Anxiety is characterized by feelings of fear, uneasiness and dread, as well as somatic symptoms such as increased perspiration and tension. Meta-analysis has identified that older adults with elevated levels of anxiety are around twice as likely to experience a fall. Around 20% of older adults are thought to experience at least one type of anxiety disorder. Medication prescribed for anxiety, such as benzodiazepines and other sedatives can increase risk of falling.
Whilst anxiety is a vital component of FOF, it has been the subject of various studies as a risk factor for falls in its own right. A review from Hadjistavropoulos, Delbaere, & Fitzgerald (2010) distinguishes between definitions of anxiety and FOF, suggesting that FOF can be described as low self-efficacy toward balance. Hadjistavropoulos, Delbaere, & Fitzgerald argue that FOF and anxiety can be distinguished as certain beliefs can lead to fear and anxiety, crucially without always co-occurring with anxiety. In addition, FOF and anxiety can be distinguished by duration. An older adult may always present a fear of falling – however may only feel anxiety when locomoting, anticipating future locomotion or when contemplating upon past locomotory experiences.
The effects of anxiety upon postural control and gait are well researched. Stiffening strategies are often employed by older adults whom are anxious about completing a particular movement. These strategies often involve co-contraction the tibialis anterior, soleus, and gastrocnemius muscles, which reduces the range of motion of center of mass. Stiffening strategies may sometimes lead to a decreased risk of falling, by avoiding potentially destabilizing motor patterns, such as excessive ankle dorsiflexion or plantarflexion, providing the demands of the task are fairly low. However, Young, & Williams (2015) argue that many day to day activities, such as walking along uneven pavements can be highly demanding for some older adults, and that stiffening strategies may increase risk of falling. Young, & Williams state that stiffening strategies may lead to an increase in reaction times, as well as increased likelihood of misplacing steps.
Anxiety in older adults is suggested to affect visual behavior. Young, Wing, & Hollands (2012) measured state anxiety, gazing behavior and step accuracy throughout a number of walking tasks amongst 8 older adults at high risk of falling (score of 45/56 or less on Berg balance scale or suffered a fall within past year). The tasks involved walking along a 10m pathway, with various obstacles added within each consequent trial. The results indicate that increased task difficulty was associated with statistically significant increases in measures of anxiety. In addition, increased task difficulty was also associated with increased stepping inaccuracies and increased extent of early gaze transfer. This means that anxious older adults would transfer their gaze away from an obstacle sooner, in order to focus on the consequent step after that. Young, & Hollands (2010) state that such visual behaviors may jeopardize safety, due to looking away from an obstacle before foot contact, leading to poorer stepping accuracy. This could increase the risk of tripping, and lead to a fall.
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