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Keeping the body FallProof!

TM : The importance of balance training in reducing falls in older adults

By: Heather Lenz, M.S. UNMCs EngAge Wellness Program

Learning Objectives
Discuss the various problems falls impose on older adults & the healthcare system Identify and discuss risk factors associated with falling

(poor balance)
Discuss age related changes in the older body that contribute to balance problems Explore trusted resources on fall prevention Discuss the importance of disseminating fall prevention

education to older adults (the healthcare professionals


role)

How big is the problem?


In 2005, a total of 15,802 persons aged >65 years died as a result of injuries from falls (1) 30% of people aged 65 and over fall once or more per year (2) 42% of people with mild/moderate, and 60% with severe dementia fall per year Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death (3) Unintentional Injury Data

How big is the problem?


In 2000, direct medical costs of falls totaled a
little over $19 billion$179 million for fatal

falls and $19 billion for nonfatal fall injuries.


This equals $28.2 billion in 2010 dollars (5) On average, the hospitalization cost for a fall injury is $17,500 (8)

CDC Total Lifetime Medical Costs of Unintentional Fatal Fall-Related Injuries in People 65 Years and Older By Sex and Age, United States, 2005

Risk factor model for falls in older age from the WHO

Intrinsic vs. Extrinsic Risk Factors


Risk factors for falls are divided into two major categories: 1. Intrinsic Risk Factors (4)
Dizziness, frailty, gait abnormalities, confusion, poor

coordination, poor lower body ROM, cognitive impairment,


inadequate lower body strength, foot problems, underlying pathological disease issues (neuropathy, tingling, numbness, etc) , history if falls

2. Extrinsic Risk Factors (4)


Floor surface, poor lighting, cluttered furniture, obstacles,

non-level surface, poor shoes

Modifiable Risk Factors


Modifiable fall risk factors include
1. Muscle weakness 2. Reduced joint ROM 3. Gait and balance problems 4. Poor vision 5. Home hazards

Systems Contributing to Balance & Mobility


Sensory systems (visual, vestibular, somatosensory) Motor system Musculoskeletal system Nervous system Cognitive system

Age-Related Changes in the Older Body


Vision changes (Sensory)
1. Reduced visual acuity 2. Reduced or impaired depth perception 3. Reduced contrast sensitivity 4. Narrowing of the visual field, especially in the peripheral region. 5. Eye diseases

Age-Related Changes in the Older Body


Somatosensation Changes (Sensory)
1. Reduced vibration threshold 2. Reduced sense of joint position (proprioception) 3. Conditions associated with other age related issues (i.e. neuropathy)

Vestibular Changes (Sensory)


1. Gradual decline of hair cells within the system

2. Moderate reduction in vestibuo-ocular reflex

Age-Related Changes in the Older Body


Central & Peripheral Motor Changes
1. Reduced reaction time, movement time, and response time

2.
3.

Difficulty selecting the proper movement strategy in a


given situation Reduced ability to anticipate changes in the environment

or the demands associated with a task

Musculoskeletal Changes
1. 2. 3. Decrease in muscle strength Decrease in muscular endurance Decrease in muscle power

Age-Related Changes in the Older Body

Cognitive Changes
Reduced attention & memory Reduced divided attention

Can changes in balance and mobility be reversed or improved?


Some changes are small (slight reduction in visual acuity), whereas some are large (chronic condition) Growing evidence suggests that individuals can slow the rate of decline occurring in some, or all of these systems (6)

How can you do to help older adults to reduce their risk of falling?
Encourage regular exercise!

Perform regular reviews of medications.


Provide patients with a home safety checklist.

Encourage regular vision check-ups.

Effective Fall Prevention Strategies


Focusing on Physical Activity & Exercise

Exercise program in itself!


Tai Chi
1. Moving for Better Balance
Includes 24 Tai Chi forms that emphasize weight shifting, postural alignment, and coordinated movements. Participants in the Tai Chi classes had fewer falls and fewer fall injuries, and their risk of falling was decreased 55 percent.

FallProof! Balance & Mobility Training

FallProof!TM Balance & Mobility Training Overview


FallProof has been proven to reduce the risk of falling in people who have completed one or more rotations of the 12-week/24class program.
FallProof was recognized in 2003 by the National Council on Aging as one of the seven exemplary model programs promoting healthy aging and improved quality of life. Includes both pre & post assessments to determine balance impairments. Participants will enjoy full participation, as ALL activities can be modified to accommodate individual capabilities and limitations.

UNMCs EngAge Wellness Presents FallProof!TM Balance & Mobility Training

The goal of FallProof! is to reduce the risk of falls


and improve balance and mobility through
1. Improving postural alignment
2. Increasing limits of stability 3. Improving integration of sensory information 4. Increasing balance related self-efficacy 5. Improving strength & flexibility

Closing Discussion
Health and social care agencies need to work together to prioritize fall prevention as part of their overall strategy for promoting healthy aging.

Multi-factorial interventions, including exercise,


education and home modification should be a priority.

Falls with or without injury also carry a heavy quality of life impact. Educate, Educate, Educate! And..Refer!

Trusted resources for you to use!


WHO Global Report on Falls Prevention CDC Falls Compendium of Effective Fall Interventions- What works for Community Dwelling Older Adults http://www.ncoa.org/improve-health/center-for-healthy-aging/fallsprevention/state-coalitions-map/nebraska.html - National Council on Aging (Coalition right here in NE!)

http://www.stopfalls.org/ - Fall Prevention Center of Excellence


http://www.f1rst.org/ - NE Safety Council : F1rst (Fall Intervention Reaching Seniors Together)
http://www.f1rst.org/MBBClassSchedule.htm - MBB Class Schedule here in Omaha Home Safety Checklist

References
1. 2. CDC. Fatalities and injuries from falls among older adults---United States, 1993--2003 and 2001--2005.

MMWR 2006;55:1222--4.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Webbased Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed November 30, 2010.

3. 4. 5. 6.
7.

Alexander B.H., Rivara F.P., Wolf M.E. (1992). The cost and frequency of hospitalization for fall

related injuries in older adults. American Journal of Public Health; 82(7):10203.


Rubenstein, L.K. (2006). Falls in older people: epidemiology, risk factors & strategies for prevention. Age Ageing, 35-S2: ii37-ii41. Stevens J.A., Corso P.S., Finkelstein E.A., Miller T.R. (2006). The costs of fatal and nonfatal falls among older adults. Injury Prevention;12:2905. Rose, D.J. (2003): FallProof: A Comprehensive Balance and Mobility Training Program. Gardner M.M., Robertson M.C., Campbell A.J. (2000). Exercise in preventing falls and fall-related

injuries in older people: a review of randomized controlled trials. British journal of sports medicine.
34:7-17. 8. Roudsari, B.S., Ebel, B.E., Corso, P.S., Molinari, N.M, & Koepsell T.D. (2005) The acute medical care costs of fall-related injuries among the U.S. older adults. Injury, Int J Care Injured; 36:1316-22.

Thank You all SO much for your time and attention!

Questions?