When your mother in law fell and broke her hip at age 72 you were concerned because she is still

Any ideas on how I can relieve my mother’s anxiety of her thinking an animal got in the house? I can’t find anything and have moved the couches but she is convinced and scared.

She’s always been a worrier, plus her thinking has been deteriorating and her vision is impaired a bit. I take care of her and my Dad both 94. She gets upset if I tell her I think she just thought she was seeing something and says I think she is crazy. Last night she woke me up shaking and practically in tears because she thought she saw it again -I offered for her to come sleep with me but she wouldn’t. Any suggestions? — C.S.

Thanks so much for sending in this question. This is actually a very common complaint that I hear from family caregivers, so happy to share some thoughts about what might be going on, and what you can do.

Now, I can’t say for sure what is going on with your mother. That’s because she’s not my patient, and I’m not in a position to interview her and examine her.

What I can say, however, is that it’s very common for older adults to develop persisting fears, worries, and complaints that often strike their family members as irrational, paranoid, absurd, or ridiculous.

Why is this?

Among my own patients, I’ve found this is often related to underlying cognitive impairment. Meaning, dementia that hasn’t yet been fully diagnosed by doctors. (For a variety of reasons, it’s pretty common for older adults with dementia to experience a delay in getting diagnosed.) In other cases, this kind of complaint ends up being one of the very earliest signs of clinical dementia.

Lewy-Body dementia in particular is associated with visual hallucinations. But any process causing brain deterioration (Alzheimer’s, vascular dementia, etc.) can result in anxieties spiraling out of control, or persisting strange beliefs.

That said, it’s quite possible for an aging person to express such fears and not have it be dementia. Maybe there really is an animal in the house, or a person stealing your parent’s things. It’s also possible for people to develop confusion or false beliefs due a problem other than dementia, such as mental illness or delirium.

(For more in-depth information on the most common causes of paranoia and strange beliefs in older adults, see this article:
6 Causes of Paranoia in Aging & What to Do.)

Still, given your mom’s age and the fact you’ve noticed other signs of “thinking deterioration,” there’s a good chance that her persisting fear could be related to some chronic underlying cognitive impairment.

4 Things to try to help your mother

I can’t tell you what you should do, but here are some ideas that are generally helpful for this type of situation:

1. Evaluate her underlying cognitive condition. In other words, get her evaluated for possible underlying dementia. Alzheimer’s and other dementias are not curable, but if that’s what’s going on, getting a diagnosis sooner rather than later can help you. For instance, if she gets this diagnosis then you’ll know to look for relevant caregiver resources, including resources on communication in dementia.

There are also a number of things you can do to help her thinking be the best it can be, such as avoiding certain medications, minimizing stress, and promptly recognizing delirium.

Last but not least, if she is diagnosed with dementia, your family should address advance care planning, and prepare for further cognitive decline. (This is sad to think about, but important!)

2. Reason why, rather than reasoning with. Instead of trying to convince her that nothing is there, see if you can figure out what might be triggering her perception that an animal is in the house. Is there a flapping curtain or other object that she’s misinterpreting, given her vision problems? Would better lighting in the house at night help?

3. Prioritize reassurance, validation, and emotional connection over rational explanations. No matter what their age or mental condition, people respond to feeling heard and loved.

And once the brain starts changing, it’s even less likely that a logical explanation will relieve a person’s anxiety. So, try focusing on acknowledging her concern and helping her feel better. It does sound like you’re already trying to do this, but since it’s such an important point, I’m saying it anyway!

Interestingly, research indicates that even people with poor memories maintain a lasting impression of an emotional experience. So keep fostering those positive emotions however you can. You might find that a hug and song work better than moving all the couches, and having your mother worry that you think she’s crazy.

4. Consider getting ideas from others caring for elderly relatives. Other family caregivers are often an excellent source of advice for trouble-shooting common problems such as anxiety, or even delusions.

You can start getting ideas — and support — from other caregivers right away through an online forum; there’s a very active forum at AgingCare.com. I would recommend doing this while her cognitive evaluation is pending, as you and she need practical behavior solutions sooner rather than later.

(Need more guidance on how to implement the suggestions above? I do offer a course to help families with all of this: Helping Older Parents with Early Memory Loss.)

Whom to ask for help

Of course, I always recommend families bring up their concerns with their relative’s doctors. Most concerns families have about an aging parent do track back to underlying medical problems that should be identified and addressed.

That said, many primary care doctors don’t have the time or experience to provide the optimal evaluation and support. If her doctor doesn’t seem very helpful, consider a specialty consultation with a neurologist, memory center, or geriatrician. (See this post for ideas on how to find a geriatrics consultation.) This should enable you to get a better understanding of what brain and body problems might be affecting your mother’s behavior.

For managing day-to-day challenges, you can get excellent practical advice from geriatric care managers, but this usually requires paying out of pocket.

I hope some of this advice helps. This is a tough situation to deal with, but if you’re persistent about investigating and looking into other ways to respond, you’ll hopefully hit upon an approach that brings your family some relief.

If nothing else, finding out that other people are dealing with similar problems is often a big relief to people.

You might also find my free online training for families helpful (see below), in which I teach families how to better communicate with an aging parent who may have memory loss.

[This article was first published in 2014 and minor updates were made in February 2022.]

To be honest, people don’t usually ask me this.

Instead, they want to know things like “How do I keep my mother from falling?” or “What should I do? My grandfather’s been falling.”

After all, falls are a scary thing. Most people know that falls are dangerous for older adults.

The Center for Disease Control (CDC) reports that one in five falls causes a serious injury such as a broken bone or head injury. Fear of falling can also seriously affect an aging adult’s quality of life and sadly, can keep a person from being active and thriving.

So, many older adults and family caregivers are interested in fall prevention because the risks are so great. And the good news is that although it’s not possible to prevent all falls, it almost always IS possible to take actions that will reduce the chance of a bad fall.

If you want to learn more, you’re in the right place.

In this post, I’ll cover:

• How understanding why aging adults fall can help you keep an older parent — or yourself — safer,
• Why personalized fall prevention plans work better than relying on general fall prevention tips,
• The four-step process I use to help older adults prevent falls,
• A practical example showing you how to use these steps to avoid falls yourself.

First, understand why older people fall

There are many reasons that aging adults fall. Most older people will be falling due to their own unique combination of reasons.

So how, exactly, should YOU go about reducing fall risk?

Now, you can — and should — try to implement the general tips that are often listed in most fall prevention resources: exercise, medication review with the doctor, vision checks, and home safety reviews.

But if you really want to help an older loved one avoid falls, I recommend you learn to better understand why he or she, in particular, might fall.

Why? Because when you understanding the specific reasons an older person may be falling, you’ll then be able to:

• Identify which fall prevention strategies are most likely to help the person you worry about,
• Recognize risky situations, and take steps to avoid them,
• Know which medical conditions — and which medications — to ask your doctors to look into,
• Understand what may have caused a specific fall, which can help you avoid future falls.

In other words, learning why older people fall means that you’ll be able to figure out why YOUR older relative is likely to fall — and take steps to help them.

Why personalized fall prevention works better than general fall prevention

Once you understand the particular factors contributing to your older loved one’s risk, it will be easier to focus on the fall prevention strategies that are most relevant to your situation. In other words, you’ll be able to personalize your approach to fall prevention.

Personalizing fall prevention is critical. You don’t want your mom to start by spending a lot of time on tai chi, if her current major risk for falls might be that her blood pressure medications are too strong, or her eyesight is terrible.

Also, don’t assume that most doctors will identify and manage the most important risk factors for falls. In my experience, busy doctors often miss opportunities to reduce fall risk, unless a family is proactive in asking for the right kind of help.

Now that we’ve covered how understanding falls can help you, let’s talk about falls. First, I’ll explain why any fall happens. Then I’ll share my framework for understanding why a particular older person might fall.

Why a fall happens

Why does a fall happen? Fundamentally, no matter who you are and what age you are, here’s why:

Challenge to balance or strength > Ability to stay upright”

In other words, we fall when we experience some kind of event that challenges our balance or strength. If this event overwhelms our ability to remain upright, down we go.

When we’re young and healthy, we tend to have lots of ability to stay upright. So if we stumble, we can often catch ourselves and recover before we fall. But of course, a big enough knock off-balance will send even a 20-year-old sprawling. And if that 20-year-old happens to be tipsy, it will take even less of a trigger to provoke a fall.

Illness or weakness is another situation that will reduce anyone’s ability to stay upright. (This is why people of all ages are prone to fall in the hospital.) But of course, older adults often have many other things going on which affect their ability to stay on their feet.

4 Steps to Reduce Fall Risk

Falls in older people are almost always “multifactorial.” This means there are usually several factors that are contributing to a fall, or to a person’s fall risk.

It can be hard to try to address every single factor. And some, such as slower reflexes, may be impossible to reverse.

Still, it’s often useful to go through them and try to spot a few that are either easy to fix, or potentially offer a big reduction in fall risk.

As a geriatrician, here’s what I do:

• Create a list of factors contributing to an individual older person’s fall risk.

• Identify risk factors and triggers related to recent or recurrent falls.

• Identify the factors that are easiest to modify or change. This is partly about the factor itself, and partly about what’s feasible for my patient to try to change. (Stairs can be a risk, but changing houses can be tricky.)

• Implement practical strategies to address modifiable fall risk factors. 

3 types of fall risk factors you should consider

I also find it helpful to think of the factors as belonging to one of three categories:

• Health-based risks. This includes things like balance problems, weakness, chronic illnesses, vision problems, and medication side-effects. They are specific to an individual person.

• Environmental risks. These are things like home hazards (e.g. loose throw rugs), outside hazards (e.g. icy sidewalks), or risky footwear (e.g. high heels). This category can also include improper use of a walker, cane, or other assistive device.

• Triggers: These are the sudden or occasional events that cause a challenge to balance or strength.  They can be things like a strong dog pulling on a leash, or even health-related events like a moment of low blood sugar (hypoglycemia) in a person with diabetes.

Now, you will probably find it hard to make a list of all these factors on your own. The health-based factors, in particular, tend to be closely related to medical problems. So they can be hard to properly sort out unless you’ve learned a lot about medicine.

Still, I encourage older adults and family caregivers to learn to think about fall risk factors, since this can help people get better at asking their doctors the right questions.

Example: Why is Mr. Jones falling?

Let’s consider an example together, to illustrate how you can put this understanding to work.

Mr. Jones is 82 years old. He lives at home with his wife, and takes a daily walk in his neighborhood. He has had diabetes for a long time, and has chronic numbness in his feet.  He is on medication for diabetes, high blood pressure, and also uses Tylenol PM.

His daughter Wendy subscribes to a newsletter about better health for aging parents, and she recently read the CDC’s fact sheet on how important fall prevention is. She would like to keep her father from falling.

What should Wendy do? As I mentioned earlier, the usual recommendations to lower fall risk are a good place to start. So Wendy could encourage her father to remain physically active, and she might want to take a closer look at the house to remove common trip hazards.

She might also want to help him get evaluated for vision problems and for low leg strength, since these are common fall risk factors among people Mr. Jones’ age. Furthermore, diabetes can cause or worsen vision problems.

But if Wendy wants to personalize the fall prevention plan, she should also consider asking the doctor to help make a list of Mr. Jones’ health-based risk factors.

In Mr. Jones’ case, some additional factors that jump out at me are:

• Chronic numbness in feet. This is a common problem in people who have had diabetes for a long time, and it can definitely affect how easily people stay on their feet.
  • It’s good to be aware of this risk, however, this problem usually can’t be cured or reversed.

• Diabetes. Some people with diabetes are prone to episodes of low blood sugar (hypoglycemia), especially if they take insulin or other drugs to actively lower blood sugar.
  • Wendy could ask her father if he ever has low blood sugar episodes, which could trigger a fall. If he does, she should make sure this is addressed with the doctor.
  • It is often appropriate to relax blood sugar control as people become older and frailer. This is because as people age, tight control brings fewer benefits but more risks.

• Blood pressure medication. This could increase fall risk, especially if Mr. Jones’ blood pressure is often below 120/80.

• Tylenol PM. Any over-the-counter medication labeled “PM” contains a sedative, usually in the form of an antihistamine such as diphenhydramine (brand name Benadryl). Older adults are often sensitive to these drugs, which can worsen balance or even thinking.
  • Wendy should help her father review his medications. She should focus on spotting sedatives or any other medications with strong “anticholinergic” effects, such as a medication for overactive bladder. (For a link to a good list of anticholinergic drugs to avoid, see this post.) All sedating or anticholinergic drugs increase fall risk, but doctors may forget to avoid or minimize them unless a family specifically requests this.

You may have noticed that in this example, I’ve particularly focused on medications.

That’s for three key reasons:

• Medications are among the most common causes of increased fall risk in older people.

• Medications are often a fixable risk factor, when it comes to falls in older adults.

• Medication-based risks are often missed by busy regular doctors. Family caregivers can make a big difference by being proactive in this area.

If you’re concerned that you or your older relative might be on medications that are increasing your fall risk, see this article: 10 Types of Medications to Review if You’re Concerned About Falling.

Take the next step: create a personalized fall prevention plan

Remember, older adults usually fall because a) multiple risk factors make them vulnerable to falling, and b) a stumble or moment of weakness triggers the actual fall.

Most fall risk factors are health-based, and are related to chronic medical conditions or medications. And then some fall risk factors are environmental, and involve the home or outside environment.

You can definitely reduce fall risk by encouraging strength and balance exercises, and by optimizing the home environment.

But you’ll be most effective in preventing falls if you can get your doctors to help you understand your loved one’s personal fall risk factors.

This way, you’ll be able to develop a more personalized fall prevention plan…one that targets the risks and vulnerabilities most relevant to your situation.

Questions about preventing falls in older adults? Please let me know in the comments below!

Or you can take my online Fall Prevention Mini-Course, in which I walk you through how to spot the fall risk factors most likely to matter in your situation.