Falls Prevention/Balance

Recognising the problem

Falls represent a common and significant problem, especially in our elderly population. Approximately 30% of community dwelling older persons fall in Australia each year, resulting in significant mortality and morbidity, as well as increased fear of falling and restriction in physical activity. Falls are common in people aged 65 years and older and are the leading cause of injury in this age group. Around one-third of generally healthy people aged 65 and older will have at least one fall each year, and the rate of falls and severity of the resulting complications increase dramatically with age. Falls are such common events for older people that it is easy to overlook their often very serious consequences for the person. The serious consequences of falls include trauma, pain, impaired function, loss of confidence in carrying out everyday activities, loss of independence and autonomy and even death.

The muscle-wasting condition ‘sarcopenia’ is now a recognised disease. 

As we grow older, the size and strength of our muscles progressively deteriorates. This can affect our capacity to perform everyday activities like standing up from a chair, climbing stairs or carrying groceries.

Falls – The Facts

• In older people living in the community, about 50% of falls occur within their homes and immediate home surroundings.
• Most falls occur on level surfaces within commonly used rooms, such as the bedroom, lounge room and kitchen.
• Comparatively few falls occur in bathrooms, on stairs, or from ladders and stools.
• Some falls involve a loose rug or a slippery floor.
• Commonly reported environmental factors include pavement cracks and misalignments, gutters, steps, construction works, uneven ground and slippery surfaces.
• Most falls occur during periods of maximum activity in the morning or afternoon, and only about 20% occur between 9pm and 7am.

Risk factors for falling?

The majority of falls occur because of multiple interacting factors, but leg muscle weakness (sarcopenia) and impaired balance contribute to most falls. Our bodies change constantly throughout our lives. Normal ageing involves:

• Poor eye sight – we may find that we can’t see as clearly, are less able to judge distances and depth or can’t cope with sudden changes in light levels or glare.
• Worse balance, weaker muscles and stiffer joints, which can change the way we walk and move around.
• Less feeling in the feet and legs, increased likelihood of pain and even changes to the shape and flexibility of our feet.
• Slower reaction times and more difficulty concentrating on several things at the one time.

We often don’t notice these normal changes as they happen very slowly over the years. For example, you may trip over a mat that has been in the same place for years. Maybe you are not lifting your feet as high when you walk, causing you to trip over the mat, or perhaps you can’t see the mat as clearly any more.

Consequences of falls

• The most common injuries include superficial cuts and abrasions, bruises and sprains.
• The most common injuries that require hospitalisation are hip fractures, pelvic fractures, leg fractures, arm fractures and fractures of the neck and trunk.
• The ‘long lie’ — that is, remaining on the ground or floor for more than one hour after a fall. The long lie is a marker of weakness, illness and social isolation, and is associated with high mortality rates among older people.
• Time spent on the floor is associated with fear of falling, muscle damage, pneumonia, pressure sores, dehydration and hypothermia.

Myths about falls

These are common myths about falls that are NOT true:

• Falls are accidents that are beyond our control
• Having a fall means you are losing your mind
• As you grow older, falls become inevitable
• Older people aren’t able to change their ways

The solution – falls prevention programs!

Strength, flexibility, balance and reaction time are considered the most readily modifiable risk factors for falls. People, even in their 90s, can improve their strength and balance to achieve stability and avoid falls. Research supports the effectiveness of exercise programs for falls prevention with 35% reduction in the number of falls, and a 35% reduction in the number of fall related injuries. 

The PURPOSE of a falls prevention program

1. Injury rehabilitation
2. Maintenance of function
3. Independence
4. Maximise skills that optimise mobility and independent functioning.

The Benefits of falls prevention

Since older people who fall are more likely to shift to long-term care, preventing falls will help maintain independence for older people living in the community. Falls prevention programs have the potential to save hospital admission and long-term care costs, the major costs associated with fall-related injuries.

Activities common to older people such as walking and gardening are not associated with gains in muscle strength or with halting of the muscle atrophy associated with ageing. Personalised strength and balance retraining exercises are required and will possibly be a new concept for older people.

With increasing age there is a progressive loss of muscle strength and stability, but the weakness needs to reach a certain threshold before daily functions are affected. It is possible that, when the person is near this threshold, even small gains in strength and balance can lead to a significant improvement in stability.

How does exercise prevent falls?

There is now good evidence that exercise prevents falls in older people, by decreasing a number of key risk factors. For example, exercise can improve muscular strength, balance, balance confidence and walking speed, as well as psychological factors such as mental ability and mood. Exercise is recommended for all community members. However the benefits of exercise in frailer people are less certain and multifaceted interventions may be necessary for fall prevention in this group.

Other management strategies to prevent falls

1. Talk to your doctor

It is important to talk to your doctor about any falls you have. Don’t just dismiss them as ‘not concentrating’ or ‘clumsiness’. Falls can be a sign of a new medical problem, muscle weakness, balance problems, medication side effects or a combination of these and other problems.

It will help your doctor if you give him or her information about the time of day you fell, what you were doing and how you were feeling just before the fall. Your family may be able to fill in the details if you can’t remember.

2. Keep yourself mobile

Inactive or unfit people tend to have poorer balance and weaker muscles and can be unsteady when walking. These can all increase the risk of falling. It is common for people who feel unsteady to do less walking. Over time this actually makes you more likely to fall because your muscles get weaker, your joints stiffer and your balance gets worse. Our bodies were designed to move. Physical activity keeps us healthy and reduces the risk of falls. It can also:

• Improve balance
• Improve muscle strength and flexibility
• Keep bones strong
• Increase energy levels
• Help with sleeping problems
• Help to control blood pressure, blood sugar levels and weight
• Help you to feel good about life

3. Managing worries about falling

If you have experienced a bad fall, it is natural to feel worried about falling again. It is also common to become fearful of falling even if you haven’t fallen. This fear may relate to unsteadiness or the thought of the possible injuries or other consequences of fall. People who are worried about falling tend to restrict their activity, gradually doing less and less. For some people this can mean less social activity. Physiotherapists can help prevent this downward spiral with suitable exercise programs and guidance. Speak to us to find out more.

References and further information:

Falls Prevention Guide – St George Private Hospital – Falls Prevention Guide The definitive guide to preventing falls, tumbles, slips and spills. http://www.stgeorgeprivate.com.au/-/media/Documents/SGP/For-Patients/StGeoPH-Falls-Prevention.pdf?la=en

Adelaide now – Record number of injuries from falls in SA public hospitals –  http://www.adelaidenow.com.au/news/south-australia/record-number-of-injuries-from-falls-in-sa-public-hospitals/news-story/6a4783b4b7e6cdc1b6d7ee3333c16919?nk=4e7382122df053e0c923c61c693fa35c-1506481602

Don’t fall for it – falls prevention resources for health providers  2011

Exercise is Medicine Australia www.exerciseismedicine.org.au

Find an Accredited Exercise Physiologist www.essa.org.au

Exercise Right www.exerciseright.com.au

Australian and New Zealand Falls Prevention Society www.anzfallsprevention.org

Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 1997; 337(18): 1279–84.

Moller J. Changing resource demands related to fall injury in an ageing population. NSW Public Health Bulletin 2000; 13(1–2): 3–6.

Moller J. (2003). Projected costs of fall related injury to older persons due to demographic change in Australia. Canberra: Commonwealth Department of Health and Ageing.

Sherrington C, et al. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 2008; 56(12): 2234–43.

Wolf SL, et al. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. J Amer Geriatr Soc 1996; 44(5): 489–97.

Cameron ID, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2012 Dec 12;12:CD005465.

Gillespie LD, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012 Sep 12;9:CD007146.

Falls prevention service directory Sept 2011

Otago falls prevention march 2003