A loose rug…a tottering gait…a powerful drug…and poor eyesight are all well-known causes of falls. But there’s a hidden risk that few people would ever guess.

Latest development: Researchers are now discovering that, paradoxically, the fear of falling significantly increases one’s risk of falling. In fact, if you’re very afraid of falling, you are 34% more likely to fall than someone with the same level of health and fitness who isn’t as afraid. Why the difference? It’s probably because you slow your walking speed, widen your stance and stiffen your body—changes that worsen balance. What you need to know about this dangerous risk…


Make no mistake, falls are scary. In adults age 65 and older, falls are the number-one cause of injury-related visits to emergency departments. The most common serious injury that results from a fall is hip fracture, which often leads to permanent disability, loss of independence—or death.

What has surprised even researchers is the degree of harm that can result when people have an unwarranted or excessive fear of falling (which means you’re more concerned about falling than you need to be) and how widespread this fear is. Studies show that two out of five older adults are afraid of falling, including many who are reasonably fit and have never taken a spill. In fact, research shows that more seniors are afraid of falling than of robbery, financial troubles or even ill health!

Those who are afraid of falling are also more likely to avoid everyday activities such as walking outside, shopping for groceries or taking a bath…and are far more likely to end up in a nursing home.

Here’s a quick rule of thumb: If you’ve had two or fewer minor falls in the past year…if you don’t walk more slowly than other people your age…and if you can stand up from a chair without using your arms, you probably don’t need to limit your activities dramatically due to concern about falling. However, if you are more afraid of falling than you need to be, it’s important to take steps to reduce your fear.

It helps to see a physical therapist for an evaluation. He/she can assess your need for an assistive device such as a cane or walker and, if needed, give you exercises to improve your balance and strength.


My colleagues and I conducted a small, preliminary study that reduced fear of falling in eight seniors. Each participant received eight one-hour sessions in his/her home conducted by a physical therapist and psychologist. Among the approaches we used…

Exposure therapy. With this type of therapy, you’re exposed to what you fear, little by little, in a safe environment, until you’re comfortable encountering or doing the thing you fear. In this study, exposure was the most effective technique for reducing fear of falling.

Example: If you avoid taking baths, perhaps because a friend fell in the tub and you think it will happen to you, start by sitting on the side of the tub. When this is no longer fear-provoking, put your legs in the tub. After that, put your legs in the tub with a little bit of water in the bottom. Then do so with four inches of water.

You may need to repeat each of these actions 20 to 30 times over a few weeks until you are certain you can do each one without fear. The final action would be taking a bath.

If you are very concerned about doing this, you might want to start by having a person present while you do these activities—perhaps for a week in the same room, then for a week in the next room, then on a different floor. Eventually, doing these activities alone will reinforce the sense that you can bathe safely.

Note: The risk of falling and fear of falling are two different things. Precautions that reduce the risk of falling can sometimes make fear of falling worse. In the example above, if there’s always another person present, it could foster fear, sending you the message that bathing alone is very dangerous.

Caution: If your doctor or physical therapist says that it isn’t safe for you to do an activity alone, then your fear is not unwarranted or excessive and you should not do exposure therapy.

What you can do: Gradually expose yourself to the specific situations you fear, or ask a psychologist or physical therapist to help you do so. A friend or family member can do this as well if he gets some training from a psychologist or physical therapist.

Home safety. If you make your home more fall-proof, you’ll be less afraid of falling. For example, replace loose floor coverings with mats that have slip-resistant backing…make sure no cords or cables are in walkways…install grab bars in the bathroom…and put a slip-resistant mat in the tub or shower stall. Also, use brighter lights.

Cognitive restructuring. This technique replaces counterproductive, fearful thoughts with helpful, fear-reducing thoughts. To get started, identify thoughts that are unhelpful. Next, when you have such a thought, substitute a helpful thought. For example…

You think: “If I walk on the grass, I’m likely to fall.” Substitute: “I have walked on the grass many times and didn’t fall.”

Exercise. Balance-improving exercises that the people in my study found enjoyable and effective…

• Walking backward. This strengthens legs, improves balance and builds confidence. What to do: Find a place where you can walk backward for 10 to 20 feet without looking over your shoulder to avoid obstacles, then reverse direction and walk backward the other way. Try to do this two to three times per day. Helpful: See how it’s done at Eldergym.com/backward-walking-for-increased-balance.

If you are very concerned about doing this exercise, start by doing it with someone else in the room and gradually work up, over a month or so, to doing it alone.

• Sit down in a chair and stand up without using your hands. This exercise is easy to do, builds leg strength and improves balance and confidence. Repeat at least 10 times, once a day.

For additional information on preventing falls, consult the National Council on Aging at NCOA.org (click on “Healthy Aging,” then on “Falls Prevention”).

Related Articles