Falls Risk and the Elderly - Podcast 4 

Today's Brainstorm Bites podcast is an important one. Particularly for those in the community who are elderly, have elderly loved ones or for people who work within aged care health, seniors hostels or community health services. Falls risk is a severe issue for our communities. This edition of Brainstorm Bites will highlight the impact, potential causes and simple strategies to limit the effect.

A falls risk is a factor that can potentially lead to an individual inadvertently coming to rest on the ground or floor. It is familiar with around 30% of people aged over 65 years will experience a fall. Moreover, this risk increases by 10 % for the next five years of age. That can be interpreted that a small group of ten aged persons, four will experience a fall. That is frightening!!

More statistics, up to 50 % of people living in care institutions fall each year, and over 40% will experience more than one episode. The consequences of the fall often lead to medical attention. With up to 30% of falls lead to severe injuries and total, just under 20% of all emergency visitation in public health facilities. The most common fall-related admission are hip fractures, upper limb injuries and traumatic brain injuries.

A lot of energy and resources have started to focus on prevention of falls risk. Consequently, the statistics show that following hip fracture, one every five will die from the injury. Likewise, following a fall, the elderly would experience depression, immobilization, confusion, loss of independence and restriction of daily activities.

One significant consequence of fall risk is the fear of falling. The individual will restrict, and at times, remove themselves for activity. While this sounds plausible and sensible, this defense is dangerous and will deteriorates the elderly individual health. A fear of falling cycle is established.

Such that a FALL leads to FEAR OF FALLING AGAIN, leads to LESS ACTIVITY, leads to DECREASED MUSCLE STRENGTH AND BALANCE, leads to INCREASED RISK OF FALLING. In brief, the less activity and strength and balance, the protection and control for stability can be compromised.

An earlier podcast, Brainstorm Bites number 2; we discussed the balance control and vestibular system. It probably would be useful to revise or recap from this podcast edition, so we welcome you to backtrack to this that podcast.

In brief, healthy balance control is dependent upon a strong and stable vestibular system. The vestibular system requires both visual system and proprioceptive control to be healthy. Considering that the human brain devotes a large area for visual processing information, it would not be too surprising that your balance control depends on a lot of this information. Such that weakness or the eyes, poor muscle control of the eye muscles or fatigue can create a mismatch and disrupt the balance control.

However, proprioceptive control is pieces of information telling your brain on where your joints and muscles are positioned. Think about it; if you close your eyes and outstretch your hand; it is because of the information from the joints and muscles of your hand, you can be fully aware of where the hand is placed. That is a function of proprioception. Therefore, if you were to have disturbance to the proprioception, balance can be impaired because of reduced movement control and feedback correction errors.

Clinical examination utilising force platform tests (such as Computerised Dynamic Posturography (CDP) and Test of Balance protocols - in particular Limits of Stability LOS), is a modern approach to assess balance problems quantitatively. Such advanced instrumentation methods are efficient objective means to identify potential Falls Risk. Accurately identifying the cause of the falls risk, will assist a therapist to target appropriate therapy.

In summary, falls has a significant economic and social impact upon our community. Each year, one in every three adults age 65 and older will fall. Falling is the leading cause of injury-related death and the most common cause of nonfatal injuries and hospital admissions for trauma, amongst the elderly. The aging process involves the declining function of several physiological systems which support balance; such systems include the Visual system, the Muscular system, Sensory system and Vestibular system. An accurate measure and detection of falls risk should assess the status of all physiologically related factors.

At Brainstorm Rehabilitation, we are dedicated to switching brains on. For references and resources jump onto the web at brainstormrehab.com.au or join the conversation on Facebook. Thanks for joining us today on our brainstorm bites podcast on FALLS RISK.

More Reading
 Alrwaily, M., & Whitney, S. L. (2011). Vestibular rehabilitation of older adults with dizziness. Otolaryngologic Clinics of North America, 44(2), 473–496, x. https://doi.org/10.1016/j.otc.2011.01.015
Holmgren, E., Lindström, B., Gosman-Hedström, G., Nyberg, L., & Wester, P. (2010). What is the benefit of a high intensive exercise program? A randomized controlled trial. Advances in Physiotherapy, 12(3), 115–124. https://doi.org/10.3109/14038196.2010.491555
Lynn, S. G., Sinaki, M., & Westerlind, K. C. (1997). Balance characteristics of persons with osteoporosis. Archives of Physical Medicine and Rehabilitation, 78(3), 273–277. Retrieved from http://www.archives-pmr.org/article/S0003-9993(97)90033-2/abstract
Stevens, J. a. (2005). Falls among older adults--risk factors and prevention strategies. Journal of Safety Research, 36(4), 409–411. https://doi.org/10.1016/j.jsr.2005.08.001
Visser, J. E., Carpenter, M. G., van der Kooij, H., & Bloem, B. R. (2008). The clinical utility of posturography. Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology, 119(11), 2424–2436. https://doi.org/10.1016/j.clinph.2008.07.220
Young, W., Ferguson, S., Brault, S., & Craig, C. (2011). Assessing and training standing balance in older adults: a novel approach using the ‘Nintendo Wii’ Balance Board. Gait & Posture, 33(2), 303–305. https://doi.org/10.1016/j.gaitpost.2010.10.089

Falls Risk and the Elderly - Podcast 4 --