Fall Prevention



At Integral Performance Physio, we often have patients that come in following fall injuries, whether it be slipping on ice outside or falling during physical activity. These can lead to some more minor injuries such as ankle sprains or bruises, but can also lead to more important injuries such as hip fractures. It is estimated that fall-related injuries can affect about 30-60% of older adults. In order to avoid falls, it is important to understand both the intrinsic and extrinsic factors that influence it.



Intrinsic Factors



First off, an intrinsic factor is related to changes and limitations that occur within someone's body. One major intrinsic factor is age. As people get older, there are a few physiological changes that can put them at greater risk of falls. The main physiological changes we commonly see are:


  • Poor balance and walking
  • Chronic conditions such as stroke and Parkinson's Disease which can alter proprioception
  • Altered cognitive state such as Alzheimer’s Disease and depression
  • Poor vision (decreased visual acuity and visual field)
  • Muscle atrophy/weakness
  • Reduced reflexes

Studies have found that weakness in the lower extremities increases the probability of falling by more than 4 times. An additional risk factor is an impairment in their gait and balance. Fortunately, certain intrinsic factors, such as muscular weakness, gait, and balance can be improved through continuous balance training, strength training, and spinovisual reflex training.



Extrinsic Factors



Secondly, extrinsic factors are things in someone's environment that can cause sudden falls (external circumstances can influence whether or not someone is at risk of a fall). Often, people have a few risk factors in their own homes that can be easily modified to prevent a fall. These can include poor or inadequate lighting, removing potential tripping hazards such as carpets and cables/wires, or slippery floors. If you have functional limitations, the lack of handlebars, bathroom grab bars, or stair handrails can also be considered a risk factor.


Additionally, our elderly patients tend to take multiple medications, however, these medications can also have side effects such as dizziness and vertigo. Furthermore, taking multiple medications at once may also increase the risk of falls because of potential side effect combinations. Therefore, it is important to talk to your doctor prior to taking medication to inform yourself of potential side effects, and to review your prescription if side effects do occur.


Multiple studies have concluded that the majority of falls are due to a complex interaction between these intrinsic and extrinsic factors. For example, due to poor lighting, Mr. A didn’t see the pillow on the ground, so he tripped over it, and due to his intrinsic muscle weakness, he was not able to catch himself so he fell to the ground.



Major Intervention Strategies



On a more positive note, elders can improve or even avoid sudden falls through the implementation of certain strategies. These are a few strategies that have proven to greatly reduce fall related-injuries:



1. Environmental Modifications



There are quite a few easy environmental modifications that can reduce the risk of falling in someone's home. We highly recommend eliminating any kinds of potential tripping hazards such as misplaced things, uneven or slippery floor surfaces, rugs, or mats (unless you have added a rubber cushion underneath). It is also very important to mention that elderlies should add some supportive features to their homes like rubber shower mats, grab bars, handrails, and/or ramps in order to gain more stability. A common area of falls is when exiting the bathtub, where the floor is slippery and you need to balance on one leg, thus having the mat and the grab bar can help significantly reduce the risk of falling.



2. Physical Activity-Based Interventions



Physical activity has shown to significantly reduce the occurrence of falls. Exercising can help improve your balance, flexibility, muscle strength, and gait. Studies have shown that many forms of exercise can help reduce the occurrence of an elderly person falling. With age, both our strength and balance tend to decrease, thus it is important to work on exercises that help improve these factors. Depending on each person's level of stability, a physiotherapist can prescribe exercises of an appropriate difficulty in order to help them regain good functional stability. Some exercises to improve one’s balance include: standing on both legs with feet close together, standing on one leg while practicing the “airplane” pose, or standing on a Bosu ball while throwing and catching a ball.



3. Footwear



Footwear is another very important factor to consider in order to avoid any accidents, especially here in Quebec as we have very cold and icy winters. It is important for everyone to have the right boots with a proper rubber grip (or even crampons) and the right shoe size in order to avoid any types of fall incidents. Additionally, grips for a cane and/or boost can provide more stability while walking in icy conditions. Simply wearing running shoes outdoors is not sufficient, as the sole of the shoe does not have sufficient grip on the snow.



4. Spinovisual Reflex



As we age, our reflexes become slower due to nerve fibers changes, therefore our reaction time to make appropriate adjustments to obstacles may be longer. This may predispose elderly individuals to trip over things more easily. Studies have increasingly shown the benefits of using virtual reality and videogame-based exercises on balance, gait and reflexes.



Summary



The risk of falling is something that we commonly face due to the aging population as well as the cold icy climate that we live in. For that reason, it is important to be mindful of developing strategies to reduce these falls. Understanding the intrinsic and extrinsic factors that influence your risk will help you implement the intervention strategies mentioned in this article.


If ever you require more help or would like to be properly evaluated, please don’t hesitate to contact us at Integral Performance Physio at 514-534-0380 / [email protected]