Falls Prevention – Balance

Falls Prevention – Balance

What is a fall?

• The World Health Organisation defines a fall as "inadvertently coming to rest on the ground, floor or lower level, excluding intentional change in position to rest in furniture, wall or other objects". Falls in older people cover a wide range of events, including:
• trips on raised obstacles (eg. loose rugs, cords, mats) or uneven surfaces (eg. footpaths, roads)
• slipping on wet or highly polished surfaces
• tumbles and stumbles down steps or stairs
• falling off a ladder or stepladder
• falling over in a shopping centre or while using public transport.

What a fall is not:

• Falls in older people are not accidents. Similarly, falls are not an inevitable or unavoidable part of life. The causes of a fall can usually be identified and the sequence of events leading up to the fall can be predicted and therefore can be prevented.
• Unintentional falls continue to be the leading cause of injuries requiring hospitalisation in Australia.

Risk factors for falls

Physical inactivity

• Physical activity has been shown to be the most promising falls prevention strategy, both as a single intervention and as a part of a multi-factorial approach.
• Research shows that specific exercises such as Tai Chi, balance, gait training and strength building group classes or individualised in-home programs reduce falls risk by 12% and the number of falls by 19%.
• These interventions can also increase the time before a person falls for the first time. A physical activity program should be specific for individuals and include exercise that challenges balance at a moderate to high extent with a attendance twice weekly.

What you can do to prevent this

• Proprioceptive retraining – challenging your body on unstable surfaces such as wobble discs and bosu balls helps to retrain your ability to recognise where your body is in space.
• Strengthening – a full body strength program including lower limb, upper limb and core strengthening will help to mitigate the loss of muscle mass common in the older population. Exercises such as squats, bridges, push ups and calf raises are useful examples of this.

Other modifiable risk factors for falls

• Problems with bowel and bladder control can impact on an older person's ability to stay active, healthy and independent.
• Incontinence, urinary frequency and assisted toileting have been identified as falls risk factors for residents in residential aged care facilities.
• Physiotherapy can assist with incontinence.

• Sore, aching or tired feet make it difficult for an older person to stay active and independent, and can affect the way they walk.
• Some types of footwear such as slippers, thongs or scuffs, and wearing socks without shoes can increase the risk of falls.

• Low vision, impaired vision, a change to vision or vision affected by medication can increase the risk of an older person falling. Vision impairment ranks sixth in the world's major causes of loss of wellbeing, and the prevalence of vision loss increases with age.

• There is strong evidence that falls risk is increased by medications which act on the central nervous system, such as those used to treat depression, sleep disorders and anxiety.
• For those using these medications to assist with sleep disorders and anxiety related health issues, there is a need for longer term support and use of non-pharmacological alternatives such as relaxation, reducing caffeine intake, increasing physical activity and meditation in the first instance.

• The relative risk of falls can be reduced by 20% in those with a history of falling by an occupational therapist conducting a thorough home risk assessment and arranging the recommended modifications.
• Tidying up behind you and not leaving objects on the floor can also help to prevent falls.

• Nutrition is an important factor in falls prevention, as frailty results from a loss of muscle mass and strength, neuromuscular impairment, immobilisation and malnutrition.
• Older Australians are at risk of developing nutritional health problems due to reduced energy needs and a decreased ability to absorb nutrients.

Falls can be prevented!  Staying healthy and active, maintaining strength and balance, identifying falls risk factors and improving home safety will help to minimise the risk of falling.

Talk to your physiotherapist today about minimising your falls risk factors or join our fit for life program.