Seniors & Falls - Fall Prevention, Exercises, Quality of Life, Overcome Fear of Falling

[LatteLady]

11. Great topic but with some misinformation

Greetings DU, and thanks to appalachiablue for bringing attention to this important topic. I'm a physical therapist who specializes in balance rehabilitation and fall prevention in older adults.

The NCOA is a great group, and they list several "evidence based" exercise programs. "Evidence based" is important because it means studies show it works. Assuming there is no medical reason that you might fall, the evidence is clear that to reduce your risk of falls four approaches are relevant:

1.EXERCISE is the single best intervention to improve your balance and walking, but it needs to be the right kind of exercise and you need an adequate "dose". More on this below.
2. MEDICATION MANAGEMENT - many medicines can increase your risk of falls. Talk to your doctor/provider/ pharmacist to learn if any of your medications significantly increase your risk, and to learn how to reduce or change the meds you are on if needed. DO NOT do this on your own, get medical guidance.
3. VISION CARE - get assessed each year and obtain needed corrective lenses. It's especially important to be tested for (1) contrast sensitivity, (2) depth perception, and (3) visual fields. Bifocals and multifocal lenses can increase your risk for falls, especially when you first get a new prescription. Some people get 2 different pairs, one for near and one for far, so they can swap out depending on the environment and task they are doing.
4. HOME SAFETY AND MODIFICATIONS - the CDC STEADI program (https://www.cdc.gov/steadi/index.html) has a checklist you can use. Railings, grab bars, lighting, visual cues, trip hazards, etc. A PT or an OT can come to your home if you wish, to make specific recommendations.

If you have had 2 or more unexplained falls (not from being run over, or fainting, etc.), or 1 fall with an injury requiring medical attention, or you are unable to get up off the floor after a fall, in the last 6-12 months, you are at HIGH RISK for future falls if you do nothing to intervene. Older adults with a history of falls, and those who feel unsteady when standing or walking, and/or are worried about falling, should tell their MD and ask for a prescription to physical therapy (PT) for one-on-one intervention for fall prevention.

Older adults at a lower risk may be safe going directly to a community exercise class.

More about the right kind of EXERCISE for improving balance and reducing fall risk:
1. The following forms of exercise are NOT EFFECTIVE: seated exercise, stretching by itself, walking by itself. You need to be upright and on your feet to teach your body about how to balance.
2. Exercises need to focus on balance and walking with balance challenges, with moderate to high levels of "balance intensity" (which will depend on your abilities to begin with). Never do any exercise or activity that is unsafe and will cause you to fall; match your abilities with the level of challenge. A PT can help you adapt exercises and your exercise environment to increase safety while allowing effective exercise.
3. If the balance exercise or activity does not require sustained attention and effort to keep your balance, it is too easy. If it's not possible to do the exercise or activity without losing your balance, it's too hard. Aim for a level of challenge in which you feel mildly to moderately unbalanced but with effort and repetition you can keep your balance.
4. Adding leg strengthening exercises will improve your balance and walking if done in conjunction with balance and walking exercises.

More about the needed DOSE of exercise to achieve a longer lasting reduction in fall risk
1. Exercise is not a quick fix. It takes time to build strength, speed, coordination and movement skills.
2. Evidence shows that the needed dose is a total of at least 50 hours of (moderate to high balance intensity) balance exercise delivered 2-3 times a week for 45-60 minutes at a time over a period of 2-6 months.
3. To achieve this dose, many older adults begin with one-to-one physical therapy for several weeks then if it is safe to do so, transition to community exercise programs.

If you are worried about falling, consider these two community programs:
1. A Matter of Balance - https://www.mainehealth.org/healthy-communities/prevention-and-wellness/fall-prevention-matter-balance
2. Stepping On - https://www.steppingon.com/
Both focus on education and risk management. Both have been shown to reduce fear of falling and increase self-management of fall risk. Stepping On has some simple exercises, A Matter of Balance has less exercise.

You can find a PT with expertise in balance and falls by going to "Choose PT" https://www.choosept.com/, and click on "Find a PT". Then search for a PT who is a Neurologic Clinical Specialist (NCS) or Geriatric Clinical Specialist (GCS).

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