The Client Who Won't Talk About Falling
Elena, 74, has been consistent for two months and is making progress. Recently she has missed sessions and seems withdrawn. When you ask, she admits she tripped at home last week and is now 'afraid to move much.' She has not told her daughter, who she says 'will overreact and put me in a home.' She asks you not to tell anyone. She still wants to keep coming but is visibly anxious and has started avoiding the balance exercises she previously enjoyed.
1. How do you balance her request for confidentiality with your responsibilities, and what do you do first?
Read the worked answer
Respect her autonomy and privacy as the default, but recognize that a recent fall plus new fear-driven activity restriction is a safety concern that warrants a careful conversation, not silent compliance.
First, explore the fall: what happened, whether she was injured, and what changed. Acknowledge her fear as understandable and normal rather than something to dismiss. Explain clearly what you can and cannot keep private, so she is not blindsided, and focus on what would help her stay independent.
Do not promise blanket secrecy you may not be able to keep. Work with her on a plan she owns, including who she is willing to tell and how. If there are signs of injury or serious risk, escalate appropriately through your setting's protocols while keeping her informed.
2. She is now avoiding balance work. How do you rebuild her confidence and re-engage her in the program?
Read the worked answer
Fear of falling after a fall often leads to activity restriction, which accelerates decline, so re-engaging her matters. Start by making balance work feel safe and controllable: use sturdy support (a counter or chair back), keep the challenge small and success likely, and let her set the pace.
Reintroduce balance gradually, beginning with supported, low-threat tasks and progressing only as she gains confidence. Pair it with strength work that improves her ability to recover from a stumble, and name that benefit explicitly so the work feels purposeful.
Address the anxiety directly: normalize it, celebrate small wins, and avoid framing balance work as risky. Coordinate with her on a home safety review (clutter, lighting, rugs) to reduce her fear with concrete action. Reassess her balance and confidence over time to show her she is regaining control.