Seniors’ Fear of Falling: How You Can Help
With the Baby Boomer population aging, movement professionals have to become more prepared to meet the needs of older adults. And while it may be tempting to think seniors need less when it comes to program development, clients of advanced age actually need more.
It’s not enough to modify the intensity or safety of their fitness programs. It’s also essential to understand how the mindset that older clients bring to a session—in this case a fear of falling—can influence their exercise needs. Older adults can greatly benefit from strengthening specific hip muscles, learning gait-related motor programs and understanding how their thoughts affect their bodies. Armed with this article, trainers can help seniors accomplish all three.
In Your Client’s Head
Many personal trainers overlook the mind’s impact on movement mechanics. Research shows that our thoughts affect the particulars of gait pattern, which in turn can influence injury risk while exercising. This is why it’s so important for trainers to bone up (pun intended) on their knowledge of balance, hip strength and the mechanics of normal gait, and to understand how these all relate to fall risk in senior clients.
Which Comes First, the Fall or the Fear?
If we make a list of “who” falls, it is easy to put “old people” at the top of the list. And yet, while falls are one of the most serious health issues for the elderly, age is closer to the bottom of a long list of risk factors for falling (Rubenstein & Josephson 2006). Top risk factors for falls include muscle weakness, gait deficit and balance deficit, all of which are easily remedied with a thoughtful training program.
This might seem like an issue of semantics. After all, if older people are weaker and their weakness leads to wobbly walking, isn’t age really the risk factor? The answer is, no, not really. Muscle atrophy in the elderly population is, in general, not a result of aging as much as it is a result of decreased movement over a number of years—meaning, people typically stop moving and then get weak, not the other way around.
Unraveling the Fear Factor
Our understanding of the risks of falling improved dramatically when research demonstrated that fear can actually cause people to fall. Researchers wondering whether the fall begets the fear, or vice versa, found that those who had not fallen, but who had reported a fear of falling, were more likely to fall in the future—despite a significant decrease in their activity levels (Friedman et al. 2002). Studies over a longer time (2 years) found that while a feeling of unsteadiness coupled with previous falls was a large contributor to fear, 18% of the “fearful” group had a large fear of falling even though they had not fallen themselves (Lach 2005).
Just Shuffling Along
From a distance we can recognize that unmistakable turtle-paced shuffle of the senior brigade. But it may come as a surprise to learn that gait patterns identifying someone as a senior citizen—short stride lengths, shuffling feet and low velocities—usually have no mechanical cause (Herman et al. 2005). In fact, research has found that gait disorders of this kind—in healthy seniors with no disease, no history of falls and no more muscle weakness than their counterparts—are largely a response to fear alone.
It turns out that fear-induced alterations in gait patterns can have a profound impact on the muscles used while walking. Timid walking tends to mean less clearance of the foot from the ground (shuffling), bent knees to lower the center of mass and a reduction in the natural arm swing that balances the movement of the legs.
Introduce This Issue
When teaching exercise that is specific to gait, balance or strength, initiate dialogue on the general fear of falling; this can increase confidence and encourage clients to continue with their program. Here are a few more suggestions to fuel your senior programming creativity:
Get Down on the Floor
With beds, couches and chairs abundant, many people have lost the strength to get off the floor because they just don’t get down there anymore. Getting down and back up again requires joint mobility and muscular strength. Have your clients practice doing it without using their arms and with one arm at a time. Make sure they can get up using their nondominant leg as well as their dominant one.
Create an Obstacle Course
Keeping a debris-free living space is obviously beneficial to the fall-risk group, but always moving in an obstacle-free environment will result in an atrophied ability to deal with nuances in the environment should they arrive. This ounce of prevention, then, can end up becoming the actual cause of a fall later on. The best approach is, as usual, one of moderation. While it is wise not to increase fall risk with clutter, it is also smart to train for obstacles. Consider creating a safe and supervised obstacle course, or have your clients practice walking with one foot up on a curb and one on the ground. You can even end each session by having them get down on the floor, roll onto their backs and get back up again.
For more information, please see “Addressing the Fear of Falling” in the online IDEA Library or in the May 2013 issue of IDEA Fitness Journal.
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