Taking a tumble may do more than break an elderly person’s bones. It could also damage their confidence, bruise their sense of independence and increase the possibility of developing a mental illness such as depression or anxiety.
Everyone can be at risk of having a fall, but older adults can be more vulnerable due to the presence of a long-term health condition, reduced balance, impaired vision and medications. Falls occur in up to one third of all people aged over 65 who are living in the community and more than half of all elderly people living in residential care facilities. 20-30% of falls result in moderate to severe injury. Falls threaten the independence of elderly people and can cause a number of individual and socioeconomic consequences, such as restricted mobility, social isolation, and mental health issues. Many elderly people are reluctant to report a fall if it only resulted in a minor injury. This may be because they attribute falling to the ageing process, they fear having to restrict their activities or being admitted to hospital or residential care.
The physical impacts of a fall can have vast and debilitating consequences for older people. However, the psychological and social impacts can be overlooked and often result in equally debilitating outcomes. One of the most negative effects of falling is the fear of falling again, which occurs in up to 60% of elderly people who have had a prior fall. This fear can result in a number of secondary consequences, such as avoidance of daily activities such as cleaning, shopping and visiting friends and an over reliance on walking aids. Limiting activity after a fall may lead to stiff joints and muscle weakness which further reduces mobility and increases the risk of falls. It can also result in greater dependency on family and professional carers which can reinforce feelings of helplessness and lead to depression.
After a fall, elderly people may experience the following emotions:
Shame and embarrassment: The fall may have happened in a public place such as tripping down the stairs at a shopping centre. Elderly people may feel embarrassed that they had been so clumsy and caused such a fuss. Equally embarrassing they may have slipped in the shower and a family member has found them naked and unable to get up.
Guilt: After a fall they may not be as mobile as they used to be and rely on their family to do things, such as shopping and cleaning. Elderly people may feel guilty that they have become a burden for their family.
Frustration: If the elderly person had previously been very active, independent and autonomous, it may be frustrating for them to have to sit still and rest, to be unable to do things for themselves and to have to ask for help, even if it is just for a few weeks while they recover.
Anger: Older people may feel angry at themselves for not paying attention to where they were walking, or dwell on the incident thinking about what they could have done differently. Alternatively they may be angry at their family or carer for not looking after them. They may have thoughts like ‘why did they leave the chair pulled out where I could trip on it?’ or ‘why weren’t they there to help me?’
Depression: Recovering from a fall can be a long process which restricts mobility and completing daily activities such as hanging out the washing or driving to the shops. Restricted mobility may cause isolation and loneliness. It may also stimulate feelings of helplessness and hopelessness.
Anxiety: Experiencing a fall can be a painful and daunting experience for older people, especially if they sustained severe injuries or were unable to get up unassisted. Anxiety may develop as a result of thinking about having another fall. This may result in the individual losing their confidence and becoming withdrawn.
How a psychologist can help
After a fall it is common for older people to not feel themselves. They may feel anxious about falling again or about their future, they may feel down on themselves or think that they will never get their functionality back to the way it was before the fall. Some people might even start to feel like a failure because their mental or physical health has declined from where it was before the fall or that they are not recovering at the rate they thought they would.
Psychologists can work with older people to help them learn and utilise effective strategies to restore their function and well-being. Recovering from a fall is not an easy feat. Apart from the initial fall, people may experience secondary issues such as knee or hip surgery, needing to move house, spending some time in respite care or learning how to do things differently.
Therapy can be helpful for understanding and managing the emotions and physical challenges that may come after a serious fall. Psychologists are good at helping people to overcome feelings of shame and embarrassment by providing a healthy and objective perspective of the situation. They can help people reduce their frustration through breathing or meditation exercises, communication skills or cognitive restructuring. In some cases, people may develop depression or anxiety after a fall. Therapy can be effective for dissipating the black cloud of depression and restoring a person’s sense of purpose.
Sometimes all that is needed is a change in perspective and the tools to get started. Psychologists can help people put new strategies into place and support them on their recovery journey.
Department of Trade and Industry. (1993). HASS listings for 1993, for males and females aged 50 and above for falls. Consumer Unit, DTI.
Rubenstein, L. Z., Josephson, K. R., & Robbins, A. S. (1994). Falls in the nursing home. Annals of Internal Medicine, 121(6), 442-51.
Sterling, D. A., O’Connor, J. A., & Bonadies, J. (2001). Geriatric falls: Injury severity is high and disproportionate to mechanism. Journal of Trauma–Injury, Infection and Critical Care, 50(1), 116-9.
Tinetti, M. E., & Speechley, M. (1989). Prevention of falls among the elderly. New England Journal of Medicine, 320, 1055-1059.
Tinetti, M. E., Speechley, M., & Ginter, S. F. (1988). Risk factors for falls among elderly persons in the community. New England Journal of Medicine, 319, 1701-724
Tinetti, M. E. (1990). Falls efficacy as a measure of fear of falling. Gerontology , 45, 239-43