Fall Prevention
Falls are a major cause of morbidity and mortality. Each year over 3 million older adults have a fall severe enough to require an emergency room visit and over 800,000 are hospitalized because of a fall. Falls result in over 30,000 hip fractures annually, and over 80,000 traumatic brain injuries with total medical costs of over $50 Billion each year.
If a person falls once, they are at twice the risk of falling again. This is because of fear of falling.
Once a person falls, they decrease their activity level, causing increased weakness and balance issues.
There are many causes of falls in the elderly. Lower body weakness due to disuse is a major cause of falls. Poor walking gait and balance due to arthritis, Parkinson’s, prior stroke, or other causes is another reason for falls. Use of medications like blood pressure medications such as diuretics (water pills) sedatives like Valium or Xanax, medications like Viagra, and antihistamines can
all cause falls. Vision issues like cataracts or macular degeneration is common in the elderly. Foot pain or poor footwear can cause falls. Another cause is home hazards such as stairs with clutter on them, exposed wires, and throw rugs.
Fall prevention starts many years prior to the risk of falling increases. An active lifestyle can dramatically decrease risk of future falls. Exercises such as walking, jogging, calisthenics, weightlifting, yoga and tai chi all can lower future risk of falls. In addition, weight bearing exercises such as those mentioned above will all help prevent osteoporosis or thinning of bones due to calcium loss. Osteoporosis can cause a simple fall or mild trauma to result in a broken bone. Preventing osteoporosis through a lifelong active lifestyle can help prevent a future hip fracture.
Some simple common-sense things to do to help prevent falls include removing hazards from around the house. Make sure there are no exposed electric cords to trip over. Keep clutter off the floor, especially near steps. Get rid of throw rugs as they are a major tripping hazard. Make sure that any wet spots are cleaned up immediately. Take extra care when out in the yard or when on uneven surfaces, especially when doing yard work or gardening.
If you have vision issues, make sure your prescription glasses are up to date. If you have foot issues, ask your doctor if they could recommend a good foot doctor (podiatrist) for you to see. Make sure you are wearing good solid footwear. If you have balance problems, avoid sandals or flip flops as they are unstable.
If you are on medications that cause light headedness or dizziness, ask your doctor to review your medications and if possible, make a substitution for ones that could cause falls.
Lastly, I am going to present some exercises to help with balance and lower extremity weakness. Disuse of muscles is probably the main contributor to falls, because if you have a strong core, hip and leg muscles, often you can correct yourself if you are falling for one of the above reasons, but if those muscles are weak, it is hard to stop a fall.
The first exercise to strengthen your lower extremities is the squat. The squat works the quadriceps. (Muscles in the front of the leg) and your glutes (your behind muscles). I will give several variations to use, depending on your strength level.
Stand up straight, feet shoulder width apart. Holding a chair or table for balance, bend at the knees like you are going to sit in a chair. Go down as far as you can. If you can only go down a little bit, that is ok. As you get stronger, you should be able to go down farther. Once you reach the bottom, stand back up. Distribute your weight on your entire foot, do not put more on the forefoot or heel. As you get stronger, don’t hold on to the chair anymore. Do at least 10-20 repetitions several times daily. An alternative is to be sitting in a chair, stand, then sit back down. Again, aim for 10-20 repetitions several times daily. As you get better, do these with your eyes closed to help challenge your balance.
The second exercise is the lunge. The lunge is similar to the squat, except one foot is in front of the other. Again, holding onto a chair or table, feet shoulder width apart, one foot in front of the other by about two feet, bend your front knee then stand back up. The lung, in addition to working your quadriceps and glues also works your hips and a bit of balance. Make sure you do 10-20 repetitions per side several times daily. As you advance, do not hold on to a table or chair any more. Again, as you advance, try closing your eyes when you do the lunges.
Next, try standing on one leg and balancing. Initially hold on to a table, lift one leg and balance on the other foot. As you get better, don’t hold on to anything. As you continue to get better, balance on one foot with your eyes closed.
Another good exercise is the side lunge. Stand with your feet shoulder width apart. Holding on to a chair, step your right foot to the right and bend your right knee as you shift your weight to the right. Stand up and repeat on the left side. Do 10-15 reps per side several times daily.
Once you can do all the above exercises, try gently hopping from one foot to the next. Hold on to a chair when you first try to do this. After you get more confidence, hop without holding on to anything.
The next two exercises are to help strengthen your core, which is also important in balance. The first exercise is the plank, which I described in exercises for low back pain. Get down in push-up position and support yourself with your forearms. The only point of contact with the floor are your forearms and feet. Tighten your abdominal muscles like someone is going to punch your stomach and clench your butt cheeks together. Hold for 30 seconds if you can.
The last core exercise is the paloff press. To do the paloff press you need an exercise band. Connect the band to something at chest height. You can use a doorknob and do the exercise kneeling or connect it to something higher. Now step away so there is tension on the band. You should be perpendicular (sideways) to the anchor holding the exercise band in place. Hold the band to your chest. Now push the band out. You need to use your core to prevent yourself from turning. Bring the band back to your chest. That is one repetition. Do 10, then turn around and do 10 on the other side.