Have you fallen recently? | Physit24 Jul 2019

Have you fallen recently and are now feeling less confident when walking?

Falls in the elderly are fairly common and the primary cause of decreased mobility and independence, and increased morbidity. According to the NHS, around 1 in 3 adults over the age of 65 who live at home will have at least one fall a year with about half of these falling more frequently.

Causes of falls:

  • Idiopathic
  • Medication related (Sedatives or antihypertensives)
  • Medical conditions (e.g. Parkinson’s, heart failure, cataracts, diabetes or low blood pressure), which can lead to dizziness and a brief loss of consciousness
  • Poor environment (bad carpeting, patterned flooring/carpeting, slippery flooring)

Risk Factors:

  • Age (>65)
  • Muscle weakness
  • History of falls
  • Gait or balance abnormalities
  • Visual impairment (cataract)
  • Arthritis
  • Depression
  • Cognitive Impairment
  • Peripheral neuropathy (loss of feeling possibly due diabetes)

Complications:

  • Loss of confidence
  • Injury (fracture)
  • Both of the above can lead to a person’s eventual need to move to institutional care

How this impacts a person’s life:

After a fall the person may lose confidence in their ability and willingness to walk which means that they walk less and stay indoors more. Walking less leads to a loss of general fitness and can lead to faster muscle wasting. Exercise in the elderly is important for muscular strength to prevent falls and also the ability to get outdoors for vital vitamin D (from the sun) which is crucial for calcium absorption needed for healthy bones, muscles, ligaments, nerve signalling and the maintenance of bone density (osteoporosis). An elderly person living on their own and falls may no longer be able to look after themselves forcing them to move into institutional care and subsequently lose their independence.

How we can help:

An initial health and movement assessment with the inclusion of the Berg’s balance test will allow us to establish whether you are at a high or low risk of falling. This initial assessment also gives us an indication of the main contributing factors that lead to the fall, but more importantly how we can help prevent subsequent falls from happening. It may be something fairly simple which a combination of individualised hands-on therapy and exercise prescription can help, however if it is more complex and needs a referral to a Specialist/Consultant then we can direct you to the correct individual. Even after referring we will remain part of the care plan.

Age-related loss of muscle mass or Sarcopenia is associated with a reduction in maximal muscle strength, power and physical function which is one of the main contributing factors of falls in the elderly. Individualised home-based strengthening and balance training programmes have been shown to significantly reduce falls in the elderly. Proving that an individualised exercise programme is beneficial in preventing falls.

References:

Ageuk.org.uk. (2019). Avoiding a fall | Age UK. [online] Available at: https://www.ageuk.org.uk/information-advice/health-wellbeing/exercise/falls-prevention/ [Accessed 15 Jul. 2019].

Finnegan, S., Seers, K. and Bruce, J. (2019). Long-term follow-up of exercise interventions for preventing falls in older people living in the community: a systematic review and meta-analysis. Physiotherapy, 105, pp.e132-e133.

Hopewell, S., Adedire, O., Copsey, B., Boniface, G., Sherrington, C., Clemson, L., Close, J. and Lamb, S. (2018). Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews.

Hunter, S., Pereira, H. and Keenan, K. (2016). The aging neuromuscular system and motor performance. Journal of Applied Physiology, 121(4), pp.982-995.

Nice.org.uk. (2019). Overview | Falls in older people | Quality standards | NICE. [online] Available at: https://www.nice.org.uk/guidance/qs86 [Accessed 15 Jul. 2019].

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