Falls in the elderly can cause injuries (apart from mortal danger) leading to physical and mental decline, eventually affecting the quality of life of seniors. Old age care must definitely include co-ordination and balance exercises for fall prevention. Physiotherapists are trained experts in muscle and movement and offer treatment as well as preventive care for geriatric issues like balance and falls, Parkinson’s, Vertigo, Arthritis related issues like Joint Pain, Knee Pain, Back pain, Frozen Shoulder etc.
Mrs Bina Pillai talks about her 77 year old mother, who had a fall and was not able to move her left shoulder and hand. She contacted ReLiva Physiotherapy. She comments, “ReLiva was very responsive and immediately assigned Dr Kashmira Gupte for the treatment. My mother has fully recovered thanks to the good treatment. She is able to move her hand freely and is not in pain anymore.”
If you are a senior, ie 60year or older that means you need to take more care and precautions for yourself. Other than medical conditions or diseases which you take care by doing routine blood tests and investigations, you should not forget to keep yourself free from falls.
Why are falls dangerous for the elderly?
Why should you NOT fall?
The word “falls” doesn’t usually strike fear in most of the people but when it is in geriatric population it has devastating consequences. Falls are leading cause of injuries among adults over 65 years. One of three older adults fall each year with 24% sustaining serious injury and 6% sustaining fractures1. The prevalence of falls in India, above the age of 60 years, reported2 to range 14%–53%.
More than one third of elderly person, 65 years of age or older fall each year and in half of such cases the falls are recurrent.
As a result of fall, you may get a small injury like a bruise or mild bleeding or a muscle pull to some serious injuries like fracture (break in bone) or brain injury and deaths too.
The significance of falls3 among elderly people is that:
- the number of falls increase with age
- the injury rate is highest among the oldest old (80 years) subjects with history of falling more than twice
There is a vicious cycle where, due to poor perceived health and morbidity, there is increased tendency to fall – which itself leads to increasing disability and distress.
Why do seniors fall so much?
An Indian study4 reports that factors such as age group, education, marital status, and socio-economic status had demonstrated a significant association with fallers.
If you are osteoporotic (a condition in which bones are already weak) chances of fracture increases.
Fall risk increases with age. Henceforth, falls are common and serious health problem with devastating consequences in elderly
Prevention of fall is possible by early diagnosis and awareness about intervention. Fall should not be perceived as inevitable part of aging. All elderly, be sure to discuss the fall with doctor, even if you are not hurt. It can also be a sign of new medical condition like diabetes or change in blood pressure.
A study5 done on Preventing Falls in the Geriatric Population concludes, given the devastating effects falls have on patients and the increased burden on family members and the health care system, screening and assessment for fall risk are paramount priorities.
Physiotherapists play a vital role in prevention of falls.
What are falls and what causes them?
Falls include dropping from a standing or sitting position or from ladder or stepladder.
Falls are common in elderly. It has been proven scientifically that with aging, a lot of brain structures, muscles strength, vision, hearing and sensations show a gradual decline.
Causes of fall in the elderly
Falls and accidents seldom “just happen.” Many things can put you at higher (double or triple) risk for a fall.
Medical Risk Factors for Falls in the elderly
- Impaired musculoskeletal function, gait (read walking style) abnormality and osteoporosis
- Cardiac arrhythmias (irregular heartbeat), blood pressure fluctuation
- Depression, Alzheimer’s disease and senility
- Arthritis, hip weakness and imbalance
- Neurologic conditions including stroke, Parkinson’s disease, multiple sclerosis etc.
- Urinary and bladder dysfunction
- Vision or hearing loss
- Cancer that affects the bones
- Side effects of medications
Personal Risk Factors for Falls in the elderly
- Age. The risk for a fall increases with age. Normal aging affects our eyesight, balance, strength, and ability to quickly react to our environments.
- Activity. Lack of exercise leads to decreased balance, coordination, and bone and muscle strength.
- Habits. Excessive alcohol intake and smoking decrease bone strength. Alcohol use can also cause unsteadiness and slow reaction times.
- Diet. A poor diet and not getting enough water will deplete strength and energy, and can make it hard to move and do everyday activities.
How does Physiotherapy help in prevention and treatment of falls?
Physiotherapy has a significant effect in prevention of falls in individuals with cognitive impairment by personalized exercise program. If your loved one has a history of falls or isn’t confident enough to daily activities because of weakness, a physiotherapist can do a quick screening for them.
To screen individuals Physiotherapist will need to evaluate gait, strength and balance by few tests like: “Timed Up and Go test”, “30-second chair stand test”, “4-stage Balance test”.
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During rehabilitation, Physiotherapy is aimed at following goals:
- Improvement of motor skills (movements).
- Improvement of postural control.
- Recovery of strength and mobility.
- Gait training using walking aids.
- Getting them back to do their self-care activities.
Physiotherapy at ReLiva for Fall Prevention in the Elderly
Reliva therapists conduct a detail check including muscle strength and body sensitivity and sensation, more specifically for legs. These physiotherapists also conduct scientifically proven validated scales (Fall risk assessment scale and Berg Balance scale) to know if there is any risk of fall and to know balance problems in elderly.
Based on these assessment tests, the physiotherapist will design an exercise protocol to improve your strength and balance while sitting, standing as well as walking. Physiotherapists are specially trained for balance exercises. If required, they will prescribe an assistive device (walker or stick which can later be gradually discontinued) with regular supervised exercise sessions.
An exercise program for Fall prevention will usually include the following exercises:
- Aerobic exercise – The main aim of aerobic exercises is to enhance cardio respiratory function
- Muscular strength training exercises – The objective of muscular strength training is to take individual to a better physical function with improved balance and walking speed.
- Other exercises include working on flexibility, coordination training and spinal proprioception (joint position sense).
There are also research studies suggesting that physiotherapy exercises show beneficial effect on sleep and over all well-being.
However, fall prevention among elderly depends on the reason leading to a fall, individual’s characteristics and treatment area, therefore there is no one protocol which can be followed for everyone.
Call Reliva at +91 99209 91584, if:
- You are an elderly
- You want to get fall risk check
- You want to get balance check
- You want strengthening and balance exercises
- You want home modification tips.
For simple Tips to Prevent Falls, click here and see the infographic.
What to do if you had a Fall?
- Do not panic. Assess the situation and determine if you are hurt.
- Slide or crawl along the floor to the nearest couch or chair and try to get up.
- If you cannot get up, call for help.
- If you are alone, slowly crawl to the telephone and call nearest hospital or relatives.
- Once you are ok, do see a doctor even if you haven’t hurt yourself, to ascertain the reason for the fall.
- Apply ice at the site that has sustained the impact of fall.
- See a physiotherapist if you experience sustained pain in any part of the body
Treatment of falls
Even if you consider that your loved one has just tripped or stumbled, a proper assessment is necessary to find out the reason of fall and reduce the chances of future serious falls.
- You doctor will check and rule out causes like generalized weakness or other signs of feeling unwell to ascertain Urinary tract infection, dehydration, Anemia (low red blood cell count) or a mini stroke.
- A Physiotherapist will take a thorough assessment to check if the underlying cause is related to Walking and Balance issues. A Physiotherapist will help you understand the reason behind losing balance and treat them for the same.
- Evaluation of cardiovascular and neurological system: In few cases heart beats races up and blood pressure rises which can be a reason of fall. Neurological condition like Parkinson’s disease classically represented as tremors can be a reason for fall and is thus important to evaluate. [Read here about Parkinson’s Disease Management with Physiotherapy ]
- Vision, Hearing problems and home safety evaluation: Getting eyesight, hearing aids and home safety evaluated after the fall is important to avoid the recurrence.
The treatment for falls must be first preventive by acting on various risk factors of fall and later by acting on causes of acute and chronic falls. Adequate rehabilitation is to increase residual capacity, to educate patient and support them socially and psychologically.
This post is based on the inputs from Dr Kashmira Gupte (PT). Dr Kashmira is Masters in Musculoskeletal Physiotherapy and regularly helps patients with geriatric and orthopedic issues at ReLiva clinics.
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Scientific References:
1] Injury prevention & control: data & statistics (WISQARS) [Web page on the Internet] Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; updated 2013 Sept 20 [cited 2013 Sept 25 ]. Available from: www.cdc.gov/injury/wisqars/ [Google Scholar]
2] Dsouza SA, Rajashekar B, Dsouza HS, Kumar KB. Falls in Indian older adults: A barrier to active ageing. Asian J Gerontol Geriatr 2014;9:33-40
3] Falls In Older People – World Health Organisation, National / Regional Review, India; Dr. B. Krishnaswamy, Dr. Gnanasambandam Usha; Chennai City, Tamil Nadu State, India; https://www.who.int/news-room/fact-sheets/detail/falls
4] Pitchai P, Dedhia HB, Bhandari N, Krishnan D, D’Souza NR, Bellara JM. Prevalence, risk factors, circumstances for falls and level of functional independence among geriatric population – A descriptive study. Indian J Public Health [serial online] 2019 [cited 2019 Nov 8];63:21-6. Available from: https://pubmed.ncbi.nlm.nih.gov/30880733/
