Falls in Elderly- Physiotherapist Perspective
Falls in Elderly-Physiotherapist Perspective
An 85 year old lady fell down while draping her 7 year old Grand Daughter with a blanket and didn’t have pain or discomfort in her body immediately. After couple of days she was having pain in her back for which she went for an orthopedics consult followed by MRI which revealed multiple crush fracture in the lumbar and dorsal spine. She had complete rest with back brace for few weeks followed by comprehensive physiotherapy. Overall it took six months for her to recover from the day of fall and affected her quality of life especially to lead an active and independent life.
About one third of people over the age of 65 and almost half of people over the age of 80 will fall at least once a year. Doctors, Nurses, para- medical persons, family member , friend etc can identify fall risk person in their life and refer them to Physiotherapist for further management.
Physiotherapists can help reduce a person’s risk of falling by:
- Assessing a person’s risk of falling.
- Helping his home as safe as possible.
- Educating that person about the medical risk factors linked to fall
- Designing individualized exercises and balance training.
- Working with other health care professionals and community services to create programs for people who want to reduce their risk of falling.
Physiotherapist can do a thorough evaluation which includes:
- A review of one’s medical history
- A review of one’s medication
- A simple vision test
- A home safety assessment
- A simple screen of one’s thinking abilities.
- A check of one’s hear rate.
- BP measurements while changing position from sit to stand.
- Feet and footwear assessment.
- Assessment of any nervous system disorders such as stroke, Parkinsons, etc
- Measure one’s leg strength using simple tests such as timing how long it takes you to rise from a chair.
- Determine how quickly and steadily one can walk.
- Assess one’s balance – for instance , by having one stand on one leg or rise from a chair and walk
- Use special test to measure the balance
Based on the evaluation results, Physiotherapist will design an exercise and training program to improve one’s balance and strength. A recent systematic review of many published studies found that exercise based programs in the home or in group settings are effective in preventing falls. These programs are especially effective when balance exercises are performed in a standing position without using much arm support.
I Balance Exercises
Balance training has been shown to be an important and effective part of falls prevention. One’s Physiotherapist will design exercises that challenge his ability to keep his balance including such exercises as single leg standing
II Walking and Moving
When people walk very slowly or unsteadily, they are at risk for falling. His Physiotherapist can improve his walking ability by making him do such activities as:
- Dance steps
- Walking in circles
- “Figure 8”, exercise to strengthen the core abdominal muscles that help stabize one’s body
- Obstacle course
III Doing more than one thing at the same time safely
Older adults who have difficulty walking and talking at the same time are at high risk of falling. To help increase their safety during activities one’s Physiotherapist can design a,”dual task”, training program. This kind of training will challenge one to maintain a walking speed while he do another task such as counting backwards, engaging conversation or carrying a bag of groceries.
IV Strength Training
Strengthening exercises are a key element of fall prevention when they are done in conjunction with balance training. One’s Physiotherapist will design strengthening exercises that focus on his leg and the muscles used in maintaining posture.
V Aerobic Training
Walking is one of the safest way of aerobic training. Physiotherapist will formulate walking program according to the patient’s capacity.
VI Education& Fear Management
Physiotherapist will talk to the patient how best to manage his own risk of falling and to build his self esteem to overcome the fear of falling.
VII Community Program
Physiotherapist can participate with local groups in organizing different fall prevention activities at the community level like in the malls, senior citizen centres, clubs etc.