was able to overcome this fear and use his personal challenges as a catalyst for success.
Despite massive efforts, falls remain a devastating problem
Unfortunately, many individuals can relate to such fears – and find themselves physically and socially paralyzed by a fear of falling. Recent studies have shown that people who live in fear of falling and have low confidence of their balance skills when walking or performing daily tasks are actually at a higher risk of falling than those who don’t hold that same level of fear, with most other factors being equal.
Decreasing fall risk is paramount to public health as the statistics of falls are quite staggering. According to the CDC, 1 in 4 older adults fall resulting in 36 million falls each year. Shockingly, falls are the leading cause of injury related death in adults aged > 65 years. The age -adjusted fall death rate increased by 41% from 55.3 per 100,000 older adults in 20121 to 78.0 per 100,000 older adults in 2021. It’s no wonder so many people are fearful of falling! In fact, the prevalence of fear of falls in older adults is estimated between 20 and 39% and increases to 40-73% in those who already experienced a fall. Advanced age, female sex, and depressive symptoms were also highly correlated to increased fear of falls according to this meta-analysis.
Fear of falls increases the risk of actual falls across environments
What are the consequences of being afraid of falling? When someone fears falling, they instinctively start to limit their mobility to prevent a potential fall, thus starting a downward spiral of negative health outcomes. The positive feedback loop begins when fear prevents movement which results in weakness and poor balance – further limiting mobility and increasing fear. To complicate matters more, a study by Deshpande et al. concluded that there are significant functional differences between older people who have a fear of falls in the home and those who have a fear of falls in their community. This suggests the importance of classifying fear according to the environment. This study measured multiple domains of health including cognitive, psychosocial, and physical (inclusive of strength, balance and gait speed). Those individuals who expressed fear of falls in the home demonstrated significantly decreased outcomes in all domains when compared to their peers who expressed fear of falls in the community highlighting the importance of assessing fear in all individuals who exhibit low functioning. Understanding an individual’s unique fear, mobility status, and needs is paramount for providing them with the appropriate resources to maximize their independence while keeping them safe.
It’s time to address falls with novel solutions
There are many available tools to assess and treat fall risk, so how do you choose the best one for your patients? Sometimes the best answer is also the easiest! Simply ask your patient what they think their probability of falling within the next few months is and offer the response of low, medium, or high. Ask your patient about their history of falls and inquire about the context of that fall. For example, was it in the home or outside? Did they trip over something or just lose their balance?
Routine mobility and fall risk assessment should be required for all people aged 65 and older. Utilizing a combination of functional tests, gait assessments, fall history and understanding fear of falling gives the most complete picture of your patient’s fall status. There are many new resources and technologies that can help assess fall risk, provide interventions and detect falls as they occur.
OneStep is a digital care solution, based on patented smartphone-only motion science, equipped with all the tools needed to assess, treat, and monitor patients both in person and remotely. OneStep's fall risk assessment technology empowers providers with heightened visibility into patient mobility so that they can deliver the most precise, proactive care possible. By capturing ongoing gait and mobility data, OneStep is able to detect changes and immediately notify providers – enabling them to intervene before a fall occurs.
Additionally, patients are able to stay connected with their healthcare providers, offering them a sense of comfort knowing they can reach out with concerns and that someone is monitoring their risk for falls. They can also track their own progress and see their mobility improve in real-time, helping to boost confidence in their functional abilities.
OneStep has helped organizations across the U.S. reach more patients and progress safely toward their mobility goals. In fact, Senior Living Communities using OneStep have seen a 45% reduction in falls amongst their residents!
Encouraging health through movement
Research shows that the more patients move, the healthier they’ll be in the long run. In order to optimize mobility, providers and patients need the right tools to assess and inspire movement. It’s time to lean on technology to not only offer patients digital touchpoints and connection, but also to capture important mobility data that might otherwise be missed – resulting in poor outcomes that could have been prevented. The way we move reveals so much about us, and with technology we can listen more closely to better serve our patients.