Falls are a common and often devastating clinical problem faced by older people, causing a tremendous amount of morbidity, use of health care services including premature nursing home admissions, and mortality (Rubenstein, 2006). Many older adults develop a fear of falling that causes them to limit their physical activity (PA) and social interactions, creating a “domino-effect” that results in reduced mobility, physical weakness and decline, and feelings of isolation and depression (Altarum Institute, 2012). A couple of weeks ago, I participated in a course at the Osher Lifelong Learning Institute (OLLI-UGA) where the topic “Fall prevention: could you get up after a fall” was presented by Dr. Ellen Evans.
She explained that falls are associated with identifiable risk factors (e.g., decreased sensory function, weakness, unsteady gait, certain medications, posture hypotension and confusion, and environment). Once the factors have been identified, health practitioners and patients can work on the modifiable ones, which may significantly reduce rates of falling and the incidence of injuries and trauma-related hospital admissions in that population.
There have been some proven evidence-based strategies, including home modifications –to identify hazards-; exercise-based programs focused on improving range of motion, coordination, balance, endurance, muscle strength and aerobic capacity; and use of safety devices and mobility aids. Some of them include Stopping Elderly Accidents, Deaths & Injuries program (STEADI, a CDC initiative), and Go4Life (an NIH and NIA initiative). Overall, exercise programs are one of the most cost-effective actions to diminish the risk of falling and it could also help with others co-morbidities related to fall history (e.g., diabetes, Meniere’s disease, sarcopenia, arthritis).
Despite these proven advantages and the tons of health benefits, the majority of older adults do not achieve the recommended amount of PA, and many are inactive altogether. As can be seen, when it comes to prescribing exercises for fall prevention, there are several tools that practitioners have. They can be implemented either identifying unsafe behaviors and recommending modifications or offering effective interventions prescribing exercise programs that target health-related physical fitness components whenever we have the opportunity to work with seniors. Specifically, Dr. Evans recommends following the same PA guidelines for adults plus balance, coordination and agility activities, with special attention to overloading and progression aspects. Concerning, a physical exertion scale from 1 to 10 can be used, considering the intensity from 5 to 6 for moderate intensity activities and from 7 to 8 for vigorous.
References
Altarum Institute (September, 2012). Recommendations to Promote Health and Well-Being Among Aging Populations, pp 1-16. Retrieved fromhttp://healthyamericans.org/assets/files/Prevention%20Recommendations%20for%20Aging%20Populations2.pdf
Rubenstein, L. Z. (2006). Falls in older people: epidemiology, risk factors and strategies for prevention. Age and Ageing, 35-S2, ii37-ii41. Retrieved fromhttp://centerforhealthyhousing.org/Portals/0/Contents/Article0785.pdf