ORLANDO – Denial is a frequently used coping strategy in geriatric patients with fall-related injuries and is likely a risk factor for inadequate treatment, according to study findings presented at the annual meeting of the Gerontological Society of America.
“It is important for doctors to be aware that when they talk to geriatric patients, it is not always cognitive impairment that contributes to them forgetting about their falls; they may also simply repress it because they are so afraid to admit it,” the study's principal investigator, Dr. Klaus Hauer, said in an interview.
“These patients need a person who knows this to approach them in a different way.”
The investigation findings were based on 80 geriatric patients (average age 83 years) admitted to the hospital with serious injuries as a result of a fall.
Interviews using standardized psychological questionnaires revealed that patients frequently rely on “repressive coping,” or denial, as a mechanism to defend against the threat of chronic impairment that is associated with falling.
Previous studies have shown that “when geriatric patients are asked what they fear most, many patients say they would prefer death to the consequences of a serious fall,” said Dr. Hauer, a professor at the University of Heidelberg (Germany).
Patients who were in the highest tertile of repressive coping were significantly more likely to underreport falls, independent of depression, age, cognitive impairment, or education, Dr. Hauer reported.
Moreover, the charts of patients who used repressive coping documented significantly fewer diagnoses and less medication use, a finding that supports the association between denial and inadequate medical treatment, Dr. Hauer noted.
This population is in all likelihood undertreated, Dr. Hauer added, because they tend to downplay their symptoms and the severity of their falls, if they admit to falling at all.
Patients identified as those who rely on denial tended to report less fear of falling, fewer comorbidities, and less medication use and were less likely to regard their fall as a sign of “terminal decline,” compared with less repressive patients, he said.
Although identifying patients who use repressive coping styles is not easily done in physicians' offices or emergency departments, Dr. Hauer said that awareness of the high prevalence of denial among geriatric patients is nevertheless important.
And when denial is identified, it may take extra motivational effort to get such patients to participate in fall prevention programs.
Dr. Hauer also offered strategies that might help these patients. For example, he suggested that it may be more effective to approach them with ideas aimed at improving physical conditioning, rather than strategies focusing on risk prevention, to emphasize a positive self-image, he said.