In Part One of this blog relating to fear of falling, we discussed the definition of falls and also the impact that falls have on older adults. Sinead Tracey, of our Dundrum clinic explains how these falls can be prevented.
Physiotherapy Intervention
In order to successfully tackle a person’s fear of falling, the risk factors associated with this fear should be examined individually. These usually include living alone, increased age, greater BMI, poor balance, lack of physical activity, using a walking aid, depression, medications for depression or hypertension, and recent falls.
Balance, strength, gait and endurance should be assessed by a Physiotherapist prior to planning a falls prevention program. Assessment tests should include: a functional reach test, standing balance assessment, lower limb strength, “chair stand” test, timed up and go, time taken to climb up and down four steps, and a six minute walk test.
Physiotherapy should target lower limb strengthening, balance exercises, functional exercises, and active range of motion exercises and stretches. A program should be tailored for those at risk of falling, especially those with an established fear of falling. A 30 minute program should be carried out at least three times weekly. This should be in association with a walking program (outside the home), again, three times weekly.
Lower limb strengthening should incorporate moderate intensity exercises with weights, focusing on the following muscle groups: hip extensors and abductors, knee flexors and extensors, inner range quadriceps, ankle plantarflexors and dorsiflexors. Balance exercise and functional activities include tandem walking, walking on toes and walking on the heels, walking backwards, sideways, and turning around, stepping over objects, stair climbing in the home, sit to stand activities, bending to pick up objects, and knee squats. Stretching of tight muscles should also be included, especially muscles of the neck to improve rotation, and of the hip and lower limb to encourage correct gait patterns.
Physiotherapists should also be responsible for patient education regarding safe transfers and falling risk factors, adapting assistive devices, health promotion and awareness. Physiotherapists should also educate their patients about osteoporosis and bone health. Backward chaining exercises should be incorporated as part of a falls prevention program.
Conclusion
Falls remain a major public health concern and affect the lives of many older adults. Preventing falls through a tailored exercise program, in which strength and balance training are key components, can reduce falls prevalence.
It can also improve health in other ways, including positive systemic and cardiovascular effects. As the world’s population continues to age, Physiotherapists have a major role in enhancing quality of life and encouraging physical activity while reducing the frequency of falls in older persons.
If you would like to discuss falls intervention and devise a strengthening plan (as outlined above)with one of our Physiotherapists, please feel free to contact us to book an appointment. There also needs to be more awareness of falls in elderly people in Ireland, so as we can all help to try and limit these events occurring (as discussed here). So if you think somebody you know could benefit from reading this blog please share it with them.