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Minding our Elders: Excessive fear of falling can have varied causes

DEAR CAROL: Is it common for people with dementia to be afraid of falling? My mother has Alzheimer's. She gets around with a walker but she needs assistance. I can understand an elderly person's fear of falling because injuries can be so serious but she seems abnormally afraid. Her fear keeps her from moving around as much as she can and that's not healthy. - Steve

DEAR STEVE: Most people have a heightened fear of falling as they age since worn joints, aging eyes and even middle ear or other balance problems can cause people to feel less steady. If dementia isn't an issue, then many times exercises to increase muscle strength and balance can help people feel more secure.

Dementia, of course, adds another dimension to the problem. Many people with dementia have trouble processing and interpreting what they see. Any change in texture, pattern or color of flooring can be interpreted by the person with a cognitive disorder as a bump or hole or other threat to his or her stability. These changes may appear like optical illusions and can be confusing. Confusion, of course, contributes to fear.

Another common cause for confusion and dizziness in elderly people is a urinary tract infection. UTIs are quite common as people age. Anything from dehydration to poor hygiene, lower immune function or aging organs can contribute to this increased risk. Inner ear infections can also be a cause of dizziness which, understandably, can lead to a fear of falling. I'd suggest a medical checkup for your mom to rule out a UTI or inner ear infection.

Quite a few medications can cause dizziness, as well. If your mother is free of infections, her doctor may want to examine her list of medications, both by themselves and their interactions. If any of her medications can cause dizziness, there may be alternatives. Over medicating can also be a problem, so ask the doctor if all of her medications are necessary. Sometimes a second opinion can be helpful.

Your mother's eyes could be an issue, as well. If she needs new glasses or cataract surgery these should both be considered. At one time, cataract surgery wasn't a priority for people who were already having dementia issues, but there has been some research showing that the dimming of eyesight caused by cataracts can worsen cognitive problems.

As is often the case with changes in our elderly loved ones, when we are concerned about a health issue a visit to the doctor is in order. He or she should be able to find out where the problem lies and let you know if there could be a solution. If all causes other than your mother's dementia are eliminated, this may simply be the next step in her disease and you'll have to learn to help her in other ways.

You are on a challenging journey with your mother. Looking for the meaning behind behavior is important when caring for someone with dementia. It's good to see that you are interested in helping her improve her quality of life.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at She can be reached at