Four Ways to Help Overcome the Stigma of Being a “Faller”

Four Ways to Help Overcome the Stigma of Being a “Faller”

Falls are on the mind of your aging patients. A 1996 study by Myers, Powell and Maki* reported that 56 percent of community-living elder patients who had experienced a fall indicated an ongoing fear of falling (FOF) – a number surprisingly lower than the 58 percent of the same population living with FOF who had not themselves fallen.

Considering that no American presidential candidate has received more than 58 percent of the popular vote since Ronald Reagan in 1984, the universality of FOF should be evident. As a nation, we can’t agree on much, but as we age, we agree in large numbers that we’re afraid of falls.

Unfortunately, though this reality should unite us, it often proves to do just the opposite. As FOF grips aging adults, they’re prone to believe themselves capable of less physical activity. They frequently start making excuses to avoid situations in which they anticipate a greater risk of experiencing a fall. This decrease in ostensibly risky physical activity can breed increased social isolation. Both have their own impacts on quality of life, none of which are positive.

Standing in the way of more beneficial outcomes is the stigma aging patients associate with being labeled a “faller.” Frailty, weakness and a general inability to take care of oneself are attached to such a stigma. Naturally, nobody desires to be viewed in these terms. It’s one thing to limit one’s own activities due to a secret fear of falls, but quite another to have restrictions imposed by a caregiver or medical provider once the “faller” label has been attached. Nothing validates the feared stigma more than when a patient who has fallen is immediately told that her frailness will require serious lifestyle restrictions and changes.

Try some of the following with your patients to de-stigmatize how they feel about being labeled a “faller.” You’ll help your patients remain invested in a care plan that will preserve their perceived self-efficacy and thereby their quality of life.

Share the Facts

Empowering your patients with solid, detailed information about falls and FOF can help them start to put their own views on the matter in a more educated context. Studies abound. They’ll tell you what you already know to be true – that a plurality of your older patients have FOF.

Philips Lifeline’s eBook, Fear-of-Falling in Older Persons distills much of the recent research into a digestible, seven-page PDF. In it, you’ll learn about various assessment tools to gauge FOF in your patients, and about various interventions designed to help mitigate the negative effects of FOF.

When you coordinate these messages with the mental health providers, nurses or other caregivers who see your patients, you’ll reinforce the validity of the information, as well as give your patients the experience of participating in more and more non-judgmental and non-stigmatized conversations. Over time, you’ll help break down the notion that there is anything especially different about being a “faller.”

Knowing that you’re not alone in fearing falls is a good first step to removing the stigma in your own mind. Getting your patient to this mindset may take more than just information.

Change the Context

Sometimes it’s hard to get your brain around something that has such concrete consequences in your own current life. It’s too close to home, and too packed with immediate emotional baggage. Instead, pick another label that might be seen as unsavory – “bad at sports,” for example – and explore the dynamics of the stigma associated with that label.

Chances are, everyone has experienced being bad at sports at some point in their lives. Consider the classic “being chosen last for a sport team” scenario depicted in countless films, television shows and books. The emotionally evocative power of these scenes depends upon a universally held memory of the feelings of anxiety and embarrassment that every individual who has ever waited to be chosen has felt in the past. Though the first few kids chosen may seem confident and fearless, their reactions to being selected often reveal a palpable relief that they no longer are at risk of being chosen last. Nobody wants everyone else to think they’re terrible at sports. No children, that is.

Four Ways to Help Overcome the Stigma of Being a “Faller”

As we age, however, we learn that very few of us are destined to become elite athletes. Those who do achieve “sports hero” success frequently find other, arguably more important areas of development lacking. Over time, we gradually dismiss our childhood conception of success that revolved around the wish to be considered good at sports. Our peers also grow up and stop measuring us solely by our ability to throw a ball or shoot a basket.

Patients with FOF may laugh at how silly it would seem today if they maintained the fear of being considered bad at sports. Start conversations with your patients about how stigmas like this relate to their current FOF and how they cultivated a new perspective in the past. This may help them reorient their current relationship to FOF.

Focus on the Solution

Most medical practices focus on identifying underlying causes of conditions and treating the effects they manifest in your patients. But there isn’t any good way to explore what might cause your patients to fear being subject to the stigma of being a “faller.” Worse, even if you were to pinpoint just one such cause – assumptions about “fallers” held by others, perhaps – what impact could your interventions possibly have on the opinions of all those people not in your care? Instead of looking at the enormity of outside influences, help your patients relate differently to their perceived stigmas by focusing on solutions.

A very effective modality employed by some therapists is Solution-Focused Brief Therapy (“SFBT,” also called Solution-Focused Therapy). The system involves orienting the patient away from the past and the problem in favor of a look towards the future and the solution.

Through a series of conversations, you’ll help your patient relate differently to the stigma of being a “faller,” even though there may be no concrete changes in anyone’s behaviors.

This page from the Institute for Solution-Focused Therapy gives a great, short primer on the key concepts and important elements of using tools such as the Miracle Question and Scaling Questions.

Warning: if you’re using the Wong-Baker FACES Pain Rating Scale for pain (or another similar scale), you’ll have to spend a bit of time re-orienting your own conception of a scale to use SFBT. The Scaling Questions and scales themselves are oriented in reverse to most scaling concepts used in medical environments. Here’s another article about Scaling Questions to help get you started.

Solution-Focused techniques may alter how you approach other areas of your practice as well. As with any new strategy, it may take some time for you to master the nuances. But a future-focused voice may be more compelling to your patients who are more accustomed to voices chronicling everything that is wrong with them.

Use a Group

If you’re working with patients in a community-living environment, you may be able to arrange opportunities for them to use each other as resources. After all, their peers are living what you’re only able to talk about. The groups don’t have to be formal, or therapist-led.

This group is focused on participants simply being able to admit to peers that they are “fallers.” Given some more time, you can expect the increase in trust to result in the sharing of tips to compensate for a decrease in mobility. And, even if you’ve previously given the exact same tips to your patients, they’ll be quicker to give them a shot since they come from a trusted and credible peer.

“Edna” was extremely active in her community. She delivered meals to seniors – some of whom were younger than was she – and organized a yearly craft fair. She was 4 feet 10 inches tall, and used a stepladder to retrieve anything above her reach in her apartment. When she started to experience vertigo, her family and caregivers insisted that she stop using the stepladder, and suggested a reach-extender grabbing tool. “Edna” was not impressed with their suggestion. But while preparing for the next craft fair, she happened upon another senior, “Ella,” whose apartment was outfitted with high shelves. Though confined to a wheelchair, “Ella” had several telescoping reach-extender tools that enabled her to grab anything from any shelf. “Edna” was rarely without such a tool in the future.

Seeing and hearing is believing, but only if you’re able to relate the things you see and hear to your own life. Groups create a safe space for learning what works for those around you who are going through the same thing. Those types of voices are often the most powerful.

Keep Trying

As with most medications, you’ll find that not every option works for every patient. Some of the above techniques may seem to have contradictory elements. That’s OK, because what’s compelling for one patient will be off-putting to another. The important point is that you’re making an effort.

Falling is bad. Fear of Falling is bad, but not uncommon. But no patient should be moved to inaction or paralysis out of concern that they’ll be lumped into a stigmatized group. With some careful attention, you’ll help your patients better understand the things that are worth their concern, and start to take a stand against the survival of the “faller” stigma.

*Myers AM, Powell LE, Maki BE et al. Psychological indicators of balance confidence: relationship to actual and perceived abilities. J Gerontol A Biol SciMed Sci.1996; 51:M37-M43

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