India hosts over 76.6 million people at or over the age of 60 years making it around 7.7% of the total population. The people in this age group face a lot of problems due to the changing social and cultural norms within society. Falls are among the major issues faced by the elderly people and are considered one of the “Geriatric Giants”. It is a serious threat to their health and well-being. Recurrent falls are one of the important causes of mortality and morbidity in elderly. It is also a marker of poor physical and cognitive status. Falls can have devastating consequences for people and their support networks. They place a huge burden on health services.
There are many conditions that can cause a person to fall. These risk factors if changed or modified can prevent falls. The risk factors include:
- Lower body weakness
- Vision problems or cognitive impairment
- Difficulties with balance and walking
- Poor footwear or foot pain
- Home hazards such as throw rugs, clutter where a person can trip over, uneven or broken steps
- Environmental hazards
- Vitamin D deficiency
- Use of medicines like sedatives, tranquilizers, antidepressants. Certain OTC drugs can also affect balance
- History of falls
- Lack of physical exercise
- Disease processes
- Arthritis of lower limb joints
- Postural hypotension
- Lack of knowledge about conditions for falls or risk factors
What Can Happen After Falling?
If someone had a history of fall or injury, it affects their confidence and they develop a fear and the individual tends to avoid similar kind of activities due to their past experience.
This in turn leads to further loss of muscle strength. Which then affects even regular activities which the individual is doing. And the strength loss becomes a reason for another fall. This is a vicious cycle, the avoidance behavior due to fear makes the individual more prone to falls.
Not all falls would cause injury but some of them may cause serious injury. These injuries can make it difficult for a person to carry on with everyday activities or live by themselves.
The most common injury among elderly after a fall is a hip fracture which requires a surgical management. Head injuries, which could be very serious for a person taking blood thinner medications. Broken bones, like the ankle, arm, wrist etc. are the other areas involved.
Role of Physiotherapy
Physiotherapists play an important role in preventing falls in elderly people. They not only treat injuries but also provide guidance to prevent pain or injury that can limit one’s ability and help address the risk of falls. Additionally, they can also evaluate the home environment and identify risks which can lead to a potential falls.
The most important goal of any physiotherapist led fall prevention programme focusses on one important goal of working on the ‘fear of fall’ by working on the following areas
Especially the lower limb muscles like the quadriceps which works on the knee joint and is responsible for locking the knee joint while walking and avoid buckling of the knee. Second important muscle is the calf muscles. With strong calf muscles even if one loses his balance they can try and counter act the displacing force.
- Balance reactions and reaction time
This is a pivotal component and many are not aware how to utilize it. Reaction time and balance are inversely proportional. Higher the reaction time poor is the balance and the chances of falls also increase because the individual is unable to react in a timely fashion to avoid a fall. A Physiotherapist can identify which balance reaction needs working upon and improve the reaction time.
If flexibility is compromised, then even with good strength and balance reactions there are chances of fall. This is because the muscle cannot produce optimal strength when in a shortened position. Similarly, when muscles are overly stretched they become weak. So flexibility works both ways – an individual can be hypo (less) mobile or hyper (more) mobile.
Endurance essentially means being able to withstand an activity for a longer period of time. This also depends on an individuals’ cardiovascular fitness. A therapist identifies possible risk factors, informs if any investigations are required after a basic evaluation and chalks out a personalized plan based on the individuals’ current fitness and progresses it at regular intervals.
- Ear problems / Dizziness
It is not known to many that Physiotherapists can treat dizziness due to ear problems! Dizziness can be a real disabler and it is almost impossible to do any activity because the individual experiences dizziness which aggravates in certain positions. Physiotherapists assess the dizziness in different positions and prescribe exercises to manage dizziness.
A physiotherapist would review the medical history of a senior person to determine his or her general physical condition. A personalized exercise plan which is tailored to the individuals needs is created with the goal of improving overall physical function.
How to Reduce the Risk of Falling?
- Wearing a good pair of lace-up walking shoes which will not only support the feet but provide necessary cushioning for the joints
- Chances of tripping are higher with slippers, high heels, open-toed sandals.
- Sit while changing clothes especially lower body.
- Install grab-bars and handrails in bathrooms and stairways
- Wait 10 seconds before rising while moving from lying to sitting position. Wait 10 seconds when moving from sitting to a standing position and also for 10 seconds while moving away from a chair, bed or toilet
- Wipe up any spills, mainly from ceramic floors
- Must keep the stairways well lit by installing a nightlight at the top. Keep the house well lit in general
- Manage medications properly
- Keep regularly used items at eye level on a shelf
- Plant both feet securely on the ground while getting out of a car
- Avoid taking unnecessary risks like getting up on furniture. It is better to ask for help or at least use a sturdy stepladder
- Be mindful around pets and their stuff as feet can get caught in dog leashes. A pet like a dog can knock you down or you can trip over a wandering or sleeping pet
- Do exercises that will improve balance and make the legs stronger. Tai Chi has shown good results in an old age group to avoid falls.
- Get your eyes checked once in a year. Do not wear reading glasses or bifocal or progressive lenses while walking. Have glasses with a distance prescription for any kind of outdoor activities
If you have an elderly person at your house at risk of falling, consider hiring certified physiotherapists working with Nightingales. Visit https://www.nightingales.in/services/physiotherapy to book an appointment with an experienced physiotherapist to enjoy the services from the comfort of your house.
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