The Stable Senior

Everybody falls. At some point, regardless of age, everybody will take a spill. When it happens to children, and young adults usually there are only minor consequences. However, when it happens to an elderly person, the consequences can be much greater. For the elderly population falls can begin a sequence of events leading to severe disability, and complications can lead to death. Falls are a major source of injury related disability and can adversely affect the quality of life at a time when people should be enjoying their Golden Years.

Many reasons can contribute to a fall, some external or environmental. These may be factors such as loose rugs, poor lighting, slippery surfaces, cluttered spaces and obstacles over which to trip. Often these types of hazards can be avoided with some special attention to your surroundings. Physical and Occupational Therapists are trained to identify and help correct many of these hazards when performing home safety assessments. However, most people don’t think of asking a physical or occupational therapist about a safety assessment before it is too late. Most often it is after a fall has occurred and the person is receiving physical or occupational therapy for rehabilitation that a home safety assessment is conducted. But this can be an easy part of a comprehensive fall prevention program. Yet there are more reasons people fall, and these can affect a person’s quality of life to a much greater extent.

Intrinsic or individual factors can cause falls as well, and may be more important to identify and address. These are factors such as dizziness, weakness, poor balance, difficulty walking, and fear. Intrinsic factors can stem from a wide variety of sources including disease processes, limited mobility due to injury, poor vision, slowed reflexes, and lack of agility. Together all of these factors can lead to situations in which people do not have the ability to maintain their center of mass over their base of support, and that means they fall down. Usually it is a complex interplay of all of these factors, internal and external, that lead to a fall.

Age plays a role in the risk of a person falling because of the natural changes that occur with age. In general, joints become stiffer, muscles become weaker, people lose endurance, and these all contribute to poorer balance. However, there is hope, not everyone is destined to fall. By engaging in exercises to strengthen, improve flexibility, and train their balance people can significantly reduce their risk for falling and sustaining injuries. In fact, the methods for preventing falls and reducing the risk for falling can be varied, fun, socially rewarding, and help significantly improve one’s quality of life.

Fear of falling is another issue which can in itself lead to as much disability as an actual fall. The sequence of events which make this situation worse may start with a close call, a fall itself, or knowledge of a friend or loved one who has fallen. This may erode a person’s confidence in their ability to perform normal daily activities because they are afraid they may fall. They may start to restrict their activities leading to social isolation and an increased dependence on others. Along with this, avoiding routine activities leads to a deconditioning of the body, increased joint stiffness, muscle weakness, and limited mobility. All of this makes the risk for falling even higher. But help is out there and available. There are ways to restore a person’s confidence and physical ability to prevent falling.

Physical Therapists are the health, medical, and wellness industries’ experts at evaluating, assessing, treating, and designing programs for preventing falls. Physical therapists are the professionals seen for rehabilitation after a fall has occurred. Seeking advice from a physical therapist can allow them to identify the specific risk factors that apply to each individual. A physical therapist can then design an appropriate program to address these issues specifically tailored to that unique person. The tools to use in preventing and treating falls are as varied as the different factors contributing to the risk of falling. Some of these tools will be highlighted here.

Vestibular rehabilitation and treatment is a specific type of physical therapy performed to address dizziness and vertigo issues. The vestibular system is our inner ear balance mechanism. It is a sensitive system designed to help us stay oriented to gravity, the horizon, and feeds our brain information related to how and where our bodies are in space. For most people it works flawlessly for all of our lives. But some people experience conditions in which this vestibular system doesn’t work properly. Sensations of vertigo, nausea, and dizziness can severely affect a person’s ability to maintain their balance. Specially trained physical therapists know how to assess this system, and help correct the dysfunctions which in turn can help prevent falls due to dizziness and vertigo.

Aquatherapy or pool physical therapy is another tool to help improve strength, balance, coordination, and prevent falling. The buoyancy of water can make mobility much easier for many people with limited mobility due a variety of problems. Getting in a pool and moving around can be fun and helpful, but a pool specific to physical therapy can offer a much more beneficial effect to the exercise and training. For instance, an underwater treadmill can provide the opportunity to practice walking with a normal gait pattern that may be too difficult to achieve on land. Having underwater cameras can allow a physical therapist to provide the person feedback on how they are moving, what adjustments to make and can be an exciting way for someone to literally watch themselves improve. Allowing a person to move their body through ranges of motion, stretching and strengthening muscles in movements that are functional to the activity is a key element to training for success. Walking is a primary activity related to falls and the ability to improve a person’s capacity for walking can be crucial to reducing the risk for a fall. These specialized therapy pools can also offer resistive water jets. Once a person has the strength, balance, and coordination to walk with just the buoyancy of water, a carefully controlled jet of water as resistance can propel their strengthening and balance forward to higher level.

Another tool which has been wildly successful for preventing falls and improving people’s ability to move and enjoy life is using Applied Functional Science. Specially trained physical therapists have studied the biomechanics of human movement, how it relates to gravity, and the functional activities we perform everyday. This approach, called Functional Training, is a specific method for creating activity-specific exercises. Related to fall prevention and rehabilitation, Functional Training uses the whole body to improve balance, control, strength, flexibility, mobility, and stability. This method can easily integrate all these components into fun, diverse, and dynamic exercises and movements that produce fantastic results.

Strengthening, flexibility, and balance training all play major roles in restoring or maintaining a person’s ability to stay agile and have the capacity to prevent falls. These elements can be achieved through many, many different avenues. Traditional weight training can be of some benefit, but yoga, Tai Chi, Pilates, group exercises classes, and other forms of movement exercise can provide significant benefits. The overall goal is to improve joint range of motion, and muscle flexibility combined with the strength to produce stability during motion, plus the agility to maintain balance.

In summary, the idea is to keep active. As humans, we are meant to keep moving, once we stop moving and being active the body quickly deteriorates making falls more likely. There are many ways to help reduce your risk for falling, they involve using your body and being active. Consult a physical therapist to find out what method will help you the most. Keep living life to the fullest and enjoy moving.

Bio: Steve Politis is a Doctor of Physical Therapy and the only physical therapist in northern Michigan who is a Fellow of Applied Functional Science. He is also a Certified Strength and Conditioning Specialist who works as clinic manager at Tim Bondy Physical Therapy in Petoskey and is director of the Performance Enhancement Center.

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