Falls account for more than 85% of injury related hospital admissions among Canadian seniors and are a leading cause of admission to nursing homes.  More than one third of falls will result in a hip fracture and half of those who break a hip will never fully recover.  A shocking one in five seniors who suffer a hip fracture will die within 12 months of the injury.

Physiotherapy for seniors

With the staggering morbidity and mortality statistics associated with falls, Canadian seniors are searching for options to maintain or improve their current level of functioning. Many are turning to exercise, fitness and an active lifestyle.  Remaining active and participating in a regular exercise program will prolong their quality of life and improve resilience to injury, but is it enough to decrease a senior’s risk of falling?

For the general senior population, an active lifestyle and participating in some form of regular physical activity will significantly reduce their risk of falling.  For seniors who have already had a fall or are experiencing functional limitations or reduced mobility, physical activity alone is not enough.  For these seniors to see significant improvements in their risk of falling, a falls prevention exercise program is required.

An effective falls prevention exercise program differs from casual exercise in that it includes strengthening, stretching and balance training.  A recent meta-analysis by Catherine Sherrington and colleagues (1) finds that successful falls prevention exercise programs meet the following criteria:

  1. The exercise program must include a balance-training component that provides a moderate to high challenge to the senior’s balance.
  2. The dose of exercise must be significant to have an effect (a minimum of two hours per week is recommended).
  3. The exercise program must be ongoing.  The benefits of exercise are rapidly lost when the individual stops exercising and unfortunately this also applies to the lasting falls prevention effect.
  4. Falls prevention should be targeted at the general senior population as well as those at higher risk of falls; exercises should be tailored to the risk category of the participant.
  5. Falls prevention exercises are ideally performed in a group or home setting depending on the comfort level and the risk category of the participant.  When providing falls prevention exercises in a group setting, supplement with additional home exercises.
  6. Strength training that overloads the muscles is an integral component of a successful falls prevention exercise program.  Improving muscular strength and endurance will provide short-term benefits and may also have longer-term falls prevention benefits.

With qualified instruction, a well-designed falls prevention program can yield a 35% reduction in the in both the number of falls and the number of injuries resulting from falls (2).   Physiotherapists are ideally suited to provide instruction in a group or in-home falls prevention exercise program.  As rehabilitation professionals who are regulated in Ontario under the Regulated Health Professionals Act (RHPA), physiotherapists will work in partnership with the senior and their doctor to implement a program that will dramatically reduce the likelihood of a disastrous and life altering fall.

References:

(1)    Sherrington C, Tiedemann A, Fairhall N, Close J, Lord S, Exercise to prevent falls in older adults:  an updated meta-analysis and best practice recommendations.  NSW Public Health Bulletin.  Vol. 22(3-4) 2011

(2)    Taylor D, Stretton C, The Otago Exercise Program:  An evidence-based approach to falls prevention for older adults living in the community.  Nzfp.  Volume 31, Number 6, December 2004