DOI: 10.12809/hkmj187722
© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
LETTER TO THE EDITOR
Empowering elderly patients to overcome “self-imposed
immobility” due to fear of falling
Reza Ganji, MD
Department of Orthopedic Surgery, School of
Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
Corresponding author: Dr Reza Ganji (r.ganji@nkums.ac.ir)
To the Editor—In countries with long life
expectancies, geriatric fractures due to falls, particularly hip
fractures, are an increasing health concern associated with high morbidity
and mortality.1 The overall 1-year
mortality rate of elderly patients with hip fracture has been estimated as
17%.2 3
Orthopaedic reparative surgeries in elderly patients are intricate, and
most patients need to be hospitalised for a long period of time with
restricted mobility. Activity restriction or immobility for elderly
patients is a degenerative process that contributes to several
complications, such as ulceration, infection, decreased cardiovascular
function, deep vein thrombosis, and psychophysiological dysfunction such
as delirium.4 These complications
can increase the length of hospital stay and the cost of care; therefore,
efforts must be made to prevent these complications by early mobilisation
of these elderly patients.
Several barriers to mobilising elderly patients
have been identified, including pathophysiological and psychological
factors.5 6 Previous studies have shown that history of falls and
self-perceived mobility problems are among the independent predictors for
recurrent falls.5 Fear of falling,
typically due to the lack of self-confidence in sustaining stability
during walking, is a major psychological impediment to mobilising a
patient with a previous fall.7 More
than 55% of patients with previous fall experience are frightened of
falling again; thus, they prefer to stay immobile.8 From the patient’s perspective, immobility may be
considered as a psychological response to previous falls or a
self-protective behaviour to prevent a next possible fall.9 However, from the medical perspective, fear of falling
is a vicious cycle that can physically and psychologically restrict
patient activity and mobility, owing to the physical imbalance, lack of
self-confidence, low self-efficacy, and low self-reliance.7 8 Whatever the
cause, this type of fear can lead the patient to experience ‘self-imposed
immobility’, an immature concept that I use to express the consequence of
fear of falling.
Many health care providers around the world have
experienced patients with self-imposed immobility, either in hospitals or
in other settings such as nursing homes.9
A key responsibility of the health care team is helping and empowering
such elderly patients to overcome their fear.10
In recent years, several physical interventions have been implemented, by
either nurses or other members of the health care team, to strengthen and
empower the elderly to overcome the fear of falling.9 11 However,
evidence suggests that these interventions only reduce the fear of falling
to a limited extent and for a short time. In addition, there is a lack of
practical interventions that are suitable for helping elderly patients to
overcome the fear of falling.6 11 Consequently, fear of falling
remains a major obstacle to patient mobility. One of the possible reasons
for the failure of physical interventions is that these interventions
cannot affect and change the cognitive and psychological state of the
patient. Thus, it seems that interdisciplinary teamwork is needed, to
provide both physical and psychological interventions. Accordingly,
further well-designed trials are required to evaluate the optimal physical
interventions to overcome this fear, and psychological interventions, such
as cognitive emotional behavioural therapy, must be evaluated and
integrated into physical rehabilitation therapies. Future research should
focus on the possible psychological interventions that can be combined
with physical interventions in order to overcome the self-imposed
immobility of elderly patients with previous fall experience.
Declaration
The author has disclosed no conflicts of interest.
The author had full access to the data, contributed to the study, approved
the final version for publication, and takes responsibility for its
accuracy and integrity.
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