Understanding the psychology of falls

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Eleanor Feldman Barbera, Ph.D.
Eleanor Feldman Barbera, Ph.D.

According to the American Geriatrics Society, one in three adults over the age of 65 falls each year. Falls represent the leading cause of fatal and nonfatal injuries among older adults. You might be surprised to hear some of the contributing factors of falls and the psychology behind them.

Associated Factors

Falls are caused by many different influences, often in combination. Some common elements include:

  • Medication — the major contributors are psychotropics (especially benzodiazepines, antidepressants, and antipsychotics), medications that reduce blood pressure and anticonvulsants
  • Polypharmacy — one study found a 14% increase in fall risk with the addition of each medication beyond a four-medication regime, regardless of the group of drugs studied
  • Orthostatic hypotension — researchers noted a 69% increased risk of having an injurious fall during the first 45 days following antihypertensive treatment
  • Alcohol abuse
  • Diabetes mellitus
  • Confusion and cognitive impairment
  • Gait and balance disorders
  • Muscle weakness
  • Poor vision
  • Urinary incontinence
  • Inappropriate footwear
  • Environmental factors including home hazards

Impact of falls

Falls can have a huge effect on the quality of life of our elders, who may have diminished mobility following an injurious fall. One-third of those who have fallen develop a fear of falling again and often reduce their activities in order to decrease the likelihood of similar mishaps. For those who have fallen in a facility, staff may limit the resident's activities. Restricted activities, whether self-imposed or enforced by others, can contribute to depression. As noted above however, prescribing anti-depressants can increase the risk of future falls.

Concealed falls

Due to fear that their independence will be limited, some elders may hide the fact they've fallen. Residents have confessed past falls to me in their psychotherapy sessions, saying they were afraid they'd be forced into a wheelchair if anyone knew, or that they wouldn't be allowed to go home after rehab.

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