FALL RISKS IN OLDER ADULTS

As people age there is an increased incidence in the number of falls. One out of every three older adults fall each year, with 20% of those falls resulting in serious injuries. This incidence is even greater in the institutionalized elderly. Over the past decade, the number of deaths directly attributed to the injuries from falls has increased and is anticipated to increase with aging of the Baby Boomer generation. 

IMPORTANCE OF EXERCISE TO REDUCE FALL RISKS

A multidimensional program that includes resistance exercises, balance exercises, task specific training (gait, sit to stand, rising from the floor), correction of both environmental hazards, and selection of proper footwear should be included in patient interventions. The Academy of Geriatric Physical Therapy of the APTA list these five specific recommendations based on strong level 1 incidence. 

Non specific exercise, low - intensity exercise, and generic group exercise programs may not meet the needs of older adults and reduce fall risk. It is critical to recognize the need for long- term adherence: a dosage of at least 50 hours of challenging exercise (e.g. 2 hours/week for at least 6 months)  is needed. Improvements do not occur spontaneously and require more time than is generally approved by insurance companies; therefore, education on the importance of continuing the prescribed exercise program is critical. 

Resistance Training 


Improvements in balance and a decrease in falls occur from strength training in older adults. 
The causes of falls are multifactorial with weakness of the legs being an intrinsic risk factor. 
Strengthening the muscles of the trunk and lower extremities with resistance exercises and power training is related to reducing falls. 
Strength training has been found to benefit postural control and to decrease variability of reactions during stabilization training. 
In addition, strengthening the trunk muscles has been shown to improve performance of ADLs in older adults by contributing to efficiency in use of upper and lower extremities and improved balance.

Tai Chi

Tai chi is a mind and body practice that arose centuries ago from Asia. It incorporates postures, gentle movements, mental focus, breathing, and relaxation and has proven to be beneficial in decreasing fall risk. 
When the movements are performed quickly, tai chi is considered a form of self - defence. Tai chi also benefits heart disease, cancer, and other chronic diseases such as Parkinson's, OA and fibromyalgia.
It has been reported to improve pain, sleep and anxiety. 
When performing a tai chi, strength, self-awareness, deep breathing, static and dynamic balance, ROM, endurance, positioning and postural awareness, weight bearing, and relaxation are incorporated into the various movements performed.

Balance Training 

The ability to maintain balance requires complex integration of the somatosensory, visual, and vestibular systems - all of which are affected with aging. 

An example of balance exercise progression in the home setting by modifying the amount of support through the hands.


Both hands using light tactile cues, with eyes closed for greater challenge 

Both hands hovering above the support surface with eyes-closed for greater challenge 
One-legged standing 

Tandem Romberg