For as long as I remember my family has worried about my grandmother falling. She is a beautiful, spunky soul who cannot be told to sit down and at that time refused to use an assistive device. To this day it takes a gentle reminder for her to bring it for her outdoor walks. I’ve often heard the reference to a story at a family gathering; everyone went out for a walk to get some fresh air and my grandmother took a misstep off the sidewalk curb. Unfortunately, family time went from being enjoyable to rushing to the emergency room to find out she had broken her wrist. This event turns into orthopedic appointments, a cast for 6+ weeks, and some followup care. After all the bones were healed the lingering complication is a fear that she will fall again. That was her first fall and there have been many over the past 20 years. This story recalls a preventable fall and later we will determine the difference between a preventable fall and one that could not have been avoided. A fall does not only affect the injured individual but the support system around them as well.
According to the Center of Disease Control more than 1 in 4 older adults fall each year. According to the U.S. Census Bureau there are more than 50 million people that fall into that population. With some simple math that equates to over 12.5 million falls yearly in a population that is growing and getting older. As a physical therapist I have the skills to assess someones balance risk and treat them to improve their balance. Many kinds of exercise have been proven to reduce fall risk and many senior centers offer classes for this purpose. There are ways to reduce fall risk and there is education to healthcare providers so that they may identify the risk and take proper steps to reduce the falls. The CDC has created an initiative called STEADI Stopping Elderly Accidents, Deaths, and Injuries which puts into place the clinical practice guidelines for fall prevention.
Commonly these falls are referred to as accidents. An accident is an unfortunate incident that happens unexpectedly and unintentionally, typically resulting in damage or injury. When we get into a car we take certain precautions to prevent accidents: most people put on a seatbelt, drive the speed limit, use their blinker when turning, and avoid driving under the influence. If we thought about preventing falls in this same manner it would be recommended to put on good footwear, walk daily to keep the body active, use a cane or walker when recommended, and think of medication as an influence on our balance.
Research shows that as we age our balance declines. Common risk factors for falls are:
The sensory input called proprioception gives us information about where our body is in space and this decreases as we age or due to neurologic injury or illness. The reaction times of our ankles, hips, and stepping strategies take longer to kick in and we need larger movements to catch our center of gravity. Strength deficits can prevent us from lifting out feet as high as we need to clear stairs, area rugs, and other obstacles around the home. Medication use can calm the central nervous system which may lead to everything being slower, more of a foggy feeling. Many variables can lead to falls and having more risk factors you are more likely to fall.
Children learn to walk after crawling. They have a very wide base of support and practice daily for months prior to taking off. As we age we too need to implement those learning strategies. Practice allows our brains to develop and act when an event happens.
Non Preventable Falls
Non Preventable falls are a result of a medical origin which causes someone to pass out or become unconscious. In this case the medical change is primary and the fall is a secondary complication of that event. With the change in their physical system the body temporarily fails and they can get severely injured during the non preventable fall. Possible reasons for syncope (passing out) could be:
In these instances the individual may report they don’t recall anything about the fall and that potentially they weren’t feeling themselves prior to the fall. In order to prevent or reduce these types of falls the medical team needs to investigate and make changes to treat the primary cause of the event.
VIZSTIM has developed a fall prevention and balance program for home use. It incorporates a combination of strength, balance, and vestibular exercises. Designed by a physical therapist with a clinical specialty in neurologic care who has worked with many people suffering from neurologic injury or illness, vestibular injury or illness, and aging. This program can be easily implemented into daily use and is a program that you can first take to your physical therapist to become confident in doing these exercises. It is packaged in a way that it is easy to follow and easy to continue at home since you are given all the tools needed to succeed. There are many variations of these exercises which can be found by following us on social media and at VIZSTIM.com.