Preventing falls in the elderly through improved balance

Written by our expert contributor Neha Sasi Kumar, Team Leader Physiotherapist from Plena Healthcare at Tuncurry NSW.

Introduction:

‘FALLS’ a well-known term associated with older population and their associated injuries, are often viewed as an inevitable part of the ageing process. Falls can result in injuries, a loss of confidence and a subsequent reduction in physical activity and community participation. However, there are myriad of ways to help reduce the incidence of falls in older people. One amongst them is to improve balance.

Understanding the importance of balance:

Our sense of balance comes from many different systems working together to create stability of our body and our vision. The three components of balance comprise of the visual system (SEE), proprioceptive system (FEEL), and the vestibular system (HEAR – located in the inner ear). The brain integrates and processes all the information from these three systems to help us maintain our balance or sense of equilibrium. When you start to have problems with your balance, one or more of the above systems might be affected.

What factors cause balance problems in the elderly?

Factors that can impair balance control are, for example, pain, vision problems, vestibular issues, cognitive impairment, some prescribed medications and fear of falling. Moreover, age-related degeneration and a variety of diseases/comorbidities, more common with older age, can afflict all functions and systems involved in balance control.3

What problems can occur if balance is not maintained in the elderly:

Balance issues in elderly people is a serious problem. According to Harvard Health every 11 seconds, an older adult receives emergency room treatment for an injury sustained in a fall, the majority of which leads to hip fractures. One of the most detrimental aspects of balance issues in elderly people is that they can enter a cycle of deterioration—being unsteady or feeling dizzy makes them refrain from physical activity, which contributes to functional decline that cause the lack of balance. After the fall, elderly people develop a fear of falling that makes them stiff due to reduced physical activity, shuffle when they walk due to weakness in the muscles and restrict movement due to pain, that further increases the risk of a fall.

Treatment of loss of balance in the elderly:

There are multiple ways in which we can improve balance. The most efficient and effective ones are increasing physical activity, strengthening exercises, stretching exercises and balance exercises.

Engaging in physical activity:

Research has shown that being physically active can reduce the risk of falls. A review conducted by the George institute of Global Health Australia in 2010 found that muscle strength, balance and endurance can clearly be improved by physical activity in people aged 40-65. There is a popular phrase ‘Motion is Lotion’ which means the more you move your body, the more your joints are getting the natural lubricants they need to stay healthy and active. Physical activity such as 30 minutes of walking helps in improving circulation to the soft tissues and bone in turn reducing the joint inflammation and pain.

Balance exercises for the elderly:

Falls can be prevented by well-designed exercise programs. The biggest effect on fall rates involved a challenge to balance abilities and were undertaken frequently (e.g. for more than 2 hours a week over a 6-month period). Mentioned below are few balance boosting exercises to improve balance. It is important to make sure the environment and the surroundings are safe to perform these exercises for example near a bench top or wall for support.

• Heel to Toe/Tandem stance - Helps keep balance when you have to walk through a narrow space.
• Knee raises - Helps with climbing stairs and getting in and out of cars and buses. It also improves the pattern of walking and prevent tripping by clearing the foot from the ground.
• Side leg raises/Side stepping - Improves hip stability when you have to take weight on one leg and helps you step sideways to avoid tripping.
• Heel raises - Helps with walking and climbing stairs.
• Step up - Improves stability on steps, paths, and uneven surfaces.
• Sit to Stand - Helps with getting up and down from a chair or toilet and in and out of the car.

Incorporate Core Strengthening:

Core is our natural body corset which protects our spine and helps maintain a good posture and pelvic stability. Core stability is essential to both static and dynamic balance. Unfortunately, many traditional core-training exercises, such as crunches and leg raises, do little to improve stability. To enhance balance, core exercises should be functional (activities that mirror what you might do in real life), multiplanar and involve both single- and double-leg movements. The simple way to activate core is by bracing which means tucking the belly button in at the same time tilting the pelvis back (straightening the lumbar curve). This can be incorporated with our Activities of daily living to be more functional for example while bending and lifting objects at home or at work.

Flexibility for older adults:

Flexibility is nothing but the ability of muscles to sufficiently relax and stretch. If the muscles lose their ability to stretch, they become stiff which leads to reduced joint mobility. The mobility becomes limited because muscles are too tight, the ability to safely perform everyday tasks, as well as exercises ranging from balance to strength training diminishes. Therefore, stretching three to five days a week for five minutes not only improves flexibility but also relaxes the body after exercises and prevents any muscle soreness. Moving the joint/ muscle to the extreme range/limit during stretching is not recommended.

How to improve proprioception:

Proprioception plays an important role in the planning of precise and coordinated movements, in maintaining balance and controlling body posture. In simple words, proprioception is a sense of perception and awareness of the body’s position to communicate effectively with the environment. With the loss of proprioception during aging, the biomechanics of joints and the neuromuscular control of the limbs may change, resulting in impaired balance and a higher possibility of falls. Appropriate and proper physical activity can slow the age-related decline in proprioception.

Get Regular Vision Check-ups:

Have you got new glasses? Do you see clearly? Are you able to judge
distance and depth and adjust to changes in light and dark? Talk to your optometrist about having your eyes checked at least once a year. Update your glasses but be aware it can take a while to get used to them.

Proper Footwear:

Wearing well fitted and comfortable shoes while performing physical activity or exercises prevents tripping/avoid risk of falls.

Conclusion:

It is vital to understand that ongoing exercise is necessary. Unfortunately, the benefits of exercise are rapidly lost when exercise is ceased. Therefore, ongoing exercise would be necessary for a lasting falls prevention effect and to improve balance.

Case study:

At Estia Health Tuncurry, Group exercise program run by allied health professionals has reduced the frequent falls by conducting balance and strengthening exercise program. According to Neha Sasi Kumar, Physiotherapist working at Estia Health Tuncurry, the way to define FALL is F- Functionally A- And Actively L- Live L- Life.

Reference:

1. 1. APA April Falls: falls are no laughing matter, By Melissa Mitchell 31 Dec, 2021
   2. APTA- How does the Balance system work? By Shannon L.G.Hoffman, PT, DPT
   3. Improved Balance Confidence and Stability for Elderly After 6 Weeks of a Multimodal Self-Administered Balance-Enhancing Exercise Program: A Randomized Single Arm Crossover Study by Anna Hafström, MD, PhD 2016
   4. https://www.health.harvard.edu/topics/balance
   5. https://www.activeandhealthy.nsw.gov.au/active-living/exercise-at-home/
   6. https://www.agedcare101.com.au/articles/your-sense-of-balance-later-in-life-can-be-crucial-how-to-improve-yours
   7. https://www.health.qld.gov.au/__data/assets/pdf_file/0017/431504/exec_summary.pdf
   8. https://www.acefitness.org/resources/pros/expert-articles/6474/5-core-exercises-to-improve-balance/
   9. https://www.phrp.com.au/wp-content/uploads/2014/10/NB10056.pdfh
   10. https://www.everydayhealth.com/fitness/how-become-more-flexible-because-yes-its-important/
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