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Let’s Talk about Falls – Matter of Balance

Why discuss falls in the first place? According to National Council on Aging 1 in 4 older adults aged 65 and older fall each year.

Falls are the leading cause of fatal and non-fatal injuries for older adults. Falls can completely change a person’s quality of life and also can be very costly. Falling is not an inevitable part of aging, even though many people believe so. Identifying risk factors and making lifestyle changes can help your future stay free of falls.

Molly Gerbutavich is the Healthy Living Falls Coordinator for the Healthy Living Center of Excellence. Molly’s job is to individually assess older adults for fall risk using the Center for Disease Control (CDC) STEADI Toolkit. Molly’s main duties are to inform consumers of fall prevention tips, education, and risk factors, inform consumer of community programs to reduce fall risk, encourage consumer to engage in physical activity to reduce falls and to review a home safety checklist to ensure consumer is staying safe in the home. Molly can assess consumers both in the home and out in the community.

A Matter of Balance is a free, 8 week evidence based program developed at the Roybal Center at Boston University, which looks at practical strategies to reduce the fear of falling and increase activity levels in participants. Participants learn to view falls and fear of falls as controllable, set attainable goals to increase activity, change their environment to reduce fall risk factors, and exercise to increase strength and balance. The emphasizes on group provides an opportunity for people with a common problem to learn from each other, bounce ideas off each other, and to help one another deal with the shared problem of fear of falling.

An evidence based program is a program that has been demonstrated to be effective in basic research that involved the same target audience. The program then has been demonstrated to be effective in dissemination in the “real world.” There are clear protocols for training and conducting of the program so that community programs can maintain fidelity and be successful.

There are many contributing factors that result in falls, which range from physical, behavioral, and environmental risk factors.

Environmental risk factors include hazards in the home and/or community that may cause your loved one to fall.

In the home risk factors include:

  • Lighting – poor lighting, uneven lighting, lighting that is not accessible upon entering a room, lack of night lights.
  • Kitchen – commonly used items in not easy to reach places, use of step stools.
  • Stairs – Handrails only on one side of the steps, handrails that do not go the complete length of the steps, inability to depict edge of stairs
  • Bedroom – Lack of lights or light switches within reach of the bed, and lack of sturdy furniture or handrail to assist with getting in and out of bed.
  • Bathroom – Lack of grab bars, lack of abrasive non-slip strips in tub, low toilet seat.
  • Additional rooms – cords in the flow of traffic, scatter rugs, carpets that are in poor condition, carpets that do not lie flat on the floor, unable to move throughout the rooms with ease, and passageways that are cluttered and unclear.
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    Community risk factors include:

  • Rain and mud leading to slippery surfaces.
  • Branches that have fallen.
  • Holes, inclines changes, uneven sidewalks, ice, snow and tree roots.
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    Physical risk factors are changes in your body that increase your risk of falling (NCOA).

  • Dehydration is one of the leading causes of summer falls. Dehydration can lead to dizziness and disorientation, and falls often follow. A person with poor eye sight and/or hearing is at a fall risk.
  • Memory loss can play a big role in falls with older adults. Someone who is suffering from memory loss can forget to use safety nets that are put into place for their fall prevention, such as, forgetting to use assistive devices when ambulating around the home or forgetting to hit their personal emergency response system in the event of a fall.
  • Medications are often a physical risk factor that tends to be overlooked. Some medications have side effects that may put an older adult at a fall risk.
  • The number of medications a person is taking itself is a risk factor. Medication side effects and adverse side effects are most likely to occur when: A new medication is added, the dose has changed (increase/decrease), alcohol or illicit drug is added, the person is taking multiple sedating medications or herbal products, when there are food and/or drug interactions, and anytime.
  • Chronic conditions can also increase your risk of falling. The research is strong that both directly and indirectly most chronic conditions significantly increase the risk of falling (functional limitations and disabilities, chronic pain, sensory deprivations, vision and hearing effects, depression, balance and gait disturbances, diabetes, arthritis, and strokes). Chronic conditions may account for 30% of falls through direct effects of the disease and indirect effects. Falls as a result of chronic conditions can lead to decreased independence and confidence. Falls injuries can also exacerbate the chronic conditions. A history of falls can also put you at a greater risk for falls in the future.
  • Other physical risk factors that can lead to falls include: feeling sick, feeling dizzy or lightheaded and weak leg muscles.
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    There are things that we do every day that we may not realize that are putting us at a fall risk, otherwise known as behavioral risk factors.

  • The use of step stools or chairs in the place of step stools can put you at a fall risk, especially if you are an older adult.
  • Being lax while cleaning up spills in the home can lead to slippery surfaces that may lead to a fall.
  • Rushing to answer the door or phone is also a big fall risk.
  • Other behavioral risk factors include not paying close attention to what you are doing, multi-tasking, not wearing proper footwear both inside and outside of the home, and being unaware of your surroundings.
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    Exercise is one of the best ways to prevent falls. The body is a moving a machine and staying active at any age is very important. Some physical activity is better than none at all (CDC). You can gain a lot by staying active and lose more by not being active (Go4life). Physical activity helps maintain the ability to live independently and reduces the risk of falling and fracturing bones. Regular exercise helps keep your joints, tendons, and ligaments flexible. Keeping your muscles in shape helps you prevent falls that can cause greater problems such as a broken/fractured hip. An older adult should try engaging in different types of exercise to maximize their benefits. The four best exercises for fall prevention are balance, strength, endurance, and flexibility. Mild-weight bearing activities may slow bone loss from osteoporosis. Strengthening exercises are key to fall prevention when they are completed alongside balance training (Mayo Clinic). Physical activity can help people with chronic conditions improve their stamina and muscle strength. Exercise helps control joint swelling and pain associated with arthritis. Other benefits from physical activity include, improving your ability to do the everyday activities you want to do, reducing blood pressure with some people with hypertension, manage and improve chronic conditions such as diabetes, heart disease and osteoporosis, and helps reduce the symptoms of depression and may even improve mood and overall well-being.

    Tai Chi improves both balance and mobility. Tai chi works to benefit balance, flexibility, mental agility, and reduces falls. Tai Chi practice includes slow, low-impact and controlled movements and body positions. The movements improve the parts of your body needed for increased balance, strength, and flexibility, and the practice teaches you awareness (NCOA). As an older adult, regular physical activity is one of the most important things you can do for your health (CDC).
     

    Upcoming Matter of Balance classes in the Merrimack Valley

    9/13/17 at the Nevins Manor in Methuen from 2:00 to 4:00 pm.
    10/11/17 at the Andover Council on Aging in Andover from 2:30 to 4:30 pm.
    10/16/17 at Amesbury Council on Aging in Amesbury from 2:00 to 4:00 pm.

    For more information on the Healthy Living Center of Excellence, visit www.healthyliving4me.org.
    Molly Gerbutavich can be contacted at mgerbutavich@esmv.org or (978) 651-3033.

    1. Lindsey

      This article is so informative and easy to follow. Also very helpful!! I will be working in the medical field shortly and my parents are both getting older as well. The home risk factors are especially helpful for good habits I should start introducing around the house. Thanks for the tips!