Having a fear of falling is a slippery slope. It turns out that being afraid you’re going to fall increases the risk that you will take a tumble, even when you’ve never fallen before.

Why We Fear Falling

When a person fears falling, that fear likely stems at least in part from their own estimate of their balance and gait, according to Thomas Hadjistavropoulos, the University of Regina Research Chair in Aging and Health. If you think your balance or gait is poor, you might be underestimating yourself — or you may have good reasons. For instance, Dr. Hadjistavropoulos says, some medications can cause weakening fatigue, low blood pressure may have a dizziness side effect and poor vision can make the edges of steps look blurry.

That’s why the place to start investigating a fear of falling is with your physician. “A qualified health professional can determine whether the fear is due to an accurate estimation of your risk of falling or is excessive,” Hadjistavropoulos says.

Who’s Most at Risk?

The generally accepted explanation of how fear actually leads to falling among older people goes like this: When you are afraid of falling, you tend to limit your physical activity. For a while that strategy works, but eventually, restricting activity leads to a loss of muscle strength, endurance and mobility — three things that make you vulnerable to falling.

Research shows that fear of falling is pervasive among seniors. A University of Kansas study of 926 people age 65 and older found that nearly half had some fear of falling, and 65 percent of those fearful folks had restricted their activity as a result. But 70 percent of those who feared falling had not actually had a fall in the year preceding the study.

In the study, women were more likely to express fear of falling, and the fear became more common with increasing age. Physically, those with the greatest fear were also weaker, walked more slowly and felt less in control of their lives. And people who were slower and less confident also tended to restrict their activity.

A New Mind-Body Theory

Researchers have found that being afraid you might fall directly affects your balance. When older people are in a situation that threatens balance — say, having to walk on a raised platform as part of a lab test — they adopt a “stiffening strategy.” This is a reflex-like tightening of the major muscle groups of the lower leg, and the entire perceptual system is affected, too. When people are afraid of falling, “They produce fewer eye movements to get the information they need when walking. Also, anxiety reduces their ability to remember things about their walking path,” explains Will Young, PhD., Lecturer in Rehabilitation Psychology at Brunel University, London.

Consequently, when we’re nervous about falling, our range of motion becomes smaller, our strides are shorter and our pace is slower — a combination of events that can lead to a fall.

Researchers have also found that when older people are anxious about falling and try to do two things at once, like walking and talking, their balance and gait become less stable.

5 Ways To Gain Balance and Boost Confidence

A 70-year-old endocrinologist who we’ll call Janet (she asked us not to use her real name) has done all the right things to avoid being sidelined by her fear of falling — including not letting her fear stop her from doing what she loves to do. An avid hiker, Janet says she wants to keep hiking despite the fact that she tends to trip a lot and is always the last one in the group. To avoid falling, she uses hiking poles.

Janet has a history of vertigo, a bit of a foot drop and back problems. For the past five years her imbalance has worsened. She’s met these balancing challenges head on with water aerobics, physical rehabilitation exercises and Pilates.

Whether your fear of falling is due to physical or medical issues, or you’re just anxious, there are things you can do to help yourself stay upright:

1. Do exercises for balance and strength. You want to make your legs stronger, improve your balance and raise your confidence level.

Tai Chi is a good example of a practice that does all three.

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Yoga is strengthening and has many poses that improve balance, some of which you can do seated.

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There are also balance exercises that you can do almost anywhere — including while you’re standing in line at the grocery store.

2. If you’re taking medications, have your health care provider or pharmacist review them so you’ll know if any cause dizziness, make you sleepy or might cause you fall for any other reason.

3. Have your vision checked. (Janet says she’s always extra careful when going down steps, because her trifocal lenses can make stepping difficult.)

4. At home, put away anything you could trip over on stairs and paths that you often walk, so you won’t have to worry. You can find tips on making your home safe on the CDC website.

5. Check out your shoes. The American Podiatric Association has a 1-2-3 test that can help you evaluate whether your shoes are optimal for balance.