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Falls & Fall Prevention

More than 25% of people over 65 will fall every year. Falls are the leading cause of traumatic brain injury, fractures, and unintentional death for this population. Falls are also one of the top health care expenses every year. In 2015, Medicare costs related to falls totaled over $31 billion. In summary, falls are both very expensive and very dangerous.

70% of falls are caused by more than one risk factor. In order to treat falls and prevent future falls, one must consider 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 one’s fall risk.  Some examples of physical risk factors are leg muscle weakness, 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 age. 

There is evidence that general group exercise programs are not as effective as individually tailored exercise programs. Individually tailored exercise programs, focused on progressive balance exercises,  may be provided by a physical therapist.  A PT should first assess the patient’s risk of falling. Physical risk factors should be assessed with functional outcome measures. Each of these measures have been researched and have an established “cut-off” score which is consistent with increased fall risk. For example, if a person’s self-selected walking speed is <1 meter per second and/or they cannot stand on one leg for at least 6.5sec, their risk of falling is significantly increased. 

Once a baseline assessment has been performed, a physical therapist must provide an individualized treatment plan based on the patient’s impairments and functional limitations. The Academy of Geriatric Physical Therapy strongly recommends 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 walking while talking are at a higher risk of falling, and may benefit from dual-task performance with their normal balance and gait training. 

It requires at least 6-8 weeks for muscles to even begin gaining strength. Due to this and many other factors, balance changes do not occur overnight. There is evidence of the effectiveness of an exercise dose of at least 2 hours 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, and a therapist may recommend a person continue their exercise in a group setting, such as a yoga or tai chi class at their local fitness center. 

The AVORA Balance & Dizziness Center specializes in diagnostic testing to benchmark your fall risk level. This data will allow you and your therapist to develop a customized improvement plan together. The life you could live, you should live.


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