Balance
Balance & fall prevention are vital topics for older adults, as falls can result in serious injury, hospitalization, and increased fear of additional falls. All of these can create a negative cycle of decreasing activity level over time.
This blog answers some frequently asked questions about falls and provides some useful strategies for older adults to stay balanced and stable across the lifespan.
1. Exercise to Prevent Falls
Can exercise prevent falls?
A clear “yes”, says this 2019 systematic review, which examined 108 (!) randomized controlled trials with a total of 23,407 (!!) community-dwelling people over 60 years old
Their findings showed that not only did exercise decrease the rate of total falls by 23%, but also exercise reduced the number of people experiencing one or more falls by 15%. These are significant numbers considering the sometimes drastic consequences of falls.
Regarding the contents of the exercise programs included in the study, the most effective programs contained a combination of balance and functional exercises.
Tai Chi was also found to reduce fall risk, and resistance training was useful in reducing falls when combined with balance/functional exercise.
2. Single Leg Balance & Mortality Risk
The ability to stand on one leg can be an important indicator of future health.
This study found that the inability to stand on one leg for 10 seconds in mid/later life is associated with a 2x risk of death within the next 10 years?
Those who failed to stand on one leg had poorer health – increased proportions were obese, had heart disease, had unhealthy blood fat profiles, and had diabetes. After controlling for age, sex, and underlying conditions, inability to balance on one leg for 10 sec associated with 84% increase in all cause mortality (risk of death from any cause) in the next decade.
We cannot establish causation from this observational study, but with falls being the leading cause of fatal & non-fatal injury in older adults, we should always looking for efficient and effective ways to measure fall risk.
3. COVID-19 & Falls
The COVID-19 pandemic has had wide-ranging detrimental effects on physical health and functioning, especially for older adults.
This article from 2021, which surveyed ~2000 US adults aged 50-80, outlines a harmful “domino effect” of social isolation, leading to inactivity, leading to falls.
According to the survey, 36.9% reported decreased activity levels and 45.9% reported experiencing social isolation. Both of these factors have been connected with increased falls risk and worsened fear of falling. Authors conclude that "Public health actions to address reduced physical activity and social isolation are needed."
Our AgeProof Your Body membership program provides older adults with safe and accessible opportunities to improve physical health using exercise, while connecting to a larger community of peers and expert instructors.
4. Fall Recovery After Slips & Trips
Trips and slips present a unique challenge for older adults. Whether they occur while walking over rugs, thresholds, or slippery services, trips & slips require quick reaction time, agility, and strength to properly recover without falling.
This article examined several balance-related measures in 41 older adults, and then tested their ability to recover their balance after an experimentally-induced trip or slip during walking (don’t worry, they used a harness system for the test).
When they looked at which variables were most associated with falls, they found that knee extension strength and rapid inhibition accuracy were independently associated with falls in their experiment.
Rapid inhibition refers to the ability to "cancel" or inhibit an action.
For example, rapid inhibition can look like a pedestrian starting to step into the street, but aborting the action if a fast car is coming. This requires practice of cognitive flexibility/agility, response time, and coordinating quick motor actions. It's essentially working on the "emergency brake" to prevent unwanted actions.
Strength is also a huge factor, as leg strength and power is required to decelerate and “catch” the body’s motion after a slip or trip.
We found this article fascinating as we are always looking to include challenging (but safe!) task-specific interventions for fall prevention in our community.
References:
Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019 Jan 31;1(1):CD012424. doi: 10.1002/14651858.CD012424.pub2. PMID: 30703272; PMCID: PMC6360922.
Araujo CG, de Souza e Silva CG, Laukkanen JA, et al. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals. British Journal of Sports Medicine 2022;56:975-980.
Hoffman, GJ, Malani, PN, Solway, E, Kirch, M, Singer, DC, Kullgren, JT. Changes in activity levels, physical functioning, and fall risk during the COVID-19 pandemic. J Am Geriatr Soc. 2022; 70( 1): 49- 59. doi:10.1111/jgs.17477
Okubo, Y; Duran, L; Delbaere, K; et al. Rapid Inhibition Accuracy and Leg Strength Are Required for Community-Dwelling Older People to Recover Balance From Induced Trips and Slips: An Experimental Prospective Study. Journal of Geriatric Physical Therapy: July/September 2022 - Volume 45 - Issue 3 - p 160-166 doi: 10.1519/JPT.0000000000000312
