Falls put individuals at risk of serious injury. Falls are one of the main causes and loss of independence in people over 65 years of age. It is estimated that one-third of older adults will fall each year and the National Council of Safety estimates that over 50% of those falls could have been prevented. Fall prevention research has identified two different types of fall risk factors: extrinsic and intrinsic.
Extrinsic risk factors occur outside of the individual and are usually modifiable. Examples of this are the home environment, footwear, nutrition and activity levels. Approximately 60% of falls occur in the home and the most common environmental issues are surface and lighting-related. Using night lights with bright bulbs and removing throw rugs is one way to reduce extrinsic risk factors.
Intrinsic fall risk factors are the inevitable physical declines associated with aging. These changes can directly affect one’s balance. In order to maintain balance, the sensory system collects information from the environment and transmits this information to the brain to be processed. The brain then transmits a motor response to the muscles. Simply put, balance control is about senses and muscles; the speed and accuracy of sensory input transmitted for central processing of musculoskeletal response determines ability to prevent a fall. There are three sensory systems that provide input relative to balance and they are the vision, vestibular and somatosensory systems.
We are vision-dependent when it comes to balance. We rely heavily on visual input for information about body position and motion in relation to space and location of objects in the environment. Age-related changes in vision that affect balance include reduced depth perception, contrast sensitivity and reduced peripheral vision.
Since humans rely mostly on input from vision for balance, it is necessary that older adults learn how to better utilize input from other senses while still able to use their vision in order to reduce fall risk.
Fall prevention research has made remarkable discoveries in the role of the vestibular system and balance and how aging affects this system. The vestibular system is located in the inner ear where there are hair cells that serve as “motion detectors”. This system is activated every time a person turns the head. Also, a portion of the inner ear, called the labyrinth, contains specialized cells that detect motion and changes in position.
Age-related changes to the vestibular system include a reduced number of hair cells which results in an increased sensitivity to head movements. If a person does not experience classical vertigo dizziness symptoms, impairment in the vestibular system may go undetected until there is a loss of balance. Early detection and treatment of vestibular impairment can reduce dizziness and the risk of an accidental fall. Maximizing the use of the other sensory systems can also help decrease the risk of fall.
The somatosensory system provides valuable information about the environment and one’s balance. Proprioceptors located all over the body provide input about the body position in relation to space and these “position receptors’ are plentiful in the feet and the neck. The age-related declines of the somatosensory system contribute to postural instability as a result of older adults having a reduced ability to feel contact between the feet and the ground. This loss of sensation results in greater postural sway to determine body position in space.
The good news is that exercising to improve muscle and proprioceptor strength and the other sensory systems results in an increased awareness of body position in space, safer movements and reduced fall risk.
Older adults need lean muscle mass in order to remain independent. The natural loss of muscle mass begins in the third decade of life. “Use it or lose it.” The less activity a person gets, the more muscle mass that is lost.
The good news is that sarcopenia can be slowed by regularly participating in a strength-training program. This means 2 to 3 times each week. To gain strength, older adults must apply the “Overload Principle” which means the last 3-4 repetitions should require effort without compromising form.
The legs are the fall prevention muscles. The leg muscles get you up, but the hip muscles keep you up so it is essential to do exercises that strengthen the hips, thighs, calves and ankles. It is also essential to develop core stabilization throughout all movements as well as proper execution of the movement itself. That is why it is important to understand the body and the movement patterns of your muscles.
We all experience natural declines as part of the aging process, plus the risk of impairment in one or more of the sensory systems. The good news is that these systems can be improved with training. Following a well-designed exercise program is the best way to reduce the risk of falling. Our bodies are made to be in motion so let’s keep it that way.