Well that’s what we want to avoid, especially for our seniors. Did you know you that one-third of Nova Scotian seniors experience a fall each year? As well, 90% of the hip fractures experienced by seniors are a result of a fall, and for every hip fracture 20% of the elderly will die within a year.1,2
These are some devastating stats and the consequences of such falls place a heavy burden on our health care system and the families of seniors. A fall, even without injury, can psychologically damage the confidence of seniors and cause a downward cycle into inactivity and disuse atrophy.1-2
There are multiple reasons why an individual is at risk of falling or experiencing a fall. Fall prevention requires a multi-factorial approach to address the multiple risk factors and potential causes.3 A fall prevention program requires a multi-disciplinary focus and a team of professionals so when you are searching for help, make sure your provider can connect you with the services you need. Fall prevention is a highly underserviced area and my personal mission of mine is to implement a program to help as many people as possible. A fall prevention program should include the following components:
1. History & Screening/Evaluation:
2. Reduction, Management, and Education on Pain.
3. Lower Extremity Function (Strength, Gait, Range of Motion, Neurological Status)
4. Cardiovascular Screen & Care
5. Supervised Exercise Program
6. Medication Review
7. Vision Assessment and Appropriate Treatment
8. Home & Environment Safety
9. Nutritional Coaching
10. Behavior Modification (Reducing risky events) 3-5
Recent systematic reviews revealed that exercise does reduce the rate of falling. But what exactly do they mean by “exercise”? It appears that the rate of falls is reduced by an exercise intervention which includes any two of the following: strength, balance, flexibility and endurance training.6-8 Evidence also suggests that an exercise program of value for fall prevention should include balance training, a high exercise dose, and the absence of a walking program.8
Balance training appears to be a gold standard for obvious reasons. As well, it makes sense that a high dose (respecting muscle recovery) of strength training, which is proper exercise, would be an appropriate choice and a win-win (by also preventing sarcopenia) for the elderly. Lastly, the absence of a walking program, in a fall prevention plan is a beneficial component. The authors concluded that a walking program contributes to less time spent balance training, recovering, and exposes the individual to higher risks of walk related falls.8 This may seem contrary to conventional thinking, but is what the evidence suggests.
To recap, a fall prevention program of great worth would include a high dose of balance training, high intensity strength training, and a decreased emphasis on a walking program. If you know anyone that has a balance issue, has experienced dizziness, or has fallen within the last year, refer them to a qualified physiotherapist who can help.
References:
1. A Report on Seniors’ Falls in Canada, 2005 (Canadian Community Health Survey, Cycle 2.1 - data from 2002/2003, for those over 65 years)
2. Marika Salminen, Tero Vahlberg, Sanna Sihvonen c, Noora Sjo, Maarit Piirtola a,d, Raimo Isoaho, Pertti Aarnio, Sirkka-Liisa Kivela. (2009) Effects of risk-based multifactorial fall prevention on postural balance in the community-dwelling aged: A randomized controlled trial. Archives of Gerontology and Geriatrics 48, 22–27
3. Guideline for the Prevention of Falls in Older Persons. 2001. Journal of American Geriatrics 49, 664-672.
4. Marika Salminen, Tero Vahlberg, Sanna Sihvonen, Noora Sjo¨ sten, Maarit Piirtola, Raimo Isoaho, Pertti Aarnio & Sirkka-Liisa Kivela. 2009. Effects of risk-based multifactorial fall prevention on postural balance in the community-dwelling aged: A randomized controlled trial. Archives of Gerontology and Geriatrics 48, 22–27.
5. Gene Feder, Colin Cryer, Sheila Donovan, & Yvonne Carter. 2000. Guidelines for the prevention of falls in people over 65. BMJ VOLUME 321 21 OCTOBER.
- Interventions for preventing falls in older people living in the community, Cochrane Review 2009
7. John T Chang, Sally C Morton, Laurence Z Rubenstein,Walter A Mojica, Margaret Maglione, Marika J Suttorp, Elizabeth A Roth, Paul G Shekelle. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ VOLUME 328 20 MARCH 2004
8. Catherine Sherrington, PhD,_wz Julie C. Whitney, MSc,§ Stephen R. Lord, DSc,w Robert D. Herbert, PhD,_ Robert G. Cumming, PhD,z and Jacqueline C. T. Close, MDwk. 2008. Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-Analysis. JAGS 56:2234–2243.
