As we age, it is common for more people to be concerned about falling – and improving balance to prevent falls is critical. Balance is defined as the process by which we control the body’s center of gravity with respect to the base of support, whether we are stationary or moving. The base of support is the area around your two feet if you are standing still, and the area around one foot during walking when one foot is on the ground. When standing quietly, our goal is to align each of the body parts vertically and thereby expend the least amount of internal energy necessary to maintain an upright and stable position relative to gravity.
We also need to have mobility, which is the ability to move independently and safely from one place to another. Body sway is the path of the body’s movement during quiet standing. When a person is aligned over their center of gravity standing quietly, a body can sway 8 degrees forward, 4 degrees backward and 16 degrees sideways before having to take a step because they have reached their limit of stability. Three postural control strategies have been identified for controlling the amount of body sway.
- An ankle strategy is used when the amount of body sway is small, the body moves as a single unit around the ankles with the upper and lower body moving in the same direction.
- A hip strategy is used when the distance and speed of body sway increases or when we are standing on a surface that is narrower than the length of our feet, (e.g., when standing sideways on a narrow beam.) The upper and lower body will move in opposite directions.
- A step strategy is used when our center of gravity is displaced beyond our maximum limit of stability, or the speed of sway is too fast to control by using the hip strategy. In other words we take one or more steps to prevent falling.
We have three systems which contributes to maintaining balance in standing and moving environments: vision, somatosensory (e.g.muscles, tendons, ligaments, joints), and vestibular system which resides in the inner ear. Vision responds to light, somatosensory system responds to touch, vibration and pain, and vestibular system is activated when the head moves.
Older adults must spend more attention to balance because changes in the body systems that contribute to balance and mobility are an inevitable consequence of aging. Changes in vision can adversely affect an older adult’s ability to perceive or anticipate any changes in surface conditions or any hazards in the environment. In the musculoskeletal system, strength declines as much as 30% between the ages of 50 and 70. Larger increases after 80. Physical inactivity contributes to a loss of strength and muscle endurance, and muscle power declines 6 – 11% per decade. Muscle power is the muscle’s ability to contract forcefully in a very short time. Hair cells in the inner ear which sense head movement begins decreasing after age 30 and continues through adulthood. A decrease in these reduces sensitivity to head movements, resulting in increase body sway.
Older adults fall because of poor performance on specific balance and gait tests. This can be easily tested in the clinic. Vision changes can affect fall rates. Older adults who take 4 or more prescription medications are at a greater risk for falls. Clutter in the home, loose rugs, objects on the floor, poor lighting, poorly designed stairs can contribute to falling. Fear of falling has been shown to increase fall risk in older adults. A Balance Efficacy Scale, which is a questionnaire adults fill out, can help identify which activities affect a person’s confidence, thereby increasing their risk of falling. Falling is more common than you think:
- 1/3 of the population over 65 falls each year
- Falls are the leading cause of both fatal and nonfatal injuries among older adults
- Every 13 seconds an older adult is treated in a Emergency Department for a fall
- Every 20 minutes an older adult dies from a fall
- In 2013, 2.5 million non-fatal falls among older adults were treated in emergency departments
- Most fractures among older adults are caused by falls
- The financial toll for older adult falls is expected to increase as the population ages and may reach 67.7 billion dollars by 2020
So what do you do?
First get your balance tested with a test like the Fullerton Balance Scale. This test is easily performed in our physical therapy clinic. Based on the outcome of your test, a program is designed. Your program design may start with working on a seated balance position using stools or stability balls, progressing to standing balancing challenges, to gait and mobility challenges. There are many variables within each of these programs, such as reaching while balancing, eyes closed while stationary or moving, hard and soft surfaces to stand or walk on, the list is endless. Maintaining strength and mobility is very important, so building up the strength in your muscles helps slow down the age related decline. It is important to use a system like the Solo Step which is a harness worn by the user and attatched to an overhead track, allowing a person to work independently without the risk of falling. This works wonders for their confidence. Currently we are using this device in our clinic with great results.
This article just touches the tip of the iceberg – but know growing old isn’t for sissies. Fight it, embrace it with confidence and the attitude of a 20 year old. You can always make changes and better yourself, which will improve the quality of your life. Don’t ever let anyone tell you that you are too old to do something.
We can help you with the Balance Test, Solo Step System, and overall plan of action to get you moving without fear. We custom tailor every program, and our staff is there to help you with every step. To learn more about what we do, contact us today!
***A great book to learn more is called Fall Proof by Debra Rose. Some of the statistics noted above were pulled from this text. Highly recommend it. A good read.Read More