While having a fall as you grow older is often viewed as needing to “be more careful next time”, the reality is that the natural ageing process brings with it a wide range of changes to the body that make older adults more likely to have a fall.
In Hong Kong, a 2018 survey showed that a fall was the most common type of unintentional injury, accounting for 39.4% of all injury episodes that occurred over a 12-month period. Other countries have similar statistics, with falls accounting for 40% of all of Australia’s injury-related deaths as well as 42% of their hospitalised injuries, with one in three adults aged over 65 years having at least one fall each year.
Given that one out of five falls causes a serious injury like a broken bone or head injury, and that more than 95% of all hip fractures are caused by a fall, paying close attention to a person’s falls risk and supporting them in preventing falls is very crucial in supporting a person’s health, mobility, independence and quality of life.
This is where physiotherapy comes in, having been shown through the years to significantly reduce the risk of falls in older adults through their work in supporting a person’s balance, mobility and strength., Here’s a closer look into what causes falls, how a physiotherapist can help you prevent a fall, and what new research published in mid-2022 is saying about how strength, mobility and balance training can support a longer lifespan.
What Causes A Fall?
There are two ‘types’ of contributors to a fall in any person: intrinsic and extrinsic.- Intrinsic factors are those occurring within a person's body, often related to the ageing process. This includes changes in balance, coordination and walking, vision changes, muscle weakness, reduced reflexes, other existing injuries or problems, and medical conditions or diseases that may alter proprioception (the body's ability to perceive its own position in space). As an example, muscle weakness in your feet and legs can increase your likelihood of having a fall by over four times.
- Extrinsic factors are environmental factors that contribute to falls. This ranges from the lighting in your home to rugs that are tripping hazards to taking certain medications or multiple medications. For example, taking benzodiazepines is associated with an increase of as much as 44% in the risk of hip fracture and night falls in older adults.
It is often the combination of both intrinsic and extrinsic factors that lead to a fall - like tripping over that rug as you couldn’t see it well because of vision changes paired with lower lighting, and then didn’t have the reflexes or strength to be able to catch yourself before falling.
Preventing Falls
The good news is that it is very much possible to prevent a percentage of falls, or at least lower the risk of falling significantly. Going back to the intrinsic and extrinsic factors we talked about, many of these can be improved with the right care, attention, training and modifications. Strength, gait and balance can be improved and supported, and confidence on your feet can be somewhat restored. Tripping hazards can be removed, better lights installed, extra handlebars fitted, and better shoes purchased.
The interventions offered by physiotherapists have been shown to reduce falls risk by up to 25% through specific strength and balance retraining exercises. When paired with a multidisciplinary team, this may increase to up to 40%.
Studies have concluded that effective falls prevention in older adults needs three key elements: exercise, education and home or environmental modifications. Here at PhysioCentral, our physiotherapists work with those worried about falls, or that have had a previous fall, to reduce their falls risk by:
- Identifying muscle weakness, tightness, gait and balance problems as well as other musculoskeletal issues, then creating exercise and rehab plans to address these factors to help you regain functionality and optimise gait
- Helping you make the right footwear selections for both inside and outside of the home to minimise falls risk
- Suggesting wearable supports, like splints or braces, to support your stability and function. These may be general braces that are already in stock, or may be custom-made for you if you have problems like drop foot where a custom device may yield the best results
- Gait retraining
- Education programmes
- Helping you recover from other causes of musculoskeletal pain or injury that may be interfering with your ability to stay active and complete your daily recommended exercise requirements
- Referring you to other health professionals, from occupational therapists for a home assessment to optometrists to assess any new vision changes
New Research On The Balance As A Predictor Of Survival
In keeping up with new research, there has been an interesting new study published. In research spanning twelve years between 2008 and 2020, 1700 adults aged between 51-75 years took part in an international study or balance. It started with a standard physical exam, which included a basic one-legged balance test. Specifically, all participants were asked to stand barefoot on a foot of their choice, on top of a flat platform with their hands by their sides while looking forwards. Each participant could try this three times, with the goal being to successfully stand on one foot for just 10 seconds to meet the ‘pass’ criteria.
The results of this part of the assessment showed that while 95% of those aged between 51-55 years could complete the balance test and stay on one foot for at least 10 seconds, this ability declined rapidly after hitting age 60: 82% of those aged 61 to 65 years successfully completed the test, as did 46% of those aged between 71-75 years.
After the exam, researchers followed test participants over a median length of seven years. On reviewing the data, they learnt that those aged between 51-75 years who passed the balance test (even after adjusting for age and health variables) had a notably higher survival rate during the study timeframe compared to their peers that failed the test.
These research results emphasise the importance of strength, mobility and balance training - and exercise in general - in best supporting the maintenance of a person’s health and well-being in the long term. If this is an area where you need help, working with our physiotherapy team is easy and simple.
We start with an assessment to best understand where you are with your falls risk, as well as fitness, strength, flexibility and mobility. We’ll then create a tailored management plan that supports you in reducing your risk of falls while improving your foundations for healthy movement. Our physiotherapists stay up-to-date with the latest evidence to help you get the best results.