Falls & Fall Prevention
Falls are the leading cause of traumatic brain injuries, fractures, and unintentional deaths in people over the age of 65 years old. Falls are also one of the top health care expenses every year. In 2015, Medicare costs related to falls exceeded $31 billion, making falls both expensive and dangerous.
70% of falls are caused by more than one risk factor. In order to treat falls and prevent future falls, one must consider and address both medical and physical risk factors. Medically, factors such as polypharmacy (the simultaneous use of multiple drugs to treat a single ailment or condition), depression, and cognitive impairment may increase a person’s fall risk. Some examples of physical risk factors are muscle weakness in the legs, vision impairment, or numbness in the feet. After age 30, we begin to lose 3-5% of our muscle mass per decade. Despite this, we can gain muscle mass at any age, but it may require a little more effort as we get older.
While better than being a couch potato, there is evidence that general group exercise programs alone are not as effective as individually tailored exercise programs. Individualized exercise programs that are focused on progressive balance exercises and fall risk reduction techniques are often provided by a physical therapist (PT). A PT should first assess the patient’s risk of falling and specific deficits using functional outcome measures, which have been researched to identify the level of fall risk. For example, if a person’s preferred walking speed is <1 meter per second and/or they cannot stand on one leg for at least 6.5 seconds, their risk of falling is significantly increased. Additional computerized testing, available at AVORA, including, but not limited to, computerized dynamic posturography (CDP), video head impulse testing (vHIT or vHIMP), suppression head impulse testing (vSHIMP), dynamic visual acuity (DVA) testing, and videonystagmography (VNG) testing are highly sensitive tests to assess and quantify impairments that manual testing may miss. The most effective and efficient treatment program stems from identifying the specific impairments unique to each person!
Once a baseline assessment has been performed, a PT will provide an individualized treatment plan based on the patient’s impairments and functional limitations. The Academy of Geriatric Physical Therapy strongly recommends incorporating strength training, balance training, gait training, correction of environmental hazards, and correction of footwear or structural impairments of the feet. Older adults who have difficulty simultaneously walking while talking or processing cognitive information (i.e., thinking about something other than walking and balancing) are at a higher risk of falling, and may benefit from dual-task performance incorporated into their customized balance and gait training program. A comprehensive balance program should also include working on reaction time (something often worked on with athletes but forgotten about in seniors), education about fall risk and components to reduce fall risk, and learning safe falling techniques. Yes, learning how to fall while reducing the risk of an injury is imperative to incorporate into a balance program. We all have the potential to fall from time to time, regardless of the best laid plans, however, we can quickly recover if we have not sustained an injury from a fall.
Balance improvements do not occur overnight. Gains in muscle stretch alone take at least 6-8 weeks. Improvements in reaction time and proprioceptive awareness can take even longer. There is evidence that at least 2 hours of exercise per week for at least 6 months, with a total dose of more than 50 hours is necessary to reduce falls. All of this time does not need to be in a clinical setting. A therapist may recommend a person continue their exercise in an individual or group setting, such as a yoga or tai chi class at their local fitness center. An important component of any exercise program is to progress the program as improvements are made until the desired outcomes are achieved.
70% of falls are caused by more than one risk factor. In order to treat falls and prevent future falls, one must consider and address both medical and physical risk factors. Medically, factors such as polypharmacy (the simultaneous use of multiple drugs to treat a single ailment or condition), depression, and cognitive impairment may increase a person’s fall risk. Some examples of physical risk factors are muscle weakness in the legs, vision impairment, or numbness in the feet. After age 30, we begin to lose 3-5% of our muscle mass per decade. Despite this, we can gain muscle mass at any age, but it may require a little more effort as we get older.
While better than being a couch potato, there is evidence that general group exercise programs alone are not as effective as individually tailored exercise programs. Individualized exercise programs that are focused on progressive balance exercises and fall risk reduction techniques are often provided by a physical therapist (PT). A PT should first assess the patient’s risk of falling and specific deficits using functional outcome measures, which have been researched to identify the level of fall risk. For example, if a person’s preferred walking speed is <1 meter per second and/or they cannot stand on one leg for at least 6.5 seconds, their risk of falling is significantly increased. Additional computerized testing, available at AVORA, including, but not limited to, computerized dynamic posturography (CDP), video head impulse testing (vHIT or vHIMP), suppression head impulse testing (vSHIMP), dynamic visual acuity (DVA) testing, and videonystagmography (VNG) testing are highly sensitive tests to assess and quantify impairments that manual testing may miss. The most effective and efficient treatment program stems from identifying the specific impairments unique to each person!
Once a baseline assessment has been performed, a PT will provide an individualized treatment plan based on the patient’s impairments and functional limitations. The Academy of Geriatric Physical Therapy strongly recommends incorporating strength training, balance training, gait training, correction of environmental hazards, and correction of footwear or structural impairments of the feet. Older adults who have difficulty simultaneously walking while talking or processing cognitive information (i.e., thinking about something other than walking and balancing) are at a higher risk of falling, and may benefit from dual-task performance incorporated into their customized balance and gait training program. A comprehensive balance program should also include working on reaction time (something often worked on with athletes but forgotten about in seniors), education about fall risk and components to reduce fall risk, and learning safe falling techniques. Yes, learning how to fall while reducing the risk of an injury is imperative to incorporate into a balance program. We all have the potential to fall from time to time, regardless of the best laid plans, however, we can quickly recover if we have not sustained an injury from a fall.
Balance improvements do not occur overnight. Gains in muscle stretch alone take at least 6-8 weeks. Improvements in reaction time and proprioceptive awareness can take even longer. There is evidence that at least 2 hours of exercise per week for at least 6 months, with a total dose of more than 50 hours is necessary to reduce falls. All of this time does not need to be in a clinical setting. A therapist may recommend a person continue their exercise in an individual or group setting, such as a yoga or tai chi class at their local fitness center. An important component of any exercise program is to progress the program as improvements are made until the desired outcomes are achieved.