Falls Risk Reduction and Promotion of Physical Fitness

Fall: An unexpected event in which the participants come to rest on the ground, floor, or lower level.

Falls are a major health concern among older adults. More than one third of older adults fall each year and fall rates increase with advancing age. Falls are the leading cause of injury deaths, the most common cause of non-fatal injuries, and the most common reason for hospital admission due to trauma in older adults. Every hour, there is one death and 183 emergency department visits for falls-related injuries among older adults. More than 95 of hip fractures are caused by falls.

Risk Factors for Falling
Research shows that a cumulative effect of multiple inter- acting factors increases fall risk in any one individual.
• Muscle weakness History of falls
Gait deficit
Balance deficit
Use of assistive device
• Visual deficit(s)
• Neurologic deficits
• Arthritis
Impaired ADLs
• Depression
Cognitive impairment Age > 80 years
• Medications
• Cardiovascular deficits

Fear of Falling
Fear of Falling (FOF) is multifactorial in etiology and may be a more pervasive and serious problem than falls in older adults.
Risk factors identified for the development of FOF:
Fair or poor perceived general health Feeling unsteady
Having 2 or more falls
A fear of falling can be considered a “red flag” for the need to conduct a falls risk assessment.
Education/Environmental Assessment
• Home /Community safety assessment
• Appropriate foot wear
• Checklist inspection by patient/caregiver or professional (home visit prior to discharge, home care services) WITH recommendations for hazard resolution and resources for structural changes.
̊ Structural (stairs, doorways, grab bars)
̊ Habitual (clutter, obstacles, lighting, electrical cords)

Tests and Measures
Physical therapists can use a number of tests and measures to determine a patient’s/client’s risk of falling. Listed below are some commonly used examinations/tools. It is important to match the correct tool(s) with the correct patient/client and setting to aptly measure falls risk. This may require using more than one tool to take into account the multiple factors that may contribute to the patient’s/client’s falls risk.
Within the examination, include tests that focus on range of motion, muscle strength, and sensory integrity. Foot and ankle deficits in tactile sensitivity, ankle flexibility, and toe strength are important factors in balance and functional ability in older adults. Weakness around the knee and ankle relate to increased incidence of falls.
Interventions to Reduce the Risk of Falling with Physical Activity
Benefits of Physical Activity and Exercise: Reduce fear of falling, improve cardiovascular health and functional reserve, decrease depression, and reduce sleep disorders.
A multifactorial approach: Based on the results of the examination, interventions that address more than one risk factor or identified cause of falls (eg, environmental hazards, medications, mobility, vision, cardiovascular disorders) have the greatest benefit.
Successful Exercise Program Characteristics
• Has sufficient intensity to improve muscle strength.
• Is regular and sustainable (long-term intervention/ participation).
• Includes dynamic balance training activities (eg, Tai Chi techniques).
• May be performed at a center/clinic or home, group or individual.
• Is simple, easily instituted and low cost.
Exercises
• Concentrate on strengthening LEs, especially the ankle, and trunk/core muscles affecting motor control.
• Reduce joint pain/instability.
• Correct postural faults.
Exercise is effective in reducing falls in the spectrum of people who range from relatively fit and well and community dwelling to cognitively intact people living in residential care facilities.
Balance Retraining
Target the neuromuscular systems that control balance through various levels of challenge.
• Begin with controlling the center of gravity (COG) over the base of support (BOS).
• Progress by challenging the regulation of balance and postural stability specifically engaging visual, vestibular, somatosensory and cognitive systems.
• Elicit postural reactions and ankle, hip and step strategies by altering stimuli, surfaces, secondary tasks to mimic functional activities, resistance, direction and velocity of movement.
• Consider Tai Chi.An eastern exercise form that has been simplified and adapted to emphasize balance, weight shifting, coordination, and postural training with significant benefits to many populations at risk for falls.
Gait Training
Include all the components of gait in addition to:
• Appropriate and accurately adjusted assistive devices.
• Challenge and advance with changes in surfaces/terrain, elevations, time/rhythm, distance, physical load, attention, postural transition (start, stop, direction), and amount of support.