I’m very anxious about falling. My anxiety and fear keep me from regular activities that I don’t want to give up. What can I do?

Response from Julie Loebach Wetherell, PhD :

People over the age of 85 are the fastest growing demographic group in the United States. And by 2050, two billion adults older than 65 will be living on this planet.

Among the many concerns of older adults is an excessive fear of falling, which is a serious condition that can lead to inactivity, disability—and falls.

Fear and Avoidance

Older adults fear falling more than robbery, financial stress, or health problems. About 10 percent report excessive fear, and at least 3 percent of community-dwelling older adults avoid leaving their homes or yards.

Most people who fear falling avoid some physical activities. This fear is a better predictor of decreased physical activity than age, perceived health, number of prescription medications, gender, or history of falls.

Fear of falling and less physical activity lead to disability, including decreased capacity to perform daily living activities such as bathing and shopping. Fearful individuals often slow their gait, widen their stance, and make other adjustments that badly affect their balance. They may experience other measures of physical decline as well.

Paradoxically, the fear of falling increases the risk of falls. It also increases the risk of having to enter a health care facility and the loss of independence. Those who had excessive fear but no falls over a two-year period increased their risk of entering a nursing home five-fold relative to those with low fear.Of older adults in one scientific study, 56 percent with high levels of fear fell again within the following year, while only 37 percent of those without fear did.

Improving Your Quality of Life

Although appropriate caution is healthy, avoiding too many activities puts you at risk. If you have a fear of falling or want to help a friend or loved one, try the strategies below. But don’t be too protective. You could end up reinforcing the fear and making things worse in the long run.

• The Centers for Disease Control and Prevention [1] has helpful information about reducing the risk of falling, including ways to make a home safer (getting rid of floor rugs, improving lighting, installing grab bars, etc.).

• Some local agencies can help install and even pay for home modifications; call your local Area Agency on Aging [2] or county senior services department to find referrals.

• Have a doctor or pharmacist review a list of your medications to make sure they don’t increase the risk of falling; include all over-the-counter medications, including sleeping pills.

• Ask a doctor for a referral to a physical therapist who can evaluate and recommend activities and ways to do them safely. Use a cane or walker if they are recommended.

• With approval from a health care professional, start an exercise plan that emphasizes strength, balance, and mobility. Tai chi is particularly effective for people with concerns about falling. People who are not willing or able to leave their homes may wish to investigate classes on a local cable channel or purchase a commercial video.

• Instead of avoiding activities that make you nervous, start small and take it slow. For example, visit the mall for a brief but manageable amount of time—around 15 minutes—when it isn't crowded. Use a cane or walker if your health care provider recommends it. Work up to longer periods, and rest as needed.

To improve your health and quality of life, ask your health care providers what else you can do and how to do it safely.

Julie Loebach Wetherell, PhD, is an Associate Professor in the Department of Psychiatry, University of California, San Diego