Older people worry, legitimately, about falling. But can exaggerated anxiety about falling — even if physiological tests show your risk to be low — increase the probability that you’ll actually fall?
A team at Neuroscience Research Australia has found that it can. Conversely, older people who are physically at high risk, but don’t perceive much danger, fall less often than would be expected.
Mind over matter, as someone once said.
The study, published in the British medical journal BMJ and also reported in the New York Times, tracked 500 Sydney residents (average age: 78) who agreed to undergo a series of medical, physiological and neuropsychological tests. Most participants could accurately assess their odds of falling, but about a third were off the mark. They felt either more or less vulnerable than their strength, balance, reaction time and other physical characteristics would indicate.
Eleven percent, whom the research team dubbed the “anxious” group, had a higher perceived risk than was physiologically warranted. Twenty percent, labeled “stoics,” actually were at risk physiologically — but didn’t rate their risk as high.
Followed over a year, the anxious folks did fall more than the group as a whole: 40 percent suffered multiple or injurious falls. But only about a third of the stoics fell, despite their higher physical risk.
Psychological differences appear to affect people’s self-assessments, said Stephen Lord, an applied physiologist who was a member of the research team. “These anxious people were more likely to be depressed, to have restricted their activities, and it looks as though these factors feed on each other,” he said.
“People who are fearful do less, and that leads to deconditioning, to a loss of strength and balance,” he explained. Increasingly phobic about falling, sometimes unwilling to leave their homes, “they become preoccupied with the possibility. They catastrophize.” The stoic sorts, by contrast, maintained more positive attitudes and more active lives despite their physical problems.
Old people do fall frequently, of course, and they’re right to be concerned about minimizing the hazard. “It’s real, and the consequences are real,” Lord said.
But excessive caution that leads to a diminished life, with ruptured social connections, has consequences, too. Fear of falling is treatable, both physically and psychologically, Lord says. Regular exercise programs can help older people maintain, or regain, balance and strength, while cognitive behavioral therapy, focused and usually short-term, can reduce anxiety. The Australian team’s next project is to learn more about using these interventions.
“The message isn’t: don’t worry about falls,” Lord said. It’s that while fears can cause people to enter a downward spiral, “you can also spiral up.”