PT Works

Community Care Physicians

Physical Therapy

Fall Risk Reduction in Older Adults

December 2007

Offices are conveniently located in Clifton Park, Delmar, Latham, and Schodack.

  Fall: An unexpected event in which the participants come to rest on the floor, ground or lower surface.  Obviously this can have serious consequences, especially in the elderly.  Perhaps the simplest way to screen for a patient being at a risk for falls is the “Get Up and Go Test”. ( J Am Geriatr Soc 39: 142-8 )  Have the patient rise from the sitting position, walk 10 feet, turn around, return to chair and sit down.  If it takes less than 20 seconds it indicates good mobility and transfer skills. Longer than 30 seconds indicates higher dependence and a risk of falls.

 

Fear of falling should be a red flag for the need to do a falls risk assessment.  Falls are by far the most common reason for ER visits and hospital admissions due to trauma in the elderly. Every hour there is one death and 183 ER visits for this reason in older adults.

 

A recent review of the literature made by The Cochrane Library involved 34 studies which included a total of over 2,800 participants mostly over 75 years of age.  The reviewed revealed that an appropriate program including strengthening exercises and exercises to challenge balance were definitely helpful in improving balance in the elderly.

 

Risk of falling is multi-factorial including having to take more than 4 medications, depression, as well as cognitive, visual, neurological and cardiovascular deficits. Physical therapy can assess and treat the impact of the factors of gait and balance deficits, use of assistive devices, muscle weakness, impaired ADLs and arthritis.

 

An appropriate program would have sufficient intensity to increase strength, include dynamic balancing exercises, be regular and sustainable, as well as simple and inexpensive.  It should be able to be done safely and effectively at home or in a group setting in a gym or senior center.  Community Care Physical Therapy does offer a Fitness program so that patients may continue a program under our indirect supervision.

 

Recommendations for appropriate footwear as well as a check list of potential hazards in the home can be given to the patient and/or a family member if needed.  Hazards can be structural (stairs, doorways, grab bars) or habitual (clutter, obstacles, lighting etc.).

A referral to physical therapy is appropriate anytime there is an identified risk of falling.  Course of treatment could be short, for instance when setting up and teaching a home exercise program.  Or it could be several weeks in length if the need for skilled intervention to develop strength and balance is identified.

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