Slips, Trips and Falls: How Physical Therapy Can Help Reduce the Risk

There are over 36 million reported falls by older people in the U.S. each year and many go unreported. This means at least one in four people over the age of 65 experience a fall, resulting in more than 32,000 deaths. This makes falls the leading cause of injury and injury-related death in this age group. Falling is a public health concern – so during this week every year, we observe National Fall Prevention Awareness Week.

While not all falls cause injuries, one in five results in a serious injury such as head trauma or a broken bone, like a wrist, arm, ankle or hip fracture. These injuries can have devastating consequences, like limiting a person’s mobility or taking away their ability to live on their own.

“I explain to my patients that our muscles naturally get weaker and our balance and agility worsen as we age,” said Larry Aseo, a physical therapist at Washington Outpatient Rehabilitation Center (WORC) with more than 35 years of experience in the field. “Oftentimes it is difficult to accept that our bodies are not the same as when we were younger, but it is an important step in preventing falls.”

There are many conditions that contribute to falls, and some practical things can be done to help prevent them. These risk factors include lower body weakness; vitamin D deficiency; difficulties with walking or balance; use of certain medications; vision problems; foot pain or improper foot wear; and home hazards like broken or uneven steps and throw rugs or clutter that can cause tripping. Most falls are caused by a combination of these, and the greater the number of risk factors, the greater the chance of falling.

Prevention is the Best Medicine

Older people should talk openly with their doctor about their risk of falling, especially those who have fallen before or feel unsteady on their feet. Physicians will likely review any medicines that may cause dizziness or sleepiness and check if older patients get lightheaded when going from sitting to standing. Schedule annual vision checks and meet with a podiatrist for any foot issues. Around the house, get rid of trip hazards and make sure all staircases have handrails and adequate lighting.

Generally, more active older adults have a lower risk of falling than those who are sedentary. To prevent falls and improve overall health, it is recommended that people over 65 participate in regular activity like low-impact aerobics, tai chi, strength training and yoga. Benefits include improved balance, coordination and flexibility which all lead to greater stability and mobility.

“Many falls happen in the bedroom or bathroom first thing in the morning because people are still groggy or have low blood sugar before breakfast,” explained Aseo. “Be aware of when and where you are most vulnerable for a fall and take precautions. Sometimes this means swallowing your pride and accepting that you need a little help, perhaps in the form of an assistance device like a cane or walker.”

Physical therapists at WORC provide gait training to help people improve their ability to stand and walk, with or without the use of a cane or walker. When falls lead to injury, the specialists at WORC help patients return to their prior level of function. In addition to increasing range of motion and strength after a bone fracture, experts at the center treat vertigo and dizziness and can help patients manage the aftereffects of concussion from a head injury.

Aseo developed some basic physical tests he has patients perform to evaluate their risk of falling. These tests can also be done at home for strength training and to improve balance. Here are two that can be worked into a daily routine. Start slowly and try to increase repetitions over time, performing them one to three times a day. A cane, walker or other support should be used as needed.

• Chair Stand Test/Exercise (to measure or improve lower body strength): Sit in the middle of a straight-back chair (17” seat height) with your feet flat on the floor and arms crossed on your chest. Rise to a full standing position, then return to a seated position. Repeat for 30 seconds to see how many times you can stand up.
• One Leg Balance Test/Exercise (to measure or improve static balance, control and fall risk): Stand next to a counter or wall for safety with your arms crossed on your chest. Start a timer when you bend one leg up at the knee, heel up behind you. Timer stops when 1) raised foot touches the ground, 2) raised leg is used to support the standing leg, or 3) foot on the floor loses control. Stop test at 30 seconds and repeat with the other leg.

“If you feel unsteady on your feet, I urge you to discuss it with your physician so they can provide an order for physical therapy. We would rather see you at WORC to proactively teach you how to prevent falls than have you come to us for rehabilitation after you have been injured in a fall,” concluded Aseo.

To learn more about the Washington Outpatient Rehabilitation Center, go to whhs.com/worc or call 510.794.9672.