Health & Exercise Forum

ARE YOU AT RISK OF FALLING?

1^st of 2 Columns on Fall Prevention

New research shows that falls are the number one cause of serious orthopedic injuries such as hip fractures in the elderly. As a result, falls prevention has become a health care priority. Studies also show that a comprehensive medical evaluation and a falls prevention rehabilitation program are very effective in lower the risk of falls

To determine your risk first it is necessary to define “a fall”.  A fall is an unplanned, unexpected contact with a supporting surface. A supporting surface is not only the floor or ground, but could be a chair (when rising and you fall backwards), a wall (when loss of balance causes you to bump into a wall) or a counter (when reaching overhead loss of balance causes you to bump into the countertop).

TEST YOUR FALL RISK

How likely are you to fall? Two quick tests that can determine your fall risk:

•  Timed Up and Go Test: This test :requires that you stand up from a chair, walk 3 meters (10 yards), turn around, walk back and return to the seated position. If completed in10 seconds, you are considered independent. However, if more than 14 seconds is required, you are at risk for a fall.

• Functional Reach Test (See Photo A): Tape a yardstick horizontally along the wall at shoulder height. Stand with feet shoulder width apart. Raise one arm so it is parallel to floor and in line with the yardstick. Without moving feet, reach forward without losing your balance. Measure the number of inches reached along the yardstick before you lost your balance. If your reach is 10 inches or more you are not likely to fall. However, if your reach was less than 10 inches, you are two times more likely to fall. If less than 6 inches, you are 4 times more likely to fall.

***BE SURE TO HAVE SOMEONE STANDING AT YOUR SIDE DURING THIS TEST TO MAKE SURE YOU DON’T FALL!  

What are the reasons why an older adult may be at risk for a fall?

Age related changes in strength, endurance, flexibility, reflexes, vision and posture creates a greater risk of falls in the elderly. The strength and endurance of your leg muscles decline with age. Strength can be reduced up to 40% by 80 years of age! The flexibility of your spine as well as ankle joints diminishes. Arthritis and pain can further limit motion in these joints. A stooped posture interferes with proper postural alignment and increases fall risk. Ankle flexibility is essential for effective balance responses and reflexes. Diminished sensation in the legs and feet (i.e. peripheral neuropathy) decreases responses to balance threats.  Cataracts, macular degeneration and retinal disease reduce your ability to use vision to maintain and/or regain balance and contribute to falls. Distractions can cause a fall since many older adults require more attention to complete a task safely. Anxiety and fear of falling can have a negative effect on balance performance.

Why is it important to address the issues that put you at risk for a fall?

Identifying and remedying all possible causes may prevent a fall. Preventing or reducing the likelihood of a fall may improve your quality of life. Elderly people who have fallen avoid performing basic physical and social activities (walking, shopping) because of fear of falling. If a fall causes a hip fracture, the resulting mobility deficits may prevent living independently and require nursing home placement. Fall prevention can lower health care costs. Health care costs of fall injuries for individuals 65 and older exceeded $19 billion in 2000.

Quick and Easy Fall Prevention Exercises:

Improve Flexibility:

• Calf Stretch (See Photo B):
  • Place hands on wall. Place leg to be stretched behind other leg. Keeping the knee straight, the heel down and the toes forward. Lean toward wall allowing the front knee to bend.
  • Hold: 30 seconds
  • Repeat: 3 times

Improve Leg strength:

• Standing Toe Raises(See Photo C):
  • Standing facing a countertop, simultaneously lift front of feet and toes upwards. Only use counter if necessary.
  • Repetitions: 10
  • Sets: 3
• Chair Squats (See Photo D):
  • Begin seated on edge of chair. Rise and return to sitting, without using arms, if possible. Elevate seat with pillow if too difficult from a standard height chair.
  • Repetitions: 10
  • Sets: 3

Improve Balance:

• Stand on One Leg (See Photo E):
  • Practice balancing on one leg facing a countertop. Only use counter if necessary.
  • Hold: 15 seconds
  • Repeat: 3 times with each leg

• Heel to Toe Walking (See Photo F):
  • In a narrow hallway, practice walking heel to toe. You can use a strip of tape to “walk the line.”
  • Duration: 2 to 5 minutes

Guest Contributor: Janet Caputo, PT, DPT, OCS specializes in orthopedic and neurological rehabilitation as an associate at Mackarey & Mackarey Physical Therapy Consultants, LLC.

Read “Health & Exercise Forum” in the Scranton Times-Tribune every Monday…Next Week Read: Part 2 of 2 on Fall Prevention!  This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.