Staying steady, staying positive · Staying steady, staying positive A guide to understanding and...

Staying steady, staying positiveA guide to understanding and overcoming

anxiety about falling for older people

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About this booklet

Having fears about falling in later life is very common and often distressing. It can limit life in so many ways.

This booklet is for anyone who has fears and anxieties about falling. It may also be useful for family, carers and friends.

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It contains information on:

• How fear of falling can affect us emotionally Pg 3• What it feels like to be anxious Pg 5• How anxiety can affect mobility Pg 9• Managing anxiety about falling – how you can help yourself Pg 11• How staying active can help Pg 24• Need help with getting active? Pg 25• When should I ask for more help? Pg 26• Local sources of help Pg 28

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Anyone can have a trip or fall. As we age, fear of falling can become a serious concern. Some people worry about falling even if they have not had a fall. This may be because they worry about what might happen should they do so.

I have a fear about falling. I’m always worried about it.“

How fear of falling canaffect us emotionally

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If we have had a fall, it can leave us feeling shaken up. We can become more cautious, stop doing things and lose confidence in our abilities. This is a common reaction and very understandable. However, if we find ourselves constantly worrying about falling it can prevent us from having an active and fulfilling life.

Having anxiety about falling is a very common problem – we all have worries and fears. Anxiety can make us feel like we don’t have any control in how we feel and that there is nothing that can be done to change our situation. This can leave us feeling low in mood, frustrated and lonely.

We may be embarrassed about having these worries or fear losing our independence if we tell someone our concerns. Many people carry on living with anxiety when they don’t have to. It is not a sign of weakness or something to be ashamed about.

Help is available and you can get over your fears. This booklet will show you how.

How fear of falling can affect us emotionally

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What it feels like to be anxious

We all feel anxious at times in our lives. Anxiety is our body’s normal reaction to a real or imagined threat or danger. Anxiety can develop after any stressful life event such as having a fall. A mild level of anxiety is very common and can often be seen as normal part of life. Some people however, have very strong and constant anxiety and panicky feelings about falling. If this is affecting your life, it has become a problem.

Anxiety can be felt in the body. It can also affect how we think, feel and what we do.

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Some examples of bodily symptoms of anxiety that we may notice include:

• Rapid, pounding heart beat • Headaches • Chest, shoulder or neck pain • Feeling dizzy or lightheaded • Shortness of breath • Shaky legs • Nausea • Loss of appetite • Butterflies in stomach • Tightness in muscles

These sensations can be unpleasant but are not harmful. It is nature’s way of protecting us from danger. These feelings will go away when our anxiety reduces and we feel calmer.

If you have any of these symptoms, you should see your GP who will check your physical health first to rule out any health problems. If there are no problems then it is likely to be anxiety.


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Anxious thoughts and feelings

You may find that you:

• Feel irritable and on edge • Have frequent worrying thoughts – have a constant fear of falling. • Always think the worst will happen. For example, “I will fall and injure myself.” • Focus on just the negative rather than having a positive mental attitude e.g., “I can’t walk

far because I will fall” rather than “I will try to walk as far as I can. I am going to do the best I can.”

Negative thoughts can make things seem worse. For example, anxiety can sometimes lead you to overestimate the risk of falling. Learning to challenge these negative thoughts with more balanced ones can help reduce any worries. It just takes practice.


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What we may do when feeling anxious

The more worried you become of falling the less likely you are to keep active.

Anxiety can make you act in ways that help you feel safer. For example, holding onto things because you think you will fall or not going out. Avoiding or stopping doing things can make life difficult and less enjoyable. This can lead to low mood and depression. We lose a lot of confidence by avoiding walking. This will affect how you feel about yourself and keep fears going.

There are many opportunities available to you to remain active. See Page 25 for details

It’s the constant fear that

I have of falling that stops me

from moving around. I know I

should keep active but I have

decided that the less I move

around, the less chance I have

of falling

“

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A cycle of anxiety can develop which keeps fears about falling going. Worrying thoughts can affect how we feel and what we do.

How anxiety can affect mobility

I am afraid of hurting myself if I fall so I don’t go out as much as I used to. I don’t walk that far any more. It’s not much of a life““

Dealing with anxiety can help improve your mobility, confidence and quality of life.

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Worrying thought“What if I fall? I will hurt myself”

Loss of confidence“I can’t do it”

AvoidanceStop going out

Physical symptoms of anxietyFor example: legs shaking

More worry“I feel unsteady. I am going to fall”

How anxiety can affect mobility

Cycle of anxiety

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Ask yourself these questions

• Were you in a hurry? • Was the floor cluttered or slippery? • Were you using the correct walking aid if you use one? • Were you feeling dizzy? - It could be side effects of medication. If you are on many different

medications make sure you get these reviewed at least once a year. If you have been on sleeping tablets for some time, you might want to see your doctor about options for coming off these. Your GP can also give you advice on how to get a good night’s sleep naturally. It is important that you do not stop taking your medication without speaking to your GP.

Falls can be more common as we get older but falling is NOT a normal part of ageing so if you have a fall don’t just ignore it. You should let your GP know. You may need a medical check up to look at why it happened.

Managing anxiety about falling– how you can help yourself

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There are some things you can do to prevent falls happening which should help reduce your fears. You can also make a plan for getting help if you should have a fall. This can help you feel more secure. Your local falls prevention services can offer such information, advice and guidance. See page 28.

• If you have had a fall try not to dwell on it, even though it is understandable that you may feel worried for a short time afterwards.

• If your worries are not going away - take control and action. Talk to someone about your anxiety. It can make problems seem more manageable. Recognising there is a problem can be the first step to getting the help you need and your life back.

I was embarrassed at first to mention my worries to anyone. I thought it was just me. Now I know it is a common worry many older people have. I wish I had spoken up sooner. Things are so much better now“ “

Managing anxiety about falling – how you can help yourself

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• When getting up from a chair don’t rush. Stand, turn and move off slowly. Concentrate on one thing at a time – getting to where you need to be safely.

• Set yourself small achievable targets – walk for a short distance first (even if it is several steps in the safety of your own home) and build on this. If you feel you would benefit from a walking aid, discuss this with your doctor. Small goals will help get you feeling more confident again.

• Try to think positive and keep things in perspective. Remember all the times you haven’t fallen and keep walking and moving.

I keep telling myself that I can do this if I take my time and don’t rush“

“Managing anxiety about falling – how you can help yourself

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Reducing your fear by challenging your thoughts

Thinking positiveabout walking

Success/senseof achievement

Less anxiety andphysical symptoms

Walking withconfidence

I try not to say what if I fall? What if I don’t? I will have spent all that time worrying about something that probably will not happen. It’s my negative thoughts that hold me back.“

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• You may feel more anxious or panicky when you begin walking. You may find yourself breathing faster than normal. If you do - take some regular breaths and tell yourself that these feelings will go away. You can reduce your anxiety by slowing down your breathing and using relaxation techniques (there are some helpful relaxation exercises in this booklet please see Pages 19 - 23).

• Learn more about anxiety. Pick up a self-help guide for help dealing with stress and anxiety. There also guides that can help with panic, depression and low mood and other difficulties. These are available to borrow at your local library or ask your doctor for a copy.


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Helpful Tips

• Cut down on tea and coffee (these contain caffeine which can make anxiety worse and interfere with sleep)

• Make sure you have a well balanced diet. Eat regularly - going too long without eating can make us feel irritable and anxious.

• Get enough sleep – when you are well rested, it is much easier to cope with worries.

• Avoid too much alcohol – alcohol can make you feel better for a short time but it can make anxiety worse in the long term. It can also increase your risk of falling.

• Keep active and do things you enjoy – this can help to take your mind off worrying thoughts. It can also improve our sleep and fitness.


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Helpful Tips (Continued)

• Think about your posture, the way you hold your body. If you hold yourself up tall when you walk this can help your balance. We also need good posture in order to do daily activities well.

A few tips that can help you to have good posture are:

•Think TALL!

•Looking straight ahead and lengthen your neck by tucking your chin in

•Relax your shoulders down and away from your ears

•Lift your chest up.

•Hold in your tummy muscles and lengthen your back.

•Have a straight body with your knees in line with your ankles.

• Reward yourself for your achievements. Tell yourself how well you have done. This will help build your confidence for next time.


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Helping yourself with relaxation

This is a way of helping to calm your mind and reduce the muscle tension anxiety can cause. Try the exercises that follow. There are many different relaxation techniques, try a few and see what works for you. You can borrow relaxation CD’s and tapes from your local library (at the Health Matters section).

Don’t give up if you don’t feel better straightaway – it is skill which takes time and regular practice to get the full benefits.

In order to get the most benefit from relaxation it must become an everyday part of life. We can’t always get rid of what causes us worry completely but we can learn some skills which can help us get it under some control.


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Before you start relaxing make sure your mind, body and surroundings are just right

Prepare yourself as follows:

• Preferably, lie down on your bed or sit in a comfortable chair in a quiet, not too warm room where you will not be disturbed. Wear comfortable clothes, make sure your legs are uncrossed and take off shoes.

• Don’t try the exercises if you have just eaten or are hungry. • Don’t worry if you can’t relax immediately. Don’t think about how you are doing – just let it happen. • Thoughts may pop into your mind. Don’t focus on them just let them pass through. • Initially try to set aside 30 minutes two or three times each day. The more you practice the more

you will train your body to relax as soon as you feel worried or panicky anytime, anywhere.

If you have any medical conditions, for example breathing problems see your GP before trying any relaxation exercises.


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Breathing to relax

Breathing too quickly and deeply can make us feel dizzy, faint or even more anxious. Breathing correctly can help control anxious thoughts and feelings. A few slow regular breaths can make us feel calmer.

Place one hand on your chest and the other over your stomach. Take a slow normal breath in (through your nose if you can).

You want your stomach to move more than your chest. Encourage your stomach to move out as you breathe in. “RELAX”

Breathe out slowly through pursed lips. Watch your hands as you breathe out. Your hands on your stomach should move and your chest should not. “RELAX”

Repeat this 10 times twice a day.

It might take time to master this. Once you have you won’t need to put your hands on your stomach or watch your hands.


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Simple visualisation exercise

This exercise involves using an image as a focus.

Create in your mind an ideal spot to relax. It can be real or imaginary. Somewhere you will find restful, calming safe and happy. Imagine it in as much detail as you can – use your senses to make it as real as possible (what can you smell, hear etc). See yourself comfortably enjoying this place. Close your eyes and take a regular breath in through your nose. Become aware of your breathing. Focus on your relaxation place in all its detail and breathe out through your mouth.

Remember you can return to this place whenever you feel the need to relax.

Do this exercise for 10-20 minutes.


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Quick muscle relaxation

Here you can learn to recognise and reduce muscle tension.

• Sitting in a chair, close your eyes. • Concentrate on your breathing. Take a breath in through your nose and breathe out slowly

through your mouth. • Make a fist, squeeze your hand tightly. Hold this for a few seconds, noticing the tension.

Slowly open your fingers and feel the difference – notice the tension leaving. Your hand is much lighter and relaxed. Enjoy this feeling.

• You can relieve tension in any part of your body just by tensing and relaxing each muscle in turn.

If you have any physical injuries/conditions that may cause muscle pain don’t tense the muscle in that area.


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Cued relaxation

Once you have mastered some relaxation exercises you can use them whenever and wherever you need to throughout the day.

To do this you can use a “cue” - something to catch your eye and remind you to: • Drop your shoulders • Check your breathing • Relax the muscles in your body • Relax

Find ways of reminding yourself to relax. For example, you could put a small coloured dot on your watch or somewhere else in your home which will act as your reminder.

Make a note of how relaxed you were before and after the exercises to see if it has helped.

Don’t rush to get up after relaxation exercises. Sit with your eyes closed for a few minutes afterwards to avoid the possibility of feeling dizzy. Open your eyes and make sure you feel all right before standing up.

I p r a c t i c e m y r e l a x a t i o n exercises every day. I feel more in control now“

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How staying active can help • Getting older can have an impact on our steadiness. Without regular physical activity, it is

difficult to maintain strong bones, strength and balance. It is therefore important for us as we age to work at improving our balance through exercise.

• Regular exercises such as Tai Chi and strength and balance training can improve our stability. Don’t forget housework, shopping, gardening and walking also count.

• Activity also has a positive effect on how we feel. When we exercise, the brain releases feel good chemicals, which are known to help improve our mood, reduce anxiety and tension.

If you have not exercised for a long time, you may be afraid for fear of falling or hurting yourself. Please don’t be put off! Remember, regular exercise can help to reduce risk of falls.

I’ve been attending an exercise class for the past 12 months. I know that the strength in my legs has improved because I can walk quite a distance without getting tired and wobbly. I feel I’m getting my independence back and don’t worry as much about falling“

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Need help with getting active?GATE (Getting Active through Exercise) is part of Manchester Public Health Development Service. It provides advice on exercise opportunities and has established a number of weekly classes for the over-65’s. It also provides home based exercise programmes free of charge for those who are unable to get to a class. Contact GATE on 0161 861 2900 or visit www.mphds.org

There are also exercise referral schemes across the city that can help find the right activity for you. Your GP or health professional can refer you.

If you live in North Manchester contact PACE on 0161 681 0940If you live in Central Manchester contact ALFA on 0161 833 4434If you live in South Manchester contact SMILE on 0161 946 9438.

GettingActiveThrough Exercise (GATE)at 65+0161 861 2900

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When should I ask for more help?You should get more help if:

• You have tried some of the suggestions in this booklet to make yourself feel better and this has not made any difference.

• Your anxiety has been going on for some time and not getting any better • It is stopping you from doing things you usually do or want to do • It is strong and unpleasant. If you experience intense anxiety / panic feelings frequently,

this can be seriously distressing and disabling. Don’t just put up with it. • It is causing you emotional distress and making you feel fed up. Depression and anxiety often

go hand in hand. If you have lost interest in things once enjoyed and/or always feel low in mood it could be a sign of depression.

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Remember having anxiety about falling is common.

Please do not suffer in silence – talk to someone you trust about it. There are options and services available that can help you overcome these difficulties. Some of these are listed in this booklet.

I’m so glad l asked for help. I feel more in control now. There is no guarantee I won’t fall but I can deal with it. Fear isn’t ruling my life anymore“

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When should I ask for more help?

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Your GP can recommend options and treatments available to you and refer you to these services if necessary.

Local sources of help

The NHS Manchester Primary Care Mental Health Teams provide support and help with problems such as anxiety and depression.

Manchester Teams:

North 0161 231 0017Central 0161 861 2343South 0161 946 8260

The NHS Manchester Primary Care Falls Teams provide information, booklets and advice about preventing falls.

Manchester Teams:

North 0161 230 1840Central 0161 226 0101South 0161 217 3920

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Other Falls Services

Pills and Spills Medication Review Service (a pharmacist provides advice and information about medication) – 0161 217 4336

Manchester Care and Repair service (Free help and advice, help with minor repairs, accident prevention) – 0161 872 5500

Other Mental Health Services

Age Concern Counselling Service (Free Counselling for people over 60 and their carers) 0161 833 3944

Self Help Services – 0844 477 9971 (offer a range of services and self help groups for problems including anxiety and depression) www.selfhelpservices.org.uk

Anxiety UK (information and advice on anxiety related problems) 0844 477 5774For support via email [email protected] or visit www.anxietyuk.org.uk

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Other useful telephone numbers/help lines

Samaritans 08457 90 90 90 (24 hours emotional support everyday)NHS Direct 0845 46 47 (Advice and information 24hrs a day about health and social care) MIND Information Line - 0161 272 8205

Other useful sources of help and information

www.manchester.nhs.ukwww.livinglifetothefull.com or www.moodgym.anu.edu.au(a computer course that helps you cope better with anxiety and depression)www.mhdirectory.org.uk – an online directory of mental health information and serviceswww.manchester.gov.uk/mymanchesterservices/ - a guide to services in Manchester including Valuing Older People.www.nice.org.uk - information for the public on NICE falls guidelines (document CG21)

Booklet produced by:

NHS Manchester Primary Care Mental Health Teams (North, Central and South Districts)

Manchester Public Health Development Service – Getting Active Through Exercise (GATE)

Manchester Falls Service

April 2009

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