Avoiding Falls in the Elderly
As we age into the golden years, the risk of falls increases. A fall can be a devastating and life altering event resulting in a variety of different injuries. Some common ones are fractures in the hips, wrists, or shoulders, head concussions, bruises, and contusions. Recovering from these injuries can be difficult in the older years, and sometimes results in a loss of independence, surgery, a lengthy course of rehabilitation in the nursing home, inability to live alone, or require use of a walker/cane for safe walking in the future.
Aside from the physical trauma, the emotional damage can be equally devastating. Many elderly people feel embarrassed by a fall and deeply struggle with the loss of independence. The healthcare costs can also be a significant challenge to a personal budget with all the medical bills that often follow a traumatic fall.
So why are elderly people more at risk of falling? Let’s first talk about some of the bodily functions that change with aging, and then how we can optimize these functions to minimize the chances of having a fall.
Our vestibular system, or inner ear, is a sensory system we have in both ears that tells our brain what position our head is in, or if our head is moving. This system can decrease in responsiveness as we get older. Sometimes if it is working in one ear but not the other your brain gets conflicting signals from the left versus right sides, and can cause a spinning sensation, or vertigo. Vertigo is very treatable by a skilled physical therapist.
Eyesight tends to decrease as we get older, and vision strongly influences our balance. Vision signals from our eyes are closely coordinated in our brain with vestibular signals from our inner ears. Depth perception, peripheral vision, and nighttime vision also tend to decrease as we age, as well as the likelihood of developing cataracts.
Another balance system in your body is all of the sensory receptors in your skin, muscles, joints, and spine. They tell your brain what position your body is in. That’s why you can close your eyes and accurately describe what position your arms and legs are in even without looking at them, and you know if there is a pebble in your shoe because the sensory receptors in your foot are screaming at your brain to get it out! This crucial information is constantly and very quickly going to your brain as your brain processes it and makes necessary adjustments to keep you on balance.
As we get older these sensory receptors can sometimes decrease in sensitivity. People with neuropathy are especially prone to losing sensation in their legs and feet, and are more at risk of falling. Neuropathy is more common in people who have had low back troubles (like sciatica, spinal stenosis, or back surgery), who are diabetic, or struggle with vascular and circulation problems.
Muscle strength also declines as we age (although even elderly folks in their 90s can make significant strength improvements with an appropriate strengthening program). It goes without saying that good muscle strength is essential for good balance, especially when climbing out of a chair or going up stairs, which is where falls often occur.
So what can be done to improve balance and to decrease the chance of falling? There are many techniques and exercises that can help. Some can be done on your own, and others should be guided by a skilled physical therapist. Over the past several years I have been working as a physical therapist, I have often heard patients claim “I don’t have good balance” as if it were something they were just born with and cannot change. This is a myth and is simply not true! Balance can improve, even in elderly folks! Balance improvements and decreased frequency of falls after a good physical therapy program are very well documented in medical research, and I have seen them occur myself many times!
If you’ve ever watched a gymnast walk the balance beam, they weren’t born knowing how to do that. They practiced it many times and conditioned their bodies. While a 70 or 80 year old probably doesn’t want or need to walk a balance beam, they do need to be able to walk to their mailbox, through a parking lot, and up their stairs without losing their balance. Just like walking the balance beam, these more common tasks can be practiced and improved to the point they are natural and easy.
Let’s talk about some things you can do on your own to improve your balance:
-Stay active and exercise daily: make sure you are getting up and walking frequently throughout the day, and avoid prolonged periods of sitting or laying down during the daytime. Speak with a physical therapist about an appropriate exercise program. This should be tailored to accommodate your health condition(s), personal goals, and comfort level. Many elderly people are discouraged from exercising due to joint pain and arthritis, but there are actually lots of creative ways to strengthen your muscles and get a good workout without hurting your joints! (And by doing this it will probably make your joint pain feel better too). There is correlation between core/trunk strength, neck range of motion, and balance skills. Keeping these muscles strong and flexible reduces risk of falls. Senior fitness classes such as Tai Chi, water aerobics, pilates, etc. have shown statistical benefits in decreasing the risk of falls.
-Keep your environment safe. Avoid clutter, and consider getting rid of the throw rugs in your home. Catching the edge of a rug is the reason for many falls! Make sure you have good railings on your stairs, and a good sturdy grab bar next to your tub or shower that can support you as you climb in and out. Avoid walking around in dark or poorly lit areas. Use night lights for nighttime trips to the bathroom.
-Don’t be in a rush. Many older folks fall when they are rushing to the bathroom or to the telephone before it stops ringing. It’s always better to miss the phone call and call back, than to fall rushing to it before it hangs up! If rushing to the bathroom is a problem due to bowel or bladder problems (also common in the golden years), speak to your doctor about how this can be managed. There are medications that can help. There are also physical therapists that focus on pelvic floor issues that can resolve incontinence issues! We don’t currently have that specialty here at Recover PT, but we can connect you with therapists that do! You would be surprised to learn how many incontinence problems have resulted in a rush to the bathroom and a fall along the way.
-See your eye doctor regularly to keep your vision healthy. Keep your ears healthy and clean. A primary care doctor or an audiologist can help. Remember your vestibular system is in your ear, and if they get plugged it can affect your balance!
Now let's talk about how a doctor of physical therapy can help to avoid falls:
-In-depth balance assessment: remember there are several systems that affect your balance, and with testing we can determine if a balance problem is related to sensory, visual, strength, or vestibular problems. In determining the source of the balance deficit we can focus on that system and specifically strengthen it.
-Balance training: this can be somewhat complex and not always safe to do on your own, it often requires that you practice drills that make you feel very unsteady and on the verge of losing balance. It is often necessary to be pushed to these limits in order to improve balance, and because of the nature of the exercise it is not safe to be done alone. This is done in a safe environment under hands-on supervision of a therapist that will be able to catch you from falling and maintain an appropriate level of difficulty.
-Family training. Since balance training often requires a second person to assist, we can train family members or caregivers on how to safely and effectively work on balance at home.
-Patient training on appropriate use of assistive devices. Physical therapists can recommend whether an assistive device is needed, and which type. Sometimes getting used to a cane, walker, or crutches can be tricky and confusing. Which side do I hold the cane in? How tall should I adjust the walker? Should the walker have wheels or no wheels? How do I get my walker up the stairs? The answers to these questions vary depending on the patient’s specific needs. We can also provide guidance on whether or not it is appropriate to be using a life-alert button in case of a fall.
-Fall recovery training: when a patient has fallen, it’s important they be trained beforehand on how to address the situation. Do they know how to climb up off the floor? This is a very important skill for elderly people to have, and if it is difficult it can be practiced beforehand. Knowing how to roll over and crawl to the phone after a fall can literally be the difference between life and death, and is also a skill that can be practiced beforehand in case it’s needed.
A neurologist recently told me, “one thing about life is that none of us are getting out of here alive, but the trick is to enjoy the time that we have.” Of course we are all going to kick the can someday when our time is up, but there are things we can do to optimize our quality of life while we are here. Avoiding falls during the golden years is a great way to do that. If you are worried about your balance, or concerned about your parents or grandparents falling, please reach out to us, we are experts at Recover Physical Therapy in improving your health, strength, and life.