Falls are the most common cause of injury among older Canadians and one of the leading causes of hospitalizations among seniors. These falls can result in chronic pain, decreased quality of life, hospitalizations and injuries like hip fractures and even increased risk of early death.
While seniors underestimate their risk of falling, they may place themselves at greater risk of falling by thinking they are more capable than they are.
Factors associated with falling include:
- Weakness – muscle atrophy
- Neurological – Parkinson’s, Neuropathy, MS, ALS
- Balance – loss of proprioception, your body’s ability to know where it is in space
- Range of Motion – Osteoarthritis
- Medication – some medications can alter balance
- Environmental Factors – rugs, chairs, tripping hazards
How Do We Assess Falls Risk?
Berg Balance Scale
The Berg Balance Scale is used to objectively determine a patient’s ability (or inability) to safely balance during 14 predetermined tasks. Some of these tasks include:
- Transitioning from sitting to standing and vice versa
- Standing in a normal/neutral position with your eyes closed
- Standing with your feet together
- Turning around 360 degrees in both directions
- Looking over both shoulders from a normal/neutral standing position
The 14 tasks are graded, based on your ability & safety in performing the tasks, between 0 to 4. The maximum an individual can score on the scale is 56. The literature suggests that if a client scores less than 45 on their assessment, they are at a great risk of falling.
Timed Up and Go Test (TUG-T)
The Timed Up and Go Test is used to assess mobility, balance, walking ability and falls risk in older adults. Starting from a seated position, when instructed, the client is asked to stand, walk 3 metres, turn around, walk back and sit down. Research suggests that if it takes a client longer than 12 seconds to complete the test, they are at a high risk of falling.
Short Fall Efficacy Scale - International (FES-I)
The Short Fall Efficacy Scale is a subjective measure in which clients are asked about their fear or concern of falling when undertaking activities of daily living. These activities include items like getting dressed or undressed during your day or undertaking a bath or shower. There are 7 identified activities clients are asked about and self grade with their respect to concern of falling. The important thing to remember is that if you were to score higher than 14, you would be considered high risk for falling. You can download this scale below if you would like to fill it out at home.
Range of Motion Testing
This will look at how much motion (or lack thereof) your joints have. A couple of factors can be impacting this including
- Tight or weak muscles
- Stiff or restricted joints
How do we address falls risk?
Exercising for strength and balance have been shown to have the most effective outcomes in the reduction of falls rates. In order to be effective, exercising for strength and balance should be undertaken at least twice a week for a minimum of 6 months to make significant improvement.
Walking programs have been shown to also contribute to decreasing falls risk but also prescribed to those that can do them safely. Further, in order for them to be significantly effective, they need to be done with high intensity and high dosage.
As discussed under strengthening, the balance exercises have to be highly challenging, individualised for the patient and continue to progress in terms of difficulty. A whole host of balance exercises exist but there always are certain ones that will best fit your ability level and help you to achieve your goals faster!
Falls Recovery training is a way in which our physiotherapists can work with you to determine the best way to recover from a fall. Once you have fallen, there are techniques and items to consider to make it easier to get back safely to sitting or standing. This concept is known as “Backwards Chaining” as has been shown in the literature to not only increase the confidence around their homes but also supports in training to decrease risk of falling.