“I’ll be there to catch you if you fall”…sincerely, the ground. Part I of a 2-part series: Falls in the Elderly

 

It’s nice to feel supported…but not in this case! Mother Earth, combined with gravity, can be deadly. But it’s not the fall that is the problem, it’s that sudden hard stop of hitting the ground (or some other immovable object) that is. And it’s a big problem! Every 19 minutes an older adult dies from a fall! It’s the leading cause of fatal injury AND non-fatal trauma related trips to the ER in older adults. 

So why are falls so common in older adults? Is it just an inevitable part of aging or can something be done about it?

A lot of research has tried to answer that question: why do people fall. In 2012 a group of researchers in British Columbia, Canada used 24-hour video monitoring in a long-term care facility and found that most of the 227 falls they captured on camera occurred because of a momentary loss of balance, not because of a slip or trip. But the cause of these were hard to pinpoint. There are many possible reasons, and often several are present simultaneously, so it can be hard to determine the exact cause. Here are the top reasons experts in the field attribute most falls to:

  • Medications: many medications have a negative influence on other systems in the body that help maintain balance, movement control, and  awareness of one’s surroundings.
  • Age-related system decline in critical systems like muscle strength & endurance, vision, & nerve conduction velocity
  • Cognitive impairments: changes in mental function like memory, perception, & self-regulation. 
  • Safety of the environment / home: trip and slip hazards like thick carpet or rugs, poor lighting, or the presence of clutter.

Many of these risk factors are controllable, to a degree at least. Meaning individuals can make changes in their lifestyle or environment to decrease their fall risk. Here are some of the most powerful changes one can make:

  • Medications: the medications that increase fall risk the most are analgesics / pain medications, anti-psychotics / anti-convulsants / sedatives. These typically cause sedation & slower reaction times, impaired cognitive function, & resultant increases in loss of balance. The next most risky medications are anti-hypertensives, anti-depressants, cardiac drugs (anti-arrhythmics). Lastly, but still having a negative influence, are the diuretics. So can an elderly individual influence what medications they take? In some cases, no. But in many cases – absolutely! Lifestyle has a HUGE impact on what medications and how much of them are needed in all 3 of these categories. But this discussion must first start with one’s doctor. Then a safe plan can be developed to change lifestyle factors that may allow a decrease in medications and the subsequent fall risk.
  • System decline: it’s true, physiological systems like natural muscle strength & vision decline with age, but that doesn’t mean they can’t be improved. Many studies over the past 2 decades have proven that the health & effectiveness of these systems can, and usually do, improve with the right approach.

It starts with the right testing. Our clinicians are trained in evidence-based tests to determine an individuals fall risk, then prescribe the right type and amount of exercises to help lessen it. Regular exercise, even just simple seated movement routines, help prevent postural hypotension – a leading cause of dizziness, weakness, & fatigue. Balance-focused programs like T’ai Chi and A Matter of Balance are proven to have huge impacts on those balance systems that regulate our position in space and relay changes to the brain that require quick corrective action. For visual and tactile (also known as proprioceptive) systems, it is recommended that feet and eyes are checked at least once a year in individuals over age 65, and more often if there are known impairments. 

          Here are a few of the tests we use to determine one’s fall risk, from simplest to more complex:

           Functional Reach Test: standing distance a person can reach an outstretched arm without losing their balance.

                       Score / Rating: < 18 cm = fall risk

           30-second Chair Rise test: how many times can an individual sit / stand in 30-seconds.

                       Score / Rating to maintain independence: 

                   Age:          60-64           65-69          70-74        75-79        80-84        85-89         90-94 

                  Female:       15                  15                 14              13               12                11                9

                  Male:            17                 16                  15              14               13                11                9

           TUG (Timed Up & Go) test: speed with which an individual can stand up, walk 3 meters, turn around & walk back, then sit back down.

                       Score / Rating:   > 14 seconds = 83% increase in fall risk

           Dynamic Gait Index: how well a person can adjust their gait speed, turn, and stop / start on cue without losing their balance.

                       Score / Rating:   < 19/24 = increased risk of falls

           Berg Balance Test: a variety of tasks, from easy to difficult, measuring ones ability to complete the task all while maintaining balance. 

                       Score / Rating:   41-55 = low fall risk           21-40 = medium fall risk            0-20 = high fall risk

  • Cognitive impairments: there are many degrees and types of cognitive impairments that can happen with age. Some impact fall risk  more than others, so it’s important that an elderly person’s primary care doctor be made aware of changes and be the one to determine the most appropriate testing and course of treatment. A large 2017 study involving 7 developed countries collected data on 2,496 adults of average age of 76 years old and found that impaired executive function (neurological skills involving mental control & self regulation) & dementia, but not memory impairment, is associated with higher incidence of falls in elderly.
  • Environment / home safety: this is the category that individuals probably have the most control over, and it can mean the difference between living independently and not! Even though tripping or slipping may be the least common factor contributing to falls, it just takes 1. Many simple things like getting rid of rugs, installing brighter light bulbs, or clearing clutter from a home can greatly decrease the risks. Checklists, like this one from the CDC’s STEADI program can help point out trip hazards. 

The bottom line: elderly individuals & their family members / care givers should speak up to their doctor or physical therapist about any changes they notice, either cognitively or physically, and be evaluated regularly by their medical professional, like our staff of trained Physical Therapists.  Then, once a program is initiated, stick with it! A regular exercise regimen can lessen the risk of falling and experiencing the devastating, life-changing effects of a fall-related trauma. 

 

Look for next month’s blog on what type of exercise & training can be done to DECREASE YOUR FALL RISK!

Written by Damon

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