Trips and falls are a major cause of musculoskeletal injuries. There are volumes of statistical information pertaining to what population subcategory suffers the greatest incidence of falls, the financial cost of medical care for injury related falls, and those conditions or risk factors that increase the likelihood that someone suffers a fall. Each year, 3 million older people are treated in emergency rooms for fall injuries and over 800,000 patients a year are hospitalized because of fall injury. One particularly alarming statistic is that fall death rates in the U.S. increased 30% from 2007 to 2016 for older adults. (www.cdc.gov/HomeandRecreationalSafety) As a person ages they lose or decline in muscle mass, muscular and bone strength, joint range of motion, balance, coordination, and reaction time, all of which increase the risk of falling. The primary focus of this article is to address the health and fitness fall risk factors for older adults and to suggest some intervention strategies to reduce those risk factors. Risk factors and interventions include:
Risk Factor: Muscular Weakness. A weak muscle is also inefficient in balance, coordination, and reaction time.
Intervention: Regular resistance training program. Your resistance training can involve the use of weights, TheraBand, your own body weight, literally anything that causes you to exert force to overcome the resistance.
- To strengthen the lower body, consider exercises like squats. These can be done by simply lowering your body into a squat position and then extending upward again. Another option is to sit down on a chair or couch and then stand back up again. The squat exercise will strengthen the muscles on the front and back of your hips and knees. Because the lateral or outside of the hip is an important stabilizer for movement and balance, a side-lying exercise where you lift the upper leg against gravity is a good exercise for those muscles.
- To strengthen the upper body, consider exercises such as arm curls with hand weights or Theraband, floor pushups or modified pushups against a table, bed or other object, or simply pushing your self up from a chair. These simple exercises will help strengthen your arms, chest, and shoulders. A stronger upper body allows you to better brace yourself in the case of a lose of balance or an actual fall.
- To strengthen upper and lower body, consider Tai Chi as an enjoyable and effective whole-body exercise.
Risk Factor: Loss of Balance. Our balance is influenced by our sight or vision, feedback from sensory/stretch receptors located in our muscles and joints, and feedback from our ears.
Intervention 1: Regular balance training. Balance exercises can provide the stimulus to enhance the functioning of all the balance determinants. Your balance training can be as simple as weight shifting back and forth on your legs and progressing to standing on one leg and working to maintain balance. You can progress the intensity of the one leg balance exercise by 1) crossing your arms over your chest, 2) closing your eyes while trying to maintain balance, 3) standing on a pillow or foam source, or 4) performing all of these at the same time. Of course, when performing balance exercises ensure that you have access to “grab” bars of anything that can provide support should you start to lose your balance.
Intervention 2: Understanding what medications can affect your balance. Various prescription medications and even over-the-counter medications can affect balance. An awareness of those medications that can, and more importantly those that do, affect your balance will allow you to know when the risk might be higher and the need for enhanced precautions in performing the various activities of your day. Talk to your physician and/or pharmacist about the medications you are taking and learn of the special precautions to be taken pertaining to your balance.
Intervention 3: Use a cane or trekking pole when navigating around the home. A cane provides another base of support as you move about. With an understanding that some individuals may not want to use a cane, I have found that an outdoor hiking or trekking pole has been more readily accepted in these circumstances.
Risk Factor: Bone Weakness. If you do fall, bones that are strong are better prepared to handle the stress of an impact.
Intervention: Supplementation with vitamin D, calcium and magnesium. Strong and healthy bones require weight bearing and resistance training as previously identified, but also sufficient and balanced nutrition to ensure proper maintenance and repair. The elderly are at greater risk for bone nutrient deficiency including vitamin D, calcium, and magnesium. One reason is that they often take in less food and calories as they age, but also because the ability to absorb and metabolize those nutrients becomes impaired with age.
Risk Factor: Vision Problems: Your vision provides spatial feedback and helps you to know where you or your limbs are in relation to the things around you. A loss or reduction of good sensory feedback from your eyes can impair your balance as well as your ability to identify potential objects on the floor that could cause a trip and fall.
Intervention: Get your eyes checked and obtain or update corrective eye ware if needed. The sensory feedback from sight or vision in affecting balance, and identification of objects that hold the potential to cause a person to trip is only as good as the sensory import or the clarity of what is seen.
Risk Factor: Foot Pain or Impaired Sensory. Your feet are highly sensitive to touch and a change in surface conditions. If for whatever reason you have foot pain or have lost sensitivity due to something like diabetes, balance is affected.
Intervention 1: Wear a good shoe around the house. A good pair of shoes can help compensate to a degree for a lack of sensory from your foot and can also serve to protect your feet from trauma that could result from stepping on, or running into, objects in the terrain of your home. The correct shoes will have a sole that provides a good grip to the surface to help reduce the risk of slipping.
Determine of make a change to protect yourself or a loved one from the potentially harmful effects of a fall. The foregoing health and fitness risk factors and intervention strategies should be strongly considered for anyone at increased risk for falling. There of course, several external factors that can influence a person’s risk of tripping and falling. How to identify what those risk factors are and how to eliminate or minimize them will be discussed in another article.