Executive Summary

Fear of falling (FoF) is a significant health concern among senior Canadians, as it is directly related to falls, diminished self-confidence, reduced self-efficacy, and a lower quality of life. Fortunately, there are many affordable measures that can help alleviate this fear in public spaces. While BC offers some variety of resources to support older adults dealing with FoF, similar resources are not yet available in Ontario, a province with more snow and ice than BC. In London, Ontario, many of the risks associated with FoF can be addressed with a few simple steps, which we propose in the following suggestions:

1. Improve public spaces and increase regulations to ensure seniors are safer when leaving their homes. This can be achieved by installing anti-slip matts, ensuring even road surfaces, providing sturdy railings, and maintaining clear, uncluttered pathways.
2. Launch awareness campaign and resource advertisement to help seniors access the necessary assistance, treatment and fall prevention measures. These initiatives can include educating seniors on appropriate footwear choices, offering balance exercise classes, providing therapy options, and ensuring access to necessary medication.

Introduction

Fear of Falling (FoF) is a lasting concern of falling down that is comparable to a phobia or anxiety, affecting many older adults, especially women. In fact, more than one in five women over the age of 75 experience FoF. Five percent of these women are so fearful that they will not leave their home unaccompanied. In 2014-2015 Ontario reported over 250,000 emergency room visits due to falls among seniors over 65. Mitigating FoF is a primary concern for the maintenance of autonomy in the senior population. This fear was intensified during the COVID-19 pandemic due to reduced physical activity and higher levels of loneliness and isolation. Implementing preventive measures for FoF can improve older people’s wellbeing and decrease the number of falls. In fact, reducing fall-related injuries in Canadians over the age of 65 could save the Government of Ontario up to $400 million annually. To address these issues, it is essential to take effective measures. In this article, we outline several cost-efficient strategies to mitigate FoF among Ontario seniors.

Policy Gaps

FoF has been depicted as keeping seniors prisoners in their own homes. The snow, ice, and slick weather conditions common in Ontario and across Canada amplify this fear keeping seniors indoors and isolated. While there are many risk factors, such as medications, past falls, vision problems, weak legs, and numbness, there are policy steps that can be taken to protect the aging population and provide them with a better sense of security in public spaces. These concerns are further exacerbated during the winter months by inadequate prevention of hazards like slippery surfaces, lack of railings, poor lighting, and cluttered areas. By addressing these issues through thoughtful and cost-efficient policies, we can create safer environments for seniors year-round.

Ontario has a fall prevention collaborative that recommends the Ontario Government approach the issue with a more unified, holistic, and integrated front, but it fails to approach the issue with FoF in mind. It focuses on the governmental pitfalls in addressing the issue of old-age falls without highlighting the phobia that is associated with this. They recommend that current fall prevention methods are less fragmented and focus on the patient first to address the multiple causes of falls and the complex health needs of older adults who are at risk of a fall. They also recommend that preventative care such as exercise classes are used to reduce costs and burden on the healthcare system. Ontario currently has numerous programs in place such as the Geriatric Emergency Management Plus (GEM+ Plus) at the Ottawa Hospital. This program is designed to “enhance age-appropriate care for older adults in Emergency Departments (EDs) at high risk of unnecessary hospital utilization”. However, it does not focus on falls solely. Certain states have implemented fall based programs such as STEADI (Stopping Elderly Accidents, Deaths and Injuries) which allows primary care the tools and resources to identify patients who are not only at risk of a fall, but also to determine modifiable risk factors and effective strategies to reduce their risk. Although these policies do not directly address FoF, their proper implementation can significantly reduce the risk of falls. Unlike Ontario, British Columbia offers specific resources on FoF, including physiotherapy and occupational therapy services, personal alarms to call for help, hip protectors and discussing the fear with health professionals. It is time for Ontario to address FoF mitigation as well. Our policy recommendations aim to bridge this gap by providing fall prevention techniques in accessible formats, supporting individuals who already experience FoF, and improving public spaces to reduce FoF-related anxiety and associated fall risks.

1. Develop fall safety regulations for public spaces

While there is extensive discussion on making homes safer for seniors, there is limited focus on applying these principles to public spaces. In London, Ontario, for example, new sidewalks often have uneven surfaces and tripping hazards, grocery store entrances lack anti-slip mats, and pathways are narrow and slippery with ice, among other issues. We recommend that policies incorporate the home safety measures designed for seniors and extend them to public environments to enhance safety and reduce fall risks.

2. Develop an awareness campaign

Changing public policy takes time, so it’s essential to provide immediate resources for Ontario’s older adults. Display information on FoF and fall prevention in primary care offices, hospitals, community centers, and grocery stores. Launch awareness campaigns to help individuals access assistance, treatments, and prevention measures such as proper footwear, exercise classes, therapy, and medication. Since FoF involves anxiety, mental health support should complement mobility and safety strategies. Additionally, subsidizing senior-safe fitness classes, occupational therapy, and physiotherapy services is crucial. Investing in these preventive measures can save the government millions currently spent on fall-related injuries.

Fear of Falling is a crucial issue, especially in snowy regions like Ontario. Ensuring that Ontario’s older adults feel safe and mobile not only benefits them but also alleviates pressure on the healthcare system. By launching awareness campaigns and promoting resources for assistance, treatment, and fall prevention, alongside improving public spaces and enforcing stricter regulations, more seniors can be protected. Everyone, regardless of age, should be free from preventable fear and anxiety, ensuring safety and mobility for all.