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Falls and Balance in Older Adults

Falling in older adults is a serious problem. Every year one third of all adults over the age of 65 will experience at least one fall (1). One third of these falls will result in injury, disablement or even death (2). Falls and related injury impart a staggering financial burden on the health care system. In 2005 fall related injury expenditures in Canada was a reported two billion dollars (3). Physical injury and financial burden are not the only consequences of falling. The impact to quality of life, social and psychological well-being can be just as devastating. A single fall may ultimately result in a loss of independent community living in favour of institutionalized care. The psychological impact of falling can be equally devastating to an older adult’s independence. The World Health Organization describes a post-fall syndrome in older adults resulting in loss of autonomy, increased dependence and increased depression (World Health Organization, 2008).  In addition, it is widely recognized that heightened fear of falling in older adults is associated with increased risk of future falls and a voluntary reduction in activity level, ultimately increasing the likelihood of functional decline and disablement (4,5)


So what causes a fall? And why are older adults more at risk for falling. Falling in older adults is frequently the result of a loss of balance from a slip or trip or during an activity such as walking, turning, or reaching. Our ability to maintain balance is guided by information from three systems; visual, vestibular and somatosensory. The visual system provides information about our surroundings, our location within our environment, and identifies potential hazards or obstacles we need to avoid. The vestibular system, or inner ear, gives us information about movement of our head, which helps us determine which way is up and whether we are moving. The somatosensory system is a network of sensors throughout the body that tell the brain all about how our body is interacting with the environment, such as the temperature of a surface,  whether the sidewalk we are stepping on is level or tilted, or if it is slippery or stable. Somatosensation also tells our brains what position our joints are in so that we know if we are going to roll an ankle or will clear a stone in the path when we lift our leg.
Normal aging alters the functioning of every sensory system that influences the control of balance. As we age our vision is reduced with a loss of as much as 33% of the light reaching the retina (the light sensitive part of the eye) by the age of 60(6) .  Our inner ear also declines with age with a loss of nearly 40% of the sensitivity by age 70 (7) . The somatosensory system also declines as we age resulting in an overall change in our body’s sensitivity to the environment and its own movements. Cognitive decline in attention and memory have also been shown to impact on our ability maintain balance.  Additional diseases affecting eyesight, inner ear function, sensation and cognitive function such as macular degeneration or glaucoma, diabetes or dementia will have additional impacts on balance.
So how can we prevent falls in older adults? Physical activity and specific exercises geared towards balance and strengthening has been shown to improve balance and reduce the risk for falls in older adults (8). Some of these exercises may include balancing with eyes closed, walking or standing on uneven surfaces and performing two tasks (such as walking and talking) simultaneously. A Registered Physiotherapist can help determine risk factors for falling in older adults and educate and advise clients on the most appropriate exercises to perform in order to reduce the risk for future falls.

 

 

References:


1.  Hausdorff JM, Rios D a, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil. 2001;82(8):1050-6.
2.  Alexander B, Rivara FP, Wolf M. The Cost and Frequency of Hospitalization for Fall-Related Injuries in Older Adults. 1992;82(7):5-8.
3.  Scott BV, Wagar L, Elliott S. Falls & Related Injuries among Older Canadians: Fall related Hospitalizations & Intervention Initiatives. Prepared on behalf of the Public Health Agency of Canada, Division of Aging and Seniors. Vancouver, BC; 2010.
4.  Tinetti ME, Richman D, Powell L. Falls Efficacy as a Measure of Fear of Falling. 1990;45(6):239-243.
5.  Legters K. Downloaded from http://ptjournal.apta.org/ by guest on October 8, 2013. 2002:264-272.
6.  Spear PD. Neural bases of visual deficits during aging. Vision Res. 1993;33(18):2589-609.
7.  Matheson AJ, Darlington CL, Simth PF. Dizziness in the elderly and age related degeneration of the vestibular system. NZ J Psychol. 1999;1(1):10-16.
8.  Zheng J, Pan Y, Hua Y, et al. Strategic targeted exercise for preventing falls in elderly people. J Int Med Res. 2013;41(2):418-26.

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