Falls can diminish your ability to lead an active and independent life. About one third of people over the age of 65 and almost half of people over the age of 80 will fall at least once this year. There usually are several reasons for a fall. Physical therapists can help you reduce your risk of falling by:
Assessing your risk of falling
Helping you make your home as safe as possible
Educating you about the medical risk factors linked to falls
Designing individualized exercises and balance training
Working with other health care professionals and community services to create programs for people who want to reduce their risk of falling
What Are Falls?
The reasons for falls are complex and include:
Being 80 years old or older
Leg muscle weakness
Difficulty with balance or walking
Vision problems (cataracts, macular degeneration, wearing bifocals)
Medical conditions that limit your ability to get around, such as Parkinson disease, stroke, or diabetes
Conditions that cause confusion, such as dementia and Alzheimer disease
Taking more than 4 medications at the same time or psychoactive medications (such as sedatives or antidepressants)
Using a cane or other walking device
Home hazards (throw rugs, pets underfoot)
Low blood pressure
The more risk factors you have, the greater your risk. The factors associated with the greatest fall risk are:
A history of previous falls
Leg muscle weakness
Taking more than 4 medications or psychoactive medications
Difficulty with walking
How Can a Physical Therapist Help?
If you are worried about falling or if you recently had a fall, your physical therapist can conduct a brief check (“screening”) of your fall risk. If the screening shows that you are at risk, the therapist will perform a thorough evaluation, including:
A review of your medical history
A review of your medications
A simple vision test
A home safety assessment
A simple screen of your thinking abilities
A check of your heart rate
Blood pressure measurements while you change positions (from sitting to standing)
Feet and footwear assessment
Assessment of any nervous system disorders, such as stroke or Parkinson disease
The therapist also will:
Measure your leg strength, using simple tests such as timing how long it takes you to risk from a chair
Determine how quickly and steadily you walk
Assess your balance—for instance, by having you stand on one leg or rise from a chair and walk
Use special tests to measure your balance
Based on the evaluation results, your physical therapist will design an exercise and training program to improve your balance and strength. A recent systematic review of many published studies found that exercise-based programs in the home or in group settings are effective in preventing falls. These programs are especially effective when balance exercises are performed in a standing position without using much arm support.
Balance training has been shown to be an important and effective part of fall prevention. Your physical therapist will design exercises that challenge your ability to keep your balance, including such exercises as single-leg standing.
Walking and Moving
When people walk very slowly or are unsteady, they are at risk of falling. Your physical therapist can improve your walking ability by having you do such activities as:
Walking in circles
“Figure 8” exercises to strengthen the core abdominal muscles that help stabilize your body
Doing More Than One Thing at the Same Time—Safely
Older adults who have difficulty walking and talking at the same time are at a higher risk of falling. To help increase your safety during daily activities, your physical therapist can design a “dual-task” training program. This kind of training will challenge you to maintain walking speed while you do another task, such as counting backward, engaging in a conversation, or carrying a bag of groceries.
Strengthening exercises are a key element of fall prevention when they are done in conjunction with balance training. Your physical therapist will design strengthening exercises that focus on your leg and the muscles used in maintaining posture.
Aerobic exercise is physical exercise of relatively low intensity and long duration; it can help improve almost every aspect of your health. Walking is one of the safest forms of aerobic exercise, no matter what kind of problem you have. Once you have begun your strengthening and balance program, your physical therapist will know when you’re ready to start the aerobic exercise. Depending on your ability, the therapist might have you do three 30-minute walking sessions each week.
Your physical therapist will take the time to explain to you how to best manage your own risks for falling. Your therapist also may talk to you about the best activities for you to do to maintain your quality of life.
It will be important for you to talk with your physical therapist about any fear of falling that you have. Your therapist will work with you to determine whether there are activities you should avoid. Your therapist also will work with you to determine whether your fear may be unfounded and whether there are activities that you should be doing to keep strong and help your balance.
Several fall prevention programs are being promoted by the Injury Prevention and Control Center of the Centers for Disease Control and Prevention in collaboration with the Administration on Aging. These programs help people:
Reduce their fear of falling
Set goals for increasing their physical activity
Make their homes safer
Do more exercise to increase strength and balance
These programs often are led by volunteer coaches. Your physical therapist may be involved in setting up one of these programs and can help you find programs in your area that would be best for you.
Real Life Experiences
Andrea T. is 70 years old and has diabetes, diabetic neuropathy (numbness and poor sensation in her feet), high blood pressure, and osteoarthritis in her knees. She lives by herself and takes care of her own household chores, driving, and shopping. Referred to a physical therapist for knee pain, she also is concerned about falling. Andrea’s goals for physical therapy are to reduce her pain and improve her ability to walk.
The therapist screens her for fall risk and finds that Andrea:
Had 2 falls within the past 12 months, but no serious injury
Has difficulty rising from a chair
Is slow to turn
Has trouble walking more than a short distance
The therapist determines that she is at risk for falling and proceeds with further evaluation. He tests Andrea’s vision, which is adequate with eyeglasses. Her vital signs are normal. Andrea is taking more than 4 medications—including 2 drugs for high blood pressure and other medications for diabetes, pain, and anxiety. Testing shows that she also has muscle weakness. The physical therapist uses a special sensory test and finds that she has lost some sensation in her feet due to neuropathy. She does not like to exercise and thinks that her knee pain is worse after exercise, so her physical activity level is low. All of these factors contribute to her risk of falling.
Based on the examination, the physical therapist alerts Andrea’s physician to the possibility that she might be taking too many medications. Because the therapist is concerned that her neuropathy is worsening and her diabetes is not being controlled as well as it could be, he also refers her to the physician for diabetes management.
Focusing on Andrea’s knee pain and balance problems, the physical therapist instructs her in strengthening exercises and balance training in a standing position. The therapist monitors her progress with such exercises as standing leg lifts in all directions, standing on her toes, and standing on her heels, which Andrea is instructed to do at home daily unless she has an increase in pain. As Andrea progresses, she practices walking forward, backward, and in a circle. The therapist includes “dual-task” training such as walking and talking while maintaining walking speed. She does balance exercises on the days when she does not visit the physical therapist, increases the number of repetitions of strengthening exercises, and adds single-leg stance, chair rises, and wall squats. Her home exercise program takes about 30 minutes, and physical therapy sessions take about an hour.
After several weeks, Andrea’s physical therapist arranges for her to join a community exercise program and follows her progress via telephone. Andrea reports that she is able to take walks around the block with her grandchildren.