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Falls: managing the ups and downs of MS Fear of falling

"I had a bad fall last Christmas. Although I recovered, I now find I'm wary of going out and worried about tripping over every crack in the pavement"

For many people, particularly those who have experienced a previous fall, the fear of falling is significant.

"I've seen what a fall can do to someone and want to make sure this doesn't happen to Jane"

The fear of falling can itself be a risk factor. People who are anxious about falling may become less active or limit what they do in their day to day lives in an attempt to avoid situations where they feel they might be more vulnerable.

"I'm probably safer than my friends without MS. Having fallen before, I pay a lot of attention to potential problems in front of me - I may be slow but I'm safe"

This concern is not just restricted to people with MS. Friends or relatives of someone who has had a fall may become worried about whether it will happen again.

The problem is not just the fear, but the reactions the fear causes. Fear can be useful when it causes us to exercise necessary caution, but a person can be cautious without letting fear dictate how they live their lives.

Low activity levels cause under-used muscles to become less efficient, which means that stamina levels and fitness are reduced. As a result, everyday activities are more physically demanding and there is an even greater risk of falling.

Avoiding activities for fear of falling can also lead to a reduction in quality of life and possibly increased medication use. Regular activity helps counteract low mood and feelings of depression. Without activity, boredom and lack of motivation can set in, and the person may become increasingly and prematurely dependent on others to do tasks that they won't allow themselves to do.

Ideas to reduce the fear of falling

  • Talk about concerns and share worries with others. This can help to put concerns in perspective and may lead to other ideas for reducing the fear of falling
  • Consider getting a personal alarm system. There are several different types available ranging from simple pull-cord alarms to warn someone nearby to alarms that dial directly to a 24-hour monitoring station. Some alarms can be worn as a pendant or a watch. Your local Social Services may offer alarms to people at higher risk of falling
  • If you have one, keep your mobile with you at all times so that if you do fall, you know you can dial a neighbour/friend/family or 999 in case of emergency. Have important numbers stored on the phone so they can be called quickly
  • Consider what you would do in an emergency. If worried, arrange for a neighbour, friend or relative to call in or ring daily to check you are OK. Discuss what the plan would be were you to fall and be injured
  • Learn and practise ways to get up if you should fall - a physiotherapist can teach safe ways to get up (see page 32)
  • Try not to let your fear make you avoid social situations. People with greater social support are less likely to reduce or stop activities

Fear of falling - family and friends

It can be tempting for well meaning families and caregivers to become overly protective, even if the person with MS doesn't share their worries. However, concern for safety has to be balanced against the individual's right to live their own life and to make their own decisions about the risks they are prepared to take.

  • Discuss the fear of falling with the person with MS and try to help them to find ways to overcome their fear (and yours)
  • Respect the individual's right to decline your offer of help, and don't be offended. Let them know that your offer is always open if they change their mind
  • Rather than limiting the activities of the person you're worried about, discuss safer ways that they can maintain their independence
  • Try and help the person with MS to remain as active as possible, but don't be too ambitious in what you suggest
  • Try not to reinforce concerns about any limitations caused by MS but encourage them to recognise their abilities
  • If there are health issues that aren't being properly treated, encourage the individual to get appropriate professional help

Next page - Reasons why people fall - visual problems