How can older adults overcome a fear of falling?

Why is fear of falling a problem?

Many older people who have fallen, and many who have not, worry about falling. Some caution is sensible, but when fear leads to avoiding walking, going out or doing everyday tasks, muscles weaken, balance worsens and social contact reduces. This cycle can increase the risk of falls and loss of independence.

Fear of falling is also linked with anxiety and low mood, which can make people feel less able to cope.

Does exercise reduce fear of falling?

A Cochrane review of 30 studies with 2,878 older people living in the community found that exercise interventions, including tai chi, yoga, balance training and strength training, were associated with a small to moderate reduction in fear of falling immediately after the intervention, based on low-quality evidence 1.

Exercise also reduces falls themselves. A Cochrane review of 108 trials found that exercise reduced the rate of falls by 23 per cent and the number of people experiencing one or more falls by 15 per cent in older adults living in the community 2.

What is a falls risk assessment?

UK guidance on falls recommends assessing older people who have fallen or are at higher risk. A falls assessment may look at walking and balance, muscle strength, medicines, vision, blood pressure changes on standing, foot problems, continence, cognition and home hazards, and it may lead to a tailored plan including strength and balance programmes 3.

Addressing individual risk factors, such as adjusting medicines that cause dizziness or treating cataracts, can reduce risk and improve confidence.

How can confidence be rebuilt?

Confidence often returns through practice. A physiotherapist can help people practise feared activities in small, safe steps, such as walking outdoors, using stairs or getting up from the floor. Setting realistic goals and noticing progress helps.

Learning how to get up after a fall, or how to summon help, reduces anxiety. Personal alarms or phones kept within reach offer reassurance, especially for people who live alone.

What changes at home can help?

Removing trip hazards such as loose rugs and cables, improving lighting including night lights, installing grab rails in the bathroom and rails on both sides of stairs, and keeping frequently used items within easy reach reduce fall risk.

Wearing well-fitting shoes with a good grip, rather than loose slippers, and using a walking aid correctly if one has been recommended also help.

Can talking therapies help?

For people whose fear is strong or associated with anxiety, approaches based on cognitive behavioural therapy can help challenge unhelpful thoughts about falling and gradually increase activity. These are often combined with exercise.

Group programmes can also provide social support and motivation.

How can families support someone who is afraid of falling?

Families can help by encouraging, rather than discouraging, safe activity. Well-meant advice to sit down and rest can increase fear and weakness. Walking together, supporting attendance at exercise classes and praising progress build confidence.

Families can also help check the home for hazards, make sure glasses and hearing aids are used, and encourage the person to discuss dizziness, medicines and falls with their doctor. Listening to worries without dismissing them helps people feel supported.

When should a fall be assessed by a doctor?

Seek medical assessment after a fall with injury, head injury, especially in people taking blood thinners, loss of consciousness, new confusion, or inability to get up without help.

Repeated falls, dizziness or blackouts, or new difficulty walking should also be assessed, as they may have treatable causes.

Frequently asked questions