By: Dr. Nathaniel D. Hoover, PT, DPT, OCS
One out of every four adults over 65 years of age fall each year…and only ½ tell their healthcare provider.(1) Having one fall in the last 6 months puts you at risk for additional falls regardless of your age. This statistic alone is one that resonates with me personally, as most of us have had the situation arise where we “just didn’t see the ice under the snow” or “didn’t know the lawn was bumpy there”. Even with those ‘unique circumstances’, sustaining a fall in the last six months is statistically predictive of falling again and should be assessed to determine if treatment is needed to prevent future falls. Physical therapists are uniquely trained to assess your strength, range of motion, flexibility, reaction strategies and past medical history to determine the next steps to reduce your risk for fall and injury. At times, this may require working with your physician or primary care provider, optometrist or pharmacist to reduce other risk factors.
It should be noted that balance is not just an “older person problem”. Anyone, regardless of fitness level or age, should be exercising the multiple systems that work together to keep us balanced. This consists primarily of vision, joint proprioception (where our joints are in space) and our vestibular system. The vestibular system is a sensory system with a set of structures in your inner ear that detect head movements, acceleration and orientation in space and sends this information to your brain. Your brain uses this information from the vestibular system to help you balance and orient yourself while moving.(2) One of the things I talk with my patients about is asking them the last time they were on a swing set, merry-go-round or hung upside down? The answer for most of us 18 years of age and older is, “not very often”. Particularly as we age, we tend to not exercise our vestibular system as often as children. Using exercises to keep our vestibular system tuned can be very helpful in reduction in falls and dizziness. Your PT will help to determine if you are at a risk of falling and what the best, individualized plan is to address any concerns with balance.
Falls are costly. Falls are responsible for nearly 3 million emergency department visits per year and account for a large proportion of wrist, shoulder and hip injuries. They also are the leading cause of traumatic brain injuries. (1) While falls are scary and create a great deal of healthcare cost/pain, not every fall causes injury. It is reported that 37% of falls require medical treatment or loss of activity for at least one day. That said, now is the time to assess and change your risk as research concludes that multifactorial and exercise interventions were associated with reduced falls in multiple, quality studies. Exercise demonstrated the most consistent statistically significant benefit across multiple fall-related outcomes. (3) Know that you are not alone. In 2018, a study demonstrated that 27.5% of community dwelling older adults reported a fall in the last year. (4)
See below for more risk factors, at home screening tests and introductory balance exercises.
Risk Factors For Sustaining a Fall:
- Mobility deficits
- Leg weakness
- Taking 3 or more medications
- History of lower extremity injuries/lower extremity pain
- Environmental factors (uneven surfaces, throw rugs, clutter)
- Vision changes (difficulty with vision, low light)
- Footwear selection (ie. sandals/slip on shoes)
- Fear of falling
How to Screen Yourself?
1. Timed Up and Go Test
Sit on a chair with your back resting on the backrest and feet resting on the floor. Have a second person time you (or time yourself) and on “go” stand up, walk 10 feet, turn around and sit back down on the chair. The time it takes to complete this test can be predictive of falls.
<10 seconds = Low risk of falls
<12 seconds= Normal for healthy older adults
>13.5 seconds= Elevated risk for falls
2. Do You Have a Fear of Falling?
If the answer to this is “yes”, research is clear that you are likely at an increased risk for falls compared to your peers. While scary, this is OK and can change with treatment. Now is the time to consult with your physical therapist to assess the areas that need to be addressed to reduce your risk.
3. Leg Strength: 5x Sit to Stand
Set up a chair, start a timer and sit down and stand up 5x. Note your time compared to the normative values below. If you are near a cut-off, contact your physical therapist to discuss leg strengthening exercises to reduce your risk and build strength.
< 12 seconds: Generally normal for healthy older adults.
> 12 seconds: Indicates increased fall risk (commonly used cutoff).
> 15 seconds: Suggests significant functional impairment.
At Home Exercise:
Static balance is a good way to start to practice improving your balance. Balance is a dynamic problem, which is why static balance exercises (while often boring) are only the start of addressing the problem. Most falls occur when dual tasking, moving or are the result of environmental challenges. Your balance training should also be more than static exercises, but here is a suggestion for a static balance exercise to get you started.
At Home Static Balance:
(Complete only if you feel safe to do so) The appropriate static balance exercise should make you feel “wobbly” or hard to hold but not cause a fall.
Stand at sink with hands hovering over edge of sink. Try placing your feet in the positions pictured below and hold for 30 second each. If you are able to complete all three positions then trial holding a static stance on a single leg only.
Lets turn being “Careful” into being “Confident”. Consult with your PT to build confidence in balance today.
Want to learn more? Check out this resource or give us a call to schedule an appointment to address your balance/falls concerns: Health Center | Falls Prevention | Choose PT
Sources:
- https://www.cdc.gov/falls/data-research/facts-stats/index.html
- https://my.clevelandclinic.org/health/body/vestibular-system
- https://jamanetwork.com/journals/jama/fullarticle/2819574
- Moreland B, Kakara R, Henry A. Trends in nonfatal falls and fall-related injuries among adults aged ≥65 years—United States, 2012-2018. MMWR Morb Mortal Wkly Rep. 2020;69(27):875-881. doi:10.15585/mmwr.mm6927a5
- https://www.physio-pedia.com/Romberg_Test
