Case Report on Fear of Falling Syndrome: A Debilitating but Curable Gait Disorder

Abstract

Patient: Male, 70Final Diagnosis: Fear of falling syndromeSymptoms: Inability to get up from a chair and ambulate independentlyMedication: —Clinical Procedure: Lumbar punctureSpecialty: NeurologyObjective:Rare diseaseBackground:Fear of falling syndrome is a rare and often-missed disorder among patients with new-onset gait abnormality. The disorder is often mistaken for an organic neurologic problem, with some considering it to be a medical emergency.Case Report:This case report presents a 70-year-old man who presented to the Emergency Department due to inability to rise from a chair or ambulate independently. Onset of his chief complaint occurred subsequent to a traumatic fall in a public location. He underwent extensive workup, and an organic neurologic cause was ruled out. He was subsequently diagnosed with fear of falling syndrome after obtaining a detailed fall history, as well as utilizing a verified survey (the Falls Efficacy Scale-International). After extensive inpatient treatment, the patient improved significantly. However, upon discharge to a skilled nursing facility, he was not offered the recommended treatment. When he was readmitted for an unrelated reason 3 months later, he had regressed to the state he was in at the time of prior admission.Conclusions:This case presents a rare debilitating but reversible gait disorder, and highlights the importance of assessing “fall history” and fear of falling in older adults. Uniquely, this case presents the rapid fluctuation in outcomes dependent on treatment, and what happens when a patient fails to complete treatment regimens. The report also provides an overview of fear of falling with the corresponding gait disorder.

Adult Inpatients’ Perceptions of Their Fall Risk: A Scoping Review

“…People with cognitive impairment were excluded from most studies, with only five studies including those with mild cognitive impairment [ 23 , 24 , 25 , 26 , 27 ] and three studies including adults with mild to moderate cognitive impairment [ 28 , 29 , 30 ]. The study locations varied within the hospital and included emergency departments [ 24 , 31 , 32 , 33 , 34 ], sub-acute/rehabilitation settings [ 27 , 28 , 29 , 30 , 35 ], orthopaedic units [ 26 , 36 , 37 ], oncology units [ 38 , 39 ] and a bone marrow transplantation unit [ 40 ], with the remainder occurring in acute care wards. Of these, four studies took place across a range of wards [ 41 , 42 , 43 , 44 ], and one study occurred in a seven-hospital multi-site study across multiple wards [ 45 ].…”

“…“Fear of falling” or post-fall syndrome [ 80 ] describes people who have an anxiety of falling, which impacts their activity levels and independence, but may not have necessarily experienced a fall [ 81 , 82 ]. It is important to assess a person’s fear of falling along with their fall history to determine if they have a diagnosis of fear of falling syndrome [ 33 ]. Interestingly, Eckert, Kampe [ 36 ] found that fear of falling and fall self-efficacy are two separate constructs, yet some studies continue to incorporate self-efficacy measures to assess fear of falling.…”