Falling and the Nocebo Effect

My sister and I could be poster children for glass perception. She tends to see the glass as half empty; I see it as half full. So when my 80-something mother started to fall down more often, we each had our own spin on it. My sister was upset that mom was falling "all the time;" I was happy she never broke anything when she fell. I was also concerned that labeling my mother as a "faller" could inadvertently make her fall down more often. On most days my mother did not fall at all, so she could just as easily be labeled a "stander who sometimes fell."

Since I believe that people tend to attract more of what they focus on, my logic is that someone who obsessively focuses on falling is more likely to fall down. While many anecdotal examples support my belief, some people require hard data to be convinced that worrying about falling could actually cause someone to fall more often.

The Nocebo Effect

From a western scientific perspective, the correlation between falling down and fear of falling can be explained by the nocebo effect, a psychological term that is sometimes referred to as the placebo effect's "evil twin." The nocebo effect describes the tendency for people to experience negative outcomes as the result of believing something bad is going to happen to them. The classic example of the nocebo effect is people who die from a voodoo hex, a perplexing phenomenon that can best be explained by the power of the mind to will a healthy body to fail.

Scientific research has borne out the validity of the nocebo effect. In one medical study, researchers who were studying something else serendipitously discovered that women who thought they were likely to develop heart disease were almost four times as likely to die than women with similar health profiles who did not have this belief. Arthur Barsky, a psychiatrist at Boston's Brigham and Women's Hospital who is an expert in the field of negative expectations wrote about these women in the Journal of the American Medical Association, "They're convinced that something is going to go wrong, and it's a self-fulfilling prophecy."

Seniors and Falling

Older people are prone to fall more often than younger people because they are more likely to check off "yes" to many of the items that describe a likely faller: someone with diminishing balance and muscle strength who takes multiple medications and suffers from a neurological disease, neuropathy and/or impaired vision. Almost all older people know several friends and relatives who have fallen and broken a hip, resulting in months of rehab-a fate as unappealing to most older people as serving jail time or spending an afternoon at Chuck E. Cheese. Many older people find themselves in a "Catch 22" situation: they curtail their physical activity to avoid the possibility of falling, which causes them to lose their balance skills and muscle strength (the old "if you don't use it, you'll lose it"). This sedentary lifestyle results in a downward physical spiral that makes older people who are fearful of falling even more likely to fall.

As Helen Lach, an assistant professor at St. Louis University School of Nursing, advised a worried daughter in an article on Caring.com, "You're right to be concerned about your mother: A fear of falling is actually a risk factor for falling. In your mother's case, her fear has led her to restrict her activities, which could lead to a decline in her physical abilities, putting her at greater risk of falling."

How to Overcome the Fear of Falling

Most older people who suffer from a fear of falling do not suffer from the irrational neurosis basophobia, in which a person is afraid to stand up because they are obsessively worried about falling down.The experience of falling down even once provides a logical basis for forming an identity as someone who is more likely to fall again, a precursor to developing a full-blown fear of falling. To reduce the odds of falling, fallers must replace this fearful identity with that of a graceful, strong and balanced person.

Hiring a personal trainer or going to a physical therapist to increase strength and balance is one of the best ways for older people to regain confidence in their ability to be physically active without falling. Older people who have fallen should also get their vision checked by an optometrist and have their doctor review their medications to see if one of them could be causing lightheadedness or dizziness.

Thanks to the persistence of my concerned sister (concern is a good thing when it results in positive action), my mother has followed many of the experts' suggestions, including engaging a personal trainer and physical therapist. Her doctor recently observed a marked improvement in both my mother's strength and balance. In addition to these gains, physical therapy has taught my mother to be more mindful about her movements; instead of fearing she will fall, she is careful to use correct posture and movement strategies when walking or changing from a sitting to a standing position. In many instances, she also uses a cane or walker for help with balance and uses grab bars in her bathroom, a smart use of physical aids that helps her remain active and on her feet.

Each day that my mother and other active older people do not fall reinforces their identity as strong and balanced people who actively engage with the world around them. Or, as President Franklin D. Roosevelt might have said, "They have nothing to fear but fear of falling itself."

Sources:
http://www.washingtonpost.com/ac2/wp-dyn/A2709-2002Apr29
http://harvardmagazine.com/2005/05/the-nocebo-effect.html
http://www.caring.com/questions/fear-of-falling
http://www.phobia-fear-release.com/fear-of-falling.html
http://www.learnnottofall.com/swf/risk-assessment.html
http://www.learnnottofall.com/content/fall-facts/fear-of-falling.jsp
http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html\http://www.nlm.nih.gov/medlineplus/falls.html