Preventing Falls Through Better Balance

Did you know? By the year 2030 the Center for Disease Control (CDC) estimates the older adult population will rise to 20%? That is about 71.5 million people! Falls are the leading cause of accidental death in older adults, with ½ of falls occurring in the home. Most of these could be prevented! More than 1/3 of older adults (65+) fall each year, with 20-30% suffering moderate to severe injuries? In fact, in 2010, 21,700 people age 65 or older died from unintentional fall injuries. (CDC)

More fun facts Up to 60% of fallers express a “fear of falling” with 33% of them indicating they restrict activities due to this fear One half of older adults hospitalized for a fall related injury are discharged to a nursing home This fear of falling may cause people to limit their activities, causing even more loss of physical fitness and decreased mobility, putting them at MORE risk for fall!

Body Changes As We Age Strength, flexibility, balance and endurance decline with age Changes occur in cardiovascular and musculoskeletal function, as well as in our sensorimotor system and in our connective tissue Our maximal heart rate goes down and we can reach an intense level of exercise at lower heart rates –so even taking trash out to curb or walking up a flight of stairs may be exerting our body more than we realize – sometimes best to do a quick check on an “exertion scale of 1 -10” to see if we are pushing too hard rather than rely on our heart rate Also, there is a general decline in muscle strength with age including hips, knees and ankles Bone mineral density decreases with age, increasing susceptibility to fracture Exercise can produce significant increases in strength and decrease bone loss . Also have increase in tightness in extremity muscles, trunk extension, sending center of gravity forward. DO SEATED HS STRETCH

Strength A decline in muscle strength occurs due to loss in muscle fibers and size. Can be improved with exercise – you know the old “ you don’t use it you lose it” saying – well if you use it more, it WILL get better! Progressive exercises with bands or weights not only increases strength but assists in fall prevention by “catching self” easier with step strategies

Muscle Stiffness As we age, the ligaments and tendons increase in stiffness making movements more difficult

Slowing Reaction Time One of the biggest changes is the decreased reaction time of the sensors needed to initiate a movement following a stimulus, such as tripping over the dog! 3 sensors of the sensorimotor system In muscles and joints of foot and leg Visual sensors Vestibular apparatus in the inner ear

Sensorimotor Changes We don’t see as well It takes longer to complete the information loop between the body sensors, brain and muscles resulting in decreased coordination and increased reflex response time Brain cells are dying as we age The sheath coverings around the nerves are deteriorating The speed of transmission slows down We don’t see as well Now our sensory motor system also is vital for good balance and it also is affected as we age

Direct Results of Changes Gait becoming slower, with shorter step, wider base of support Balance decreases Fall risk increases Show walking with flexed trunk, shortened stride and why that makes person more at risk for fall – center of gravity forward, tightness hip flexors and trunk extensors. HAVE PEOPLE TRY STANDING SINGLE LEG EYES OPEN AND CLOSED

Why focus on better balance? To maintain the ability to walk comfortably and not with short shuffling steps To reduce the chance of falling through greater mobility and better reaction time Maximize independence!

Fall Factors Intrinsic - things we have difficulty controlling Extrinsic – things we can control

Intrinsic fall factors Decreased vision Decreased strength Decreased balance Increased medications (4+) Lack of sleep Possible decline in mental status Chronic disease Alcohol use Poor posture Factors within the person include many that we have already discussed: decreases in vision, strength, and balance. Other intrinsic factors may include decreased hearing and lack of sleep. Taking many medications, especially 4 or more, is also a risk factor. Decreased mental status, particularly dementia, increases the risk of falls. Chronic diseases such as MS, Parkinson’s OA / RA , diabetis with neuropathy will affect the person’s ability to maintain balance. Drugs we look at that combined can impact balance are Anti-hypertensives Anti-depressants Levodopa Antipsychotics Any sedative drugs including some muscle relaxants Long-term steroids – proximal muscle weakness Some chronic diseases may effect how easily a person moves, such as Parkinson’s, severe arthritis or MS. Blood pressure changes, esp. from sit to stand or supine to sit may cause a fall if the person does not take a few seconds to allow it to level off. (orthostatic hypotension) . Diabetic neuropathy, the tingling or decreased feeling in the feet make a person more susceptible to a fall. If a person is forward bent in posture (kyphotic), it throws center of gravity forward and places person more off balance – also may be sign of osteoporosis, especially if claims also “shrunk” couple inches – should have bone density scan to see if bones are fragile

Extrinsic Fall Factors Stairs Clutter Wet surfaces Loose rugs/carpets Cords Poor lighting Hurrying/rushing Not wearing shoes Extrinsic or environmental factors include stairs and railings, loose rugs and carpets, cords or clutter that can cause falls, wet surfaces such as around the sink, tub, or pet dishes, poor lighting at night, and hurrying or rushing. If a person if supposed to use shoes to assist with foot drop, and does not wear them may cause tripping and a resultant fall.

What can you do to prevent falls? Begin a regular exercise program Review your medications with your health care provider or pharmacist Make your home more safe Have your vision checked

Physical Activity for Balance Social Balance Stretching Strengthening A comprehensive and successful physical activity program encompasses several components; stretching, strengthening, endurance, and balance activities combined with social interaction and support. Each of these aspects is important. Stretching helps maintain flexibility and prevent injury. Strengthening helps you remain strong, which maintains mobility and independence. Strengthening activities can also reduce the risk of osteoporosis. Endurance activities help control blood pressure and weight, and boost your energy. Balance activities help reduce your risk of falling. Combining physical activity with social interaction makes it more fun and increases adherence to your physical activity program. Endurance

Finding the time Mixing up various types of exercises during television commercials makes it easy to get fit and not miss favorite shows. Achieving better balance makes it all worth while – much more fun to play with the grandkids than have them visit you in the hospital or nursing home

So What Can I Do? Watch for signs of blood pressure drop with standing Be fully upright before begin to move ( often falls occur within first 3 steps from chair!) Wear proper footwear (we call them “slippers” for a reason) Been falling? Talk to physician / family about it. Begin a regular exercise program, including strengthening, stretching, balance and cardio, going at your own pace and ability and have fun! Julie will be taking over and discussing some exercise options that are very appropriate for overall fitness and bone health

Opportunities for you to improve your balance! Matter of Balance EnhanceFitness Spectrum Health offerings Local fitness / exercise classes

Why Evidence Based Programs? Why these programs? Because we know… But the bottom line is…..get moving!

What is A Matter of Balance? A Matter of Balance is a program: Designed to reduce the fear of falling and increase the activity levels of older adults who have concerns about falls Lead by volunteer lay leaders What makes the program unique is the focus on the way we think about falls and getting rid of that “stinkin’ thinkin’!”

A Matter of Balance: Managing Concerns About Falls During 8 two-hour classes, participants learn: To view falls and fear of falling as controllable To set realistic goals for increasing activity To change their environment to reduce fall risk factors The important role of exercise to increase strength and improve balance Kitchen table talk

A Matter of Balance: Managing Concerns About Falls What Happens During Class? Participants share strategies and fears Participants learn ways to stay safer and prevent falls at home and in the community. Participants learn the connection between assertiveness and fall prevention The importance of exercise in relation to fall prevention is discussed and exercise begin in the 3rd week and done each week thereafter. Participants are empowered with skills and knowledge

Who could benefit from A Matter of Balance? Anyone who: is concerned about falls has been experiencing falls has given up things that are important to them due to a fear of falling. is interested in improving flexibility, balance and strength is age 60 or older, and able to problem -solve

A Matter of Balance Participant outcomes: Class Evaluation Results: 97% - more comfortable talking about fear of falling 97% - feel comfortable increasing activity 99%- plan to continue exercising 98% - would recommend A Matter of Balance “I am already noticing a difference in my physical being. I am sure I am a little more mobile than I had been and plan to continue these exercises. Hopefully I will be jumping over the moon soon” “ I seem to be more aware of every situation for my safety. I now ‘stop, look and listen’ to my surroundings.”

You could be a participant, a provider, or a coach! If you are looking to add more balance to your life, A Matter of Balance has many opportunities! Classes throughout the area Additional providers needed Coach’s training at AAAWM March 19 and 20!

What is EnhanceFitness? EnhanceFitness is an evidenced based group exercise program specifically for older adults Developed by the University of Washington Health Promotion Research Center and Seattle Senior Services Taught by a certified fitness instructor to ensure quality assurance and safety

EnhanceFitness What happens during three 1-hour weekly classes: Focus on strength, stretching, flexibility, 20 minutes of cardio. Participants learn to gradually increase their activity and work out at their own pace Socialize with others Become stronger, healthier, and build friendships.

EnhanceFitness Outcomes Participant Outcomes after 6 months: Improvement in: Upper and lower body strength Balance and mobility 93% reported their physical abilities had maintained or improved as a result of participating in EnhanceFitness Decrease in: Depressive symptoms Health care costs

Final Resources A fall prevention resource guide is available that includes programs offered through Spectrum Health, Grand Rapids Community College and many other local resources. Many are appropriate for people with osteoporosis. Remember the most important thing to do is keep moving!

Questions?? Nancy Mason MM PT Spectrum Health Lemmen-Holton Cancer Pavilion - 486-5055 nancy.mason@spectrumhealth.org Julie Lake Senior Neighbors - 233-0283 jlake@seniorneighbors.org

Thank You