- Falls – ACC defined as slipping, tripping, misjudging
- As of Jan 2019 new ACC claims relating to falls (data collected between June 2011-July 2018) for 30-39 year olds was 64, 301 compared to 60-60 year olds was 104, 826.
- Falls at home for 30 year olds 219, 400 compared to 60-69 year olds 298, 722
- At 80+ years old falls at home increases to 311,050
- WHO reported that falls are a leading worldwide cause of accidental or unintentional injury deaths after road traffic accidents
- The estimated number of falls deaths is approximately 424 000 globally with falls responsible for 17 million disability-adjusted life years.
Falls Risk Factors: Extrinsic (environment) and Intrinsic (the individual) factors
|Assisted devices||Behaviours/ choices|
|Drugs/alcohol||Balance, strength, gait deficits|
|Home/ neighbourhood features||Chronic conditions|
|Support from caregivers||Acute illnesses|
Falls Risk Assessment: The American Geriatrics Society and British Geriatrics Society (AGS/BGS) have published a clinical practice guideline on fall risk screening, assessment, and management. It recommends screening all adults aged 65 years + for falls annually.
Screening consists of:
- asking patients if they have fallen 2+ times in the past year
- asking if they have sought medical attention for a fall
- if they have not fallen, whether they feel unsteady when walking
Patients who answer positively to the above questions are at an increased risk of falls and require further assessment. People who have fallen once without injury should have their balance and gait evaluated; those with gait or balance abnormalities should receive additional assessment. A history of 1 fall without injury and without gait or balance problems does not warrant further assessment. It was found that primary care providers should refer patients to clinical and community resources to aid in prevention.
Older individuals show lower rates of movement and lower peak ankle moment when compared with young adults. As strength declines with age (due to muscular, tendinous and neural alterations), leg muscle strength could be the limiting factor in preventing a fall. As we have discussed above, falls are the result of both intrinsic and extrinsic factors. The most common gait changes related to the tendency to fall in older adults, (compared to younger adults), are slower gait velocity with a shorter step length, shorter relative swing phase time, and less range of motion (ROM) at the hip, knee, and ankle joints. Other studies have shown that the elderly spend less time with one foot in contact with the ground.
Primary cause for fall related gait pattern is muscle weakness and impaired balance which results in reduced walking speed. An experimental study conducted in 2018 compared strength training exercises with that of general exercises in fall related gait kinematics. Strength training consisted of half wall squatting, theraband exercises, range of movement exercises. General exercises consisted of balance exercises (included mini hurdle walking, zig zag walking, cross walking) gait training (included tandem walking, circle walking, side walking, backward walking) and joint range of movement exercises. It was found that there is a positive and large effect of strength training exercises in the management of fall related gait kinematics in the elderly. This study demonstrated that strength training improves falls related gait kinematics as there was an improvement in cadence and reduction in fear of falling.
A 2019 Cochrane Review aimed to assess the effects (benefits and harms) of exercise interventions for preventing falls in older people living in the community. The systematic review included 108 randomised controlled trials with 23,407 participants. These were carried out in 25 countries. On average, participants were 76 years old and 77% were women.
- 81 trials compared exercise (all types) versus a control intervention . Exercise reduces the number of falls over time by around one-quarter (23% reduction).
- Exercise also reduces the number of people experiencing one or more falls (number of fallers) by around one-sixth (15%) compared with control.
- It was found exercises that mainly involve balance and functional training reduced falls compared with an inactive control group. Programmes involving multiple types of exercise (most commonly balance and functional exercises plus resistance exercises) probably reduced falls, and Tai Chi may also reduce falls.
Following on from the above study, research conducted in 2018 in UK found that:
- When incorporated with multiple exercise interventions: gait, balance and functional training exercises all reduced the rate of falling by 18% and 9% respectively.
- As a single component it was found that gait, balance and functional training programmes reduced the rate of falls but not the risk of falling.
- However Tai Chi interventions were the only single intervention to significantly reduce the risk of falling (16%)
- Strength/ resistance exercises and general physical activity (walking) were not found to be effective in reducing rate or risk of falling.
- Overall it was found that in order for an exercise program to be effective at reducing the rate and risk of falls; gait, balance and functional training (incorporating balance exercises) must be included.
Due to the huge body of evidence supporting exercise and its role in reducing falls rate and risk- Refine Health have just launched ‘Mobility and Falls Prevention Classes’ which run Tuesdays and Fridays in St. Heliers clinic. If you have any questions, please do not hesitate to contact us... 09 5201832
Panel on Prevention of Falls in Older Persons. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59:148–157. [PubMed] [Google Scholar]
Chocrane Review Exercise for preventing falls in older people living in the community, Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. 31 January 2019
Long-term follow-up of exercise interventions aimed at preventing falls in older people living in the community: a systematic review and meta-analysis Susanne Finnegan a,∗, Kate Seers b, Julie Bruce a a Division of Clinical Trials, University of Warwick, Coventry, CV4 7AL, UK. Jan 2018.