Overcoming Our Fears when Living with Myositis: Focus on Falling (Part II: From Fear of Falling to Confidence)

For more information about fear and what causes it, read the first presentation in this series, entitled Part I of Focus on Falling: Defining Fear and Overcoming It with a Four-Step Approach.

Common Fears about Falling

Ms. Kleinman began her presentation by asking each group member to name a fear that they had related to falling. The responses included the following:

• Multiple fractures
• Getting heels caught in pants cuffs
• Losing balance
• Hip fractures
• Osteoporosis increasing the risk of falls
• Walking down inclines
• Stepping off a curb
• Being unable to get up from a fall

Several members expressed the fear of being alone when falling as greater than the fear of falling itself.

Ms. Kleinman responded that these were all common fears. This presentation was designed to help people understand the importance of this topic, including risk factors; emotions and how they relate to falls; coping with the fear of falling; ways to prevent falls; and how to discuss these issues with your healthcare team.

Falls are one of the main causes of injury for people over the age of 65. Older adults may take longer to recover from a fall than younger adults.

Myositis is a disease where loss of muscle strength is common, and loss of muscle strength increases the chance of falling. It makes sense, then, that improving muscle strength may help prevent falls.

It is important to note that falls can often be prevented and that many things can be done to reduce the risk of falling. Falling once also does not necessarily mean repeated falls.

Risk Factors for Falls

Some of the risk factors for falls include:

• Health problems
• Poor balance
• Muscle weakness
• Unsteady walking
• Memory problems
• Poor vision
• Previous falls
• Some medications
• Hazards in the home and environment (throw rugs, pet toys, uneven and slippery sidewalks).

Fear of Falling: An Endless Cycle

The fear of falling can lead to less activity and exercise, which can then lead to a higher risk of falling. The fear of falling, then, can make you more likely to fall. This can then lead to isolation from others; low self-esteem; depression and anxiety; and the use of more medications.

Ms. Kleinman then went on to explain that some fear is useful and helps prevent us from taking unnecessary risks. However, sometimes fear can create what she referred to as “false alarms,” which can cause avoidance of everyday activities and the cycle of stress described above.

Coping with the Fear of Falling

Ms. Kleinman suggested the following:

Do a self-assessment: try to identify what is happening to you. What is causing you to fear falling? Then, speak with your healthcare team - your physician, nurse, social worker, physical/occupational therapist - to learn what you can do to help prevent falls. It is also important to remember to be realistic about activities that you are able to do.

Another way to cope with the fear of falling is by building confidence. One way to do this is to take small steps toward your goal. For example, you might want to increase your endurance for walking. Always discuss this with your personal health care provider prior to starting a program to increase endurance or muscle strength. Ask your physician for a referral to a physical therapist who can best assess your needs. For example, you may begin by walking 1-2 blocks and then slowly increase as you feel more able to do so. This success will then help to build strength and confidence.

Preventing Falls

• Take a look at your home and look for hazards that might cause a fall:
  • Remove throw rugs, boxes, piles of paper, or cords.
  • Clear clutter and keep walkways clear.
  • Clean up spills immediately.
• Check your clothing to make sure that pant cuffs are tucked in (so that shoe heels do not get caught in the cuff) and that shoelaces are tied.
• Improve lighting by adding nightlights to halls, bedrooms, and bathrooms.
• Add safety devices, such as handrails, raised toilet seats, and bathroom grab bars, to your home.
• Consult with a physical therapist to insure that you are using canes, walkers, and other supportive devices correctly.
• Talk with someone you trust about how you are feeling.
• Seek out emotional support or guidance from a professional if needed.
• Speak with your doctor about your medicines and other health concerns.
• Being active and staying connected with others helps prevent social isolation and depression, which can increase the risk of falls. You might consider joining a club or place of worship, volunteering, and/or making contact with friends and family.
• Be prepared:
  • Keep a list of emergency numbers close at hand or on the refrigerator in your home
  • Always have a way to call for help: cell phone, Emergency Response System
• If you fall, try to stay calm.
  • Take several breaths and think about what you need to do next.
  • Are you injured?
  • Can you get help safely?

The Importance of Discussing the Fear of Falling with Your Healthcare Team

It is important to emphasize that fear of falling is a normal and common concern. Your doctor can help you prevent falls by reviewing your medications and your health needs and may also refer you to other healthcare professionals, such as physical therapists or clinical nutritionists. It is also important for you to communicate any changes in your health that could increase your risk of falling, such as balance problems, numbness, change in memory, change in activity level, or changes in vision and hearing.

In summary

• Falling is a common concern; be open and honest about it.
• If we don’t talk about it, then we can’t make the changes that would reduce our risk.
• Falling once does not mean you will fall again.
• Evaluate your living environment and work with your health care team to follow falls prevention techniques discussed here.
• Stay connected and as active as possible.
• Talk about concerns with your health care providers.

About the Myositis Support Group at HSS

Learn more about the Myositis Support Group, a free support and education group held monthly at Hospital for Special Surgery

Summary by Suzan Fischbein, LCSW, Myositis Support Group Coordinator

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