10/19/2011 - Articles

Balance Anxiety: Life as a Black Diamond Ski Trial

By: John Russo, Jr., PharmD


My first experience with balance anxiety occurred while skiing. I learned to ski while living in Utah, and actually became pretty good. On a black diamond run I was confident in my ability to descend safety. I almost never fell. Thirty years later, on a mountain in upstate New York, my confidence was gone. One run and several falls later, the joy of schussing was replaced by anxiety over potential injury — balance anxiety.

A vicious cycle
There's a vicious cycle in all of this. Fear of falling is a consequence of falling — up to 73% of older people who fall acknowledge this fear. Combining fear with anxiety has a direct negative effect on balance, which increases the risk of future falls.

Anxiety also leads to self-imposed activity restrictions and the risk of further functional decline, depression, feelings of helplessness, and social isolation.

The bottom line?
Each year one out of three seniors living in your community falls. This single event combined with underlying risk factors (e.g., osteoporosis, slowed protective reflexes) alters health, independence, and even life.

  • 5% to 10% of fallers sustain serious injury (e.g., fracture, head injury)
  • 25% to 75% of fallers with hip fractures never recover their prefracture level of function
  • 1% of fallers who sustain a hip fracture have a 20% to 30% risk of dying within a year

Subtle assistance is the first step in helping older people deal with their balance anxiety. Crossing the street? Hold mom’s arm for support. Parking the car? Open the door for your wife, and never park on loose gravel. Visiting the grand parents? Pick up items strewn across the floor. A senior with balance anxiety is unlikely to stoop to retrieve fallen items.

More about risk factors and how to reduce the risk of falling is discussed below.

An Action Plan to Reduce the Risk of Falling
John Russo, Jr., PharmD

"Given their frequency and consequences," says Dr. Mary Tinetti, from Yale University, "falls are as serious a health problem for older persons as heart attacks and strokes."

Fall screening and prevention start by assessing balance confidence. For this, you can use the Activities-specific Balance Confidence (ABC) Scale. Then, follow the American Geriatrics Society recommendations to reduce the risk of falling.


  • Resistance (strength) training and balance, gait, and coordination training reduces the risk of falls by about 16%

Reassess drug treatment

  • Modify and simplify medications
  • Treat to correct slow and rapid heart rates

Supplement with vitamin D

  • Vitamin D deficiency is common among older people and impairs muscle strength and possibly neuromuscular function
  • Provide vitamin D supplements of at least 800 IU per day to older people with proven vitamin D deficiency

Correct foot and footwear problems

  • Bunions, toe deformities, ulcers, or deformed nails predispose to falls

Home safety

  • Make needed modifications for people with a fall history or risk factors

Correct vision problems

  • Impaired vision is a risk factor for falls, but surprisingly, wearing glasses (particularly bifocals) does little to reduce the risk of falling
  • Start by correcting cataracts


  • Fall prevention programs should include education to raise awareness about risk factors for falls and actions that minimize risk

Fall prevention supports health and is cost effective. Management of psychotropic drugs and participation in tai chi (exercise) reduce costs most. Home modifications provide the best value.

See your doctor for guidance on implementing a personalized action list for fall prevention.

Created on: 10/19/2011
Reviewed on: 10/19/2011

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