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Fear of Falling

Fear of Falling

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Fear of Falling

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  1. Fear of Falling Steve Malkin Psychology Department MECRS

  2. Homework

  3. Introduction - Why talk about Fear of Falling? • Fear of Falling (FOF) is common • Severe forms are distressing & limiting • Can be a risk factor for further falls • Can be addressed • awareness versus expertise.

  4. Magnitude of the Problem • 25-50% of fallers will become anxious about future falls • About 25% of fallers will restrict activities due to fear of falling • Up to 15% of elderly non-fallers (near-misses, vicarious experience) develop fear

  5. Falls Efficacy • Confidence in ability to complete certain tasks without falling • A better predictor of poor functional and social outcomes than fear of falling per se although they are correlated (Tinetti 1994).

  6. Assessment - some things to remember • Increasing observational/behavioural focus with increasing cognitive deficits • Some level of apprehension is often reasonable and understandable i.e. who not to treat. • Phobic Criteria - marked, persistent fear recognised as out of proportion with actual abilities and/or a problem in itself?

  7. Assessment - Interview • Interview • direct questions about fear, anxiety or “nerves” in situations where falls are a possibility • consider asking questions about levels of confidence in completing certain tasks without falling • questions about activities avoided for fear of falling • questions about feelings/bodily sensations (e.g. racing heart) - often useful in vivo

  8. Assessment - Observations • In therapy/on ward • Patient recorded • Staff recorded

  9. Assessment - Inventories • e.g. Modified Falls Efficacy Scale (Hill et al 1996) • More precise measurement of degree of problem and change • encourages disciplined approach • More time consuming

  10. Options for Management • Theory from other anxiety disorders - cognitive-behavioural approach • Research • large scale community-based study (Tennstedt et al, 1998). Benefits for regular attendees • nothing in inpatient setting • anecdotal evidence - it’s difficult

  11. Considerations When Planning to Intervene • Safety First • Factoring in cognitive status • Group versus individual • meshing with existing routine • understanding the patient’s point of view

  12. Communication • Respect • Empathy • Reflective Listening • Rationales for and agreement to interventions

  13. Suggested Components of Intervention • Education re anxiety and falls prevention • Relaxation • Exposure Hierarchies • meshing with ward, physio, OT tasks - esp. when anxiety is the main barrier • Identifying and challenging maladaptive thinking • Specialist referral

  14. Organisational Challenges • selling the idea • Who coordinates? • Who does what when? - clear responsibilities and incorporation into the routine • Access to Psychological supervision/training/specialist assessment and input