Balance and Fall Prevention for Seniors

Life is all about balance–literally. And the longer we live, balance and fall prevention for seniors become critical as we become more challenged to stay on our feet. In fact, falls are the leading cause of injuries among adults 65+. According to the Centers for Disease Control and Prevention (CDC), 36 million falls are reported every year among older adults in this country. One out of five falls causes broken bones and other injuries.

Fortunately, falls are preventable. As we age, it is important to be aware of common fall risks and be proactive about avoiding them. In this article, we will look at the connection between balance and falls and provide tips to help you stay on your feet and avoid a debilitating fall.

Why Are Falls So Common in Older Adults?

Aging is just one of several factors that contribute to a balance disorder or dysfunction. A balance disorder is any condition that makes you feel unsteady or dizzy when walking or standing.

Muscle weakness, joint stiffness, inner ear problems, medications, and a sedentary lifestyle also can contribute to balance problems. Common medical conditions can play a role, too, including diabetes, arthritis, stenosis, high blood pressure, heart conditions, and macular degeneration.

Progressive neurological disorders, such as multiple sclerosis and Parkinson’s disease, also present with balance dysfunctions and can affect your independence and safety.

The Body Systems that Impact Balance and Fall Prevention

There are three primary body systems that are involved with balance. Problems occur when one or more of these body systems are not working properly.

Somatosensory System
The somatosensory system is part of the sensory system. It relays sensations, touch, pain, position, movement, and temperature between the joints, muscles, skin, and the brain.

Vestibular System
This system is part of the inner ear. It provides information about body position and allows the body to respond to self-induced and external forces. The vestibular system is also a part of eye movements, particularly when the head is moving.

Visual System
The visual system is part of the central nervous system and includes the eyes, pathways that travel through the visual cortex, and other parts of the brain. This system allows visual processing to occur.

How These Systems Work Together To Keep Our Balance

Now, let us explore how these body systems work in concert to maintain balance: The brain processes impulses from the inner ear, eyes, and body-position senses, and responds by sending signals to the muscular system to move or make adjustments to maintain balance.

Balance problems occur if the senses are not sending correct signals to the brain, or if the muscular system cannot perform the necessary movements for what ever reason. More simply put, falls occur when something, internal or external challenges our balance or strength and we are unable to maintain or correct our balance.

Signs of a Balance Problem 

Balance problems can manifest as tripping, swaying, stumbling, dizziness, vertigo, and, worst of all, falling. Standing still or performing a single task may not be troublesome but moving about or doing more than one thing at a time (like walking while turning your head to speak to another person) can become problematic.

Adults 65 and Older Should Schedule a Fall Risk Screen

The American Geriatrics Society recommends that all adults aged 65 and older be screened for falls. The Journal of Geriatric Physical Therapy, in a review of 33 other studies, identified 17 independent contributing factors in fall risks for “community-dwelling” older adults. It found a “significant interaction” between risk factors and a patient’s function level.

If you notice you are slowing down, keeping your eyes on the floor or lacking confidence, these are all signs your balance may be affected. Balance symptoms can appear well in advance before a fall occurs. The more risk factors a person has – older people that have fallen typically have two or more – the greater the chance of falling. Fortunately, while factors such as advanced age or a history of falls can’t be changed, many more can be modified to assist in fall prevention.

Physical Therapy Fall Risk Screening: What to Expect

The Journal of Geriatric Physical Therapy proposed that physical therapists screen all older adults seen in their practices, with a positive screen triggering a comprehensive fall-risk assessment.

During this assessment, the physical therapist will ask questions and/or perform tests related to motion, strength, coordination, vision, and balance. Those results help determine whether a patient should see a physician or be referred to physical therapy for a formal evaluation and customized treatment program that can reduce fall risk and fear of falling.

Here are some questions your physical therapist might ask during a balance and fall risk assessment:

• How often do you experience problems with your balance?
• What types of activities are you doing when you experience problems with your balance?
• Do you every feel off-balance or have any sensation of the room spinning?
• Have you had any falls in the past year? How many? Have any resulted in injury?
• Have you changed or decreased your activities out of the home because of your balance or fear of falling?

If fall risk is identified, a formal physical therapy program will address mobility issues such as walking speed, balance, proprioception, strength, flexibility, posture, and pain. The goal of physical therapy is to improve function and improve safety with daily activities.

Every patient is carefully evaluated, and a custom physical therapy treatment plan is created based on their individual health concerns and health goals.

Balance and Fall Prevention Strategies for Seniors

Here are practical steps you can take to reduce your risk of falls and fall-related injuries:

• Schedule a physical with your healthcare provider. Ask for an assessment of your risk for falls. Share any chronic conditions and any history of falls.
• Get your vision and hearing checked annually. Mention any changes or concerns to your provider.
• Review your medications with your doctor and pharmacist. Make sure that your primary care physician has a comprehensive list of all medications you are taking. Don’t forget over-the-counter medications and herbal supplements.
• Meet with a physical therapist. Ask about a fall risk screen and exercises to prevent falls by building balance, strength, and flexibility.
• Fall-proof your home. Store items off the floor. Make sure your home is well-lit inside and out. Remove loose or ripped carpeting and consider removing throw rugs. Make sure handrails in the bathroom and near steps are secure. Place nightlights in areas that you may navigate in the middle of the night.
• Wear the right shoes. Shoes should be the right size and be sturdy but not too flexible. Look for footwear with a slip-resistant tread and a flat sole.
• Ask for help. If you have trepidation about doing a task around the home, or want to make your home safer, ask for assistance from friends, neighbors, and family.
• Join a community balance program. Search for programs in your community that are designed to improve your balance. Community-based fall prevention programs have been shown to be effective to reduce fear of falling and increase activity levels in healthy adults. Silver Sneakers is a great resource.

How Physical Therapists Use Technology to Address Fall Risk

One of the exciting ways that our physical therapists are addressing fall risk is through the use of new technology that can measure and evaluate an individual’s balance performance in real-time against objective metrics. One such technology is called the Movement Health Platform, developed by Sparta Science. With this technology, physical therapists can conduct a simple, yet powerful, two-minute screen that is designed to provide several key metrics to help you and your physical therapist understand how well you balance and identify your fall risk.

With the technology, physical therapists are then able to leverage objective data-driven insights to focus on deficiencies in movement quality and ensure that you’re progressing towards improving your balance and reducing your risk of falling.

The Benefits of Physical Therapy for Fall Prevention

Physical therapy is one piece of the fall prevention puzzle. And it’s an important one. The American Physical Therapy Association has compiled a lengthy list of research studies that confirm the benefits of physical therapy for reducing the risk of falls and injuries from falls for older adults. Every adult should know their own risk of falling and take steps to remain active, strong, and injury-free.

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External Sources:

• Keep on Your Feet—Preventing Older Adult Falls | CDC
• Determining Risk of Falls in Community Dwelling Older Adults… : Journal of Geriatric Physical Therapy (lww.com)
• 1 new message (caringseniorservice.com)
• Value of Physical Therapy in Reducing Falls | APTA
• Assessment and Management of Fall Risk in Primary Care Settings – PMC (nih.gov)
• Phelan, Elizabeth A, et al. “Assessment and Management of Fall Risk in Primary Care Settings

.” The Medical Clinics of North America, Mar. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4707663/.