A Matter of Balance: National Program Helps Overcome Fear of Falling

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Mary D'Apice

Prevention of Falls

National Fall Prevention Day is coming. Prevention of falls is of critical concern to people with vision loss. Also, many older adults fear falls because of the risk of serious injury. Unfortunately, the fear can be equally debilitating when a person begins to restrict their activities, leading to social isolation, physical weakness, and decreased independence. A Matter of Balance is an award-winning program which seeks to help people over age 60 learn to control fear of falling through exercise, practical tips, and problem solving in a supportive group environment. Developed by the Roybal Center at Boston University, A Matter of Balance was initially delivered by healthcare professionals. Now it is led by volunteer lay leaders, which has significantly reduced costs and allowed the program to expand to 38 states, and this evidence-based program has been adapted for persons with visual impairments.

Removing Barriers

Debra Laine, Special Programs Director at the Arrowhead Area Agency on Aging in Duluth, Minnesota and a Master Teacher in the program, says "Many older adults fear that they are going to have restrictions put on them if they disclose having fallen, but we have them flip that around." A meaningful dialogue about falls often leads to concrete solutions that promote greater independence,for example, asking a doctor to change medication that is affecting balance or asking a son or daughter to address trip hazards in the home.

The workshops offer fall prevention tips such as wearing appropriate footwear. Participants have homework, like using a home safety checklist and share results with the group. Participants learn how to make changes to reduce the risk of falling. They develop action plans to eliminate barriers that prevent people from exercising. Is it simply a need for new bathing suit or pair of sneakers that is keeping a participant from exercising? And as participants bond, they hold each other accountable such as encouraging getting out one's apartment or home.

Adapting the Program to People with Visual Impairments

As Master Teacher, Laine observed dozens of classes and soon realized that programs around the state had a number of persons with visual impairment. She noticed people squinting at workbooks or not following the exercises. "It sent me on a quest to empower those with vision loss to fully access course materials and take advantage of the class."

In collaboration with the Lighthouse for the Blind in Duluth, Minnesota, Laine developed an accessible program for people with low or no vision that could easily be disseminated nationally. Now, coaches are provided with large print workbooks and content that can be used with screen readers. Exercise instructions on CDs are carefully scripted so that a person does not need visual aids to understand them. In addition to course materials, coaches learn about different types of vision loss and how to ensure program activities are inclusive. The program also includes basic etiquette such as speaking in a normal tone of voice and introducing oneself by name when greeting a person who is blind or has low vision.

The manual describes how people adjust to vision loss and the stages of grief people go through. This helps coaches better understand why someone might not identify themselves as visually impaired upon immediately joining the class, particularly if they are in denial. A Matter of Balance provides large print materials. Coaches find ways not to put people on the spot such as by casually leaving packets of large print materials on a table.

The Elephant in the Room

While exercise is integral to the two-hour, 8-week workshop, the entry-level routines are not introduced until week three. Patti League, National Program Manager for A Matter of Balance, believes it is important to lay a strong foundation for behavior change first, and that means addressing pre-conceived notions. "People are taking this big white elephant of fear and putting in the middle of the room," she says. League describes A Matter of Balance as being "flip-chart" based since the program is rooted in group discussions, brainstorming, and creative problem solving. She mentions a session in which one woman announced that she would no longer visit her brother because the idea of flying was overwhelming. The woman's peers made calls on her behalf to find out about wheelchair assistance. Once the woman knew she could be safely transported from curbside to ticket counter to gate, she immediately booked a flight.

Laine experienced many "light bulb" moments when learning about visual impairments. "I never thought of the importance of leaving a door all the way open or all the way closed for safety. I'm glad I have become more aware." A Matter of Balance coaches who teach other health education classes transfer their newfound awareness and now can make all of their classes inclusive. Laine, who also teaches a chronic disease management class, says, "I always make sure I check in with people about whether there is glare on my flipcharts." Knowing that people who are visually impaired rely on memory, she avoids randomly calling on people in a group. Instead she has people speak in the order that they are seated so that people with vision loss know who is speaking. These simple adaptations often enhance the program for others who may have low literacy, hearing impairments, or other special needs.

Conquering Fears, Enjoying Life

League notes that the lessons in A Matter of Balance can build momentum for creating positive change. "When people feel stronger they are willing to take the next steps and ask "how can I keep this going?" Some might join an exercise or dance class; others might take another health course or join a group at their community center. "One of the long-term outcomes is that people are not letting their fear of falling interfere with their social activities." For example, students often bond in the class and continue their friendship, having lunch once a week. "The process of looking at a problem and breaking it down is a useful tool that goes way beyond A Matter of Balance." League sees the power of renewed confidence can be applied to all aspects of life, "Creating a whole new feeling of overcoming obstacles."

How to Find A Matter of Balance Programs

Contact your local agency on aging or go to the MaineHealth website which hosts a listing of A Matter of Balance master trainer sites by state.

More Information on Balance and Preventing Falls

Orientation and Mobility
Home modification
Environmental assessment and modification
Low Vision
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