Dr. Ryan Towns, PT, DPT
Cadence Physical Therapy Co, Buffalo Grove
Falling is one of the most commonly reported methods of injury in the geriatric population and can often times lead to death or major permanent impairments as a result. According to the Centers for Disease Control and Prevention (CDC), in 2011, nearly 23,000 people over the age of 65 died and about 2.4 million were treated in emergency departments due to falls.1 Additionally, studies show that about 30% of all older people experience at least 1 fall per year, 30-50% of older people in long-term care facilities in the United States of America experience at least 1 fall per year, and 40% of them experience recurrent falls.2 Some of the most common causes of falls include osteoporosis, muscular weakness, low body mass index (BMI), disorders affecting an individual’s spatial perception (Alzheimer’s, Parkinson’s, Progressive Supranuclear Palsy, etc.), poor environmental arrangement, neuromuscular diseases, impulsive behaviors, and polypharmacy. While many injuries sustained during a fall might only result in minor-to-moderate soft tissue bruising, lacerations, and/or sprained ligaments amongst many other possibilities, more severe and permanent damage can occur depending on the situation and individual’s physical condition, such as traumatic brain injuries or fractures. Falls are responsible for approximately 95% of all hip fractures sustained in the elderly population annually, and 20% of those individuals die within 1 year of the incident.2
Many various interventions have been widely implemented in healthcare systems worldwide in attempt to prevent these falls from occurring to improve functional independence and quality of life in the elderly population, but not all medical professionals are entirely aware of the most effective tests/measures to determine fall risk as well as the most appropriate methods to prevent it from occurring in the future. In a systematic review conducted in 2018 to examine tools for assessing fall risk in elderly patients, it was discovered that the Berg Balance Scale and Mobility Interaction Fall chart showed the highest specificity and stability in predicting patients that are at risk of falls, while the Downton Fall Risk Index, Hendrich II Fall Risk Model, St. Thomas’s Risk Assessment Tool in Falling elderly inpatients, Timed Up and Go, and Tinetti Balance scale showed the lowest specificity. 3 Furthermore, the results of the systematic review concluded that using 2 or more assessment tools per patient instead of 1 is more effective in accurately identifying the many possible factors contributing to fall risk.3
Elderly individuals are also able to make environmental changes in their homes as well to prevent falls. For example, it is very helpful to ensure all hallways are properly lit at night when going to/from the bathroom, number of rugs are limited, all stairways have railings, and bathrooms have multiple grab bars. 2 Additionally, elderly individuals are recommended to complete regular exercise and balance activities to ensure they are stable on their feet and internal balance systems are properly operating. For example, exercises such as daily walking outdoors (when appropriate with proper assistive devices), single leg stance balance in front of the counter or chair for safety, heel-to-toe walking near a stable surface, standing marches, and heel raises are all great and effective in preventing potential falls. Elderly patients are at risk of falls as their age increases due to natural musculoskeletal and neurological changes, therefore the vast majority of these individuals would largely benefit from skilled physical therapy regardless of physical function. Whether it be to address current impairments or prevent occurrence of future falls, physical therapy is a great tool in improving the health and wellness of the geriatric population.
- Centers for Disease Control and Prevention . Check for Safety: A Home Fall Prevention Checklist for Older Adults . 2015. https://www.cdc.gov/steadi/pdf/check_for_safety_brochure-a.pdf
- Bilik O, Damar HT, Karayurt O (2017). Fall behaviors and risk factors among elderly patients with hip fractures. Acta Paulista de Enfermagem; 30(4): 420-427.
- Seong HP (2018). Tools for assessing fall risk in the elderly: a systematic review and meta-analysis. Aging Clinical and Experimental Research; 30: 1-16.