Part II – Falls in the Elderly: What can be done about it?

Part I of this 2-part series addressed ways to properly assess one’s fall risk.

In Part II, we help provide answers to these 2 questions:

       Can we decrease the fall risk in an elderly person?

       If so, how?       

Let’s look back at the most common causes of falls in the elderly: medications, age-related system decline, environment / home hazards, & cognitive impairments

Now, can we (and if so, how) influence these factors to lessen one’s fall risk?

Medications: YES, in many cases. Although some medications that affect balance carry great risks if an attempt is made to reduce or eliminate (such as cardiac arrythmia medications), many medications do not carry such risks and can be reduced or eliminated simply by changing our lifestyle habits. Take for example pain medications. Currently 1 in 3 elderly Americans are taking or have recently taken analgesics for pain control. Social norms & thus medical treatment in the U.S. have dictated pain-elimination strategies rather than pain-coping strategies. This has been 1 contributing factor to the general over-prescribing of pain medications, as evidenced by the nationwide Opioid epidemic we are now in the midst of. Other medications that are powerful balance influencers like anti-hypertensives and anti-depressants can be reduced or eliminated by appropriate stress management / reduction practices like meditation, Yoga, or social bonding.

Age-related system decline: YES, in almost all cases. Age-related system decline can be due to various reasons, but one primary reason is slowed nerve signal conduction speeds. This happens due to a process called demyelination, whereby myelin, the fat + protein substance surrounding a nerve fiber that helps the nerve function optimally, degrades with age. The result is a slowing of the speed of a nerve signal, meaning the message to your brain that you are starting to lose your balance, and the message back from the brain of what to do to correct, are slower. To make up for this loss of conduction speed, the brain centers that monitor and control balance must react more quickly to respond with the appropriate corrective movement strategies to prevent the fall from happening. This is done through specific balance exercises & coordination activities that challenge these brain centers to recognize incoming signals and respond more quickly with the appropriate muscle or movement action. Current research supports balance-targeted physical therapy (like AFFPT’s weekly Balance Class ) T’ai Chi, and other balance focused programs like Matter of Balance or the Netherlands balance training program as effective methods of helping optimize the body’s response strategies and lessen one’s fall risk.

There are also plenty of home exercises one can do to help lessen their fall risk – here are a few simple ones:        

1. Standing Balance: Simply standing in 1 place and concentrating on not losing your balance can be a very helpful, and easy, strategy to do almost anywhere, anytime. be sure you’re next to something solid you can use in case you start to lose your balance, like a wall (or 2 in a hallway), counter top, etc..

Easy:  put feet together as close as you can and look up; make it a bit more challenging by looking around side to side, up/down, or diagonals; make it harder by closing your eyes!

Moderate: same as above, but put 1 foot directly in front of the other, like walking a tightrope

Challenging: stand on just 1 leg

 

2. Add in head & eye movements: Changing the visual field and/or focal point that your eyes see (and your brain has to process), all while maintaining balance, can be a challenging task. Add these to exercise #1, just be sure you have a safety grab if needed!

Easy:  hold 2 pieces of paper out (or stick them on the wall), then quickly look back and forth between them; then try without moving the head; 

Moderate: same as above, but with more papers and in different locations (up, down, side to side, even diagonally)

Challenging: now do the same thing but while standing on an unstable surface (pillows or couch cushion) or try standing on just 1 leg!

3. Sit & stand as slow & fast as you can: this exercise helps work the muscles (both slow & fast twitch muscle fibers) that control sitting, standing, & walking.

Easy:  choose a surface about chair height or higher, then practice slowly lowering and quickly raising; use your hands on the arm rests if you need to

Moderate: try from a lower surface (low chair, stool, footrest, or a soft couch); go even slower on the decent and quicker getting back up; try NOT to use arms or armrests.

Challenging: no hands, & go slow enough so that as soon as you feel the sitting surface on your buttocks, you come right back up quickly; try with eyes closed.

4. Walking Challenges: Find an open area with a fairly flat surface. As always, be near an object to grab if you need to.

Easy:  practice walking different ways: a). mix up the size of your steps – make some big, some small; b). mix up the direction of movement: sideways, backwards, or diagonally; 

Moderate: now mix up the pace – go fast, then quickly slow down, then speed up, then slow down; add a turn each time you change pace (Note: you can use a timer or electronic alarm that beeps every ___ seconds to tell you to when to switch)

Challenging: add cross-over maneuvers, like grape-vines, where 1 foot has to cross the other one; try any of these options with your eyes closed to make it much more challenging!

 

Environment / Home hazards:   Absolutely! This starts with awareness of what is a trip or fall hazard & then making changes, often simple ones, to eliminate that hazard. Here is a great checklist anyone can use to do a home assessment of what may be a hazard.

Cognitive impairments: This is bit of an unknown. Despite the fact that we know that elderly people with dimentia have a 2-3x greater fall risk than those without, we still aren’t sure what the exact cause or mechanism is. It could be due to actual muscle or motor impairments, behavioral factors like forgetting to use grab bars or an assistive device like a cane, or it could other functional limitations associated with cognitive deficits. No matter what the cause, these folks should definitely be assessed regularly and in an active balance / fall prevention program. 

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Remember – keep the doctor informed! As with any medical condition, even if the primary care doctor is not a specialist in balance or fall prevention, they should be informed and know what’s going on so they can help get the right professionals involved, with the right resources, and monitor changes.

 

 

Written by Damon

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