The term ‘falls’ and ‘physiotherapy’ often go hand in hand and you will often see the term ‘falls prevention’ emphasised by any physiotherapist or physiotherapy organisation. But Why?
It is possible for anyone of any age who is mobile to fall and sustain anything from a little graze to a life threatening injury hence it would make sense to be aware of how to prevent such incidents from occurring. However the reality is that according to statistics, falls are the second leading cause of unintentional injury and death worldwide with those aged over 60 being at highest risk. Falls can also otherwise lead to permanently reduced quality of life and independence, loss of confidence, permanent disability and restriction of activity when death is not the immediate outcome.
What exactly causes falls in the elderly?
Both intrinsic and extrinsic factors contribute to falls in this population.
Intrinsic factors are due to the aging process and include deteriorating balance, coordination, gait pattern, reduced reflexes, vision changes, muscle weakness, sensation loss and reduced insight into your safety and environment due to cognitive changes.
Extrinsic factors on the other hand, include factors such as your physical environment (i.e. lighting in your home, tripping hazards, inappropriate footwear etc.) and polypharmacy (i.e. taking multiple medications which may affect your level of alertness.
The contribution of Intrinsic factors to falls in the elderly is inevitable due to the ageing process, however with early intervention it is possible to manage and slow the progression of these. Having multidisciplinary involvement including GP, physiotherapy, occupational therapy and exercise physiologists can play a role to manage progression of these factors. A multidisciplinary team can also review and provide solutions to extrinsic factors which once identified and controlled or removed, will greatly reduce the risk of a fall from occurring.
With this said, it makes it clear as to why one would seek a health professional’s service and advice to be able to prevent falls from occurring. As most intrinsic factors are associated with your mobility and balance, a physiotherapist is the perfect person to include in your team of health professionals!
How can we prevent falls?
Alongside the advice from a GP, a physiotherapist can assist with falls prevention through an exercise program to target identified issues with one’s mobility and balance. Further, a physiotherapist can assist by suggesting wearable supports such as splints or braces, prescribing appropriate footwear, gait re-training, simple home-modifications and by referring you to other health professionals appropriate to assist in any way such as optometrists or occupational therapists. Most importantly your physiotherapist will guide you through a comprehensive exercise program to strengthen your muscles, improve your balance, improve your gait and even show you the best practice to get back into a safe position in the event of a fall. 
I’m at risk of having a fall, what would a physiotherapy program look like for me?
Below is an example of a devised physiotherapy plan that could be implemented for an individual at high risk of falling and/or an extensive Hx of falls.
Week 1 – Initial Assessment. This may potentially involve the following activities:
- Initial subjective and physical examination to determine factors such as age, living situation, medications, gait aids, history of falls, current level of mobility and function, pain levels and past medical history that may be contributing to your presenting problem.
- Goal setting is an imperative component of an initial assessment. Your therapist will endeavor to devote ample time for goal setting with you to understand what you would like to specifically achieve and in what time frame. ‘SMART goals’ are often devised with the client – these are goals that are ‘specific, measurable, achievable, relevant and time-bound.’
- Often your therapist will determine if referrals to other professionals are necessary to assist with your falls prevention program. i.e. an occupational therapist is often consulted with to initiate the installation or provision of appropriate equipment in your house to assist with your daily living needs and mobility.
Weeks 2-6. Treatment sessions. This may involve the following:
- Provision of exercise based sessions to address your impairments that have contributed to your falls or has placed you at risk of falls.
- Often exercises targeted at strength, balance, gait and general mobility is the focus.
- Your therapist will encourage self-efficacy for you to develop a strong understanding of why we are promoting the specific exercises targeted at you so you will be empowered to continue this independently once the program is completed.
- Your therapist will provide ongoing education to broaden your understanding of different exercises and teach you specific approaches to progress your program.
- Goals are often revisited during this period to ensure you are on track for a successful completion of the program!
Weeks 7-8. Treatment sessions and conclusion of the program.
- Your therapist will continue to promote self-efficacy to enable you to manage your mobility and falls prevention goals independently once the program is complete.
- You are likely to revisit your SMART goals and determine if a favorable outcome was achieved and whether further action is required.
- An ongoing plan will be devised – this may include ongoing therapy at the same or lesser frequency or independent management of your program with a follow up in a month or two. This will all depend on the final outcome and if your goals were achieved!
- Your therapist may also refer you to more community based exercise groups to continue with your exercise journey.
To book in for your own individualised treatment plan, call us on (03) 9696 2639 or head over to our website on Contact Us | Own Body.
References
- Department of Health. (2015, September 9). Falls Prevention. https://www.health.vic.gov.au/wellbeing-and-participation/falls-prevention
- Australian Commission on Safety and Quality in Healthcare. (2009). Falls Prevention. https://www.safetyandquality.gov.au/our-work/comprehensive-care/related-topics/falls-prevention
- Department of Health and Ageing. (2011, June). Don’t Fall for it – falls can be prevented! A guide to preventing falls for older people. https://www.health.gov.au/sites/default/files/documents/2021/04/don-t-fall-for-it-falls-can-be-prevented.pdf
- World Health Organisation. (2021). Falls. https://www.who.int/news-room/fact-sheets/detail/falls
- Queensland Health. (2021). About falls risk factors – Stay On Your Feet. https://www.health.qld.gov.au/stayonyourfeet/for-professionals/about-risk-factor
- Sherrington, C., Tiedemann, A. (2015). Physiotherapy in the prevention of falls in older people. Journal of Physiotherapy, 61(2) (54-60). https://www.sciencedirect.com/science/article/pii/S1836955315000120?ref=pdf_download&fr=RR-2&rr=89cc81eee9882ea1
- Sherrington, C., Fairhall, N., Kwok, W., Wallbank, G., Tiedemann, A., Michaleff, A.T., Ng, C., Bauman, A. (2020). Evidence on Physical Activity and Falls Prevention for People Aged 65+ over: systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. International Journal of Behavioural Nutrition and Physical Activity, 17 (144). https://link.springer.com/article/10.1186/S12966-020-01041-3
- Montero-Odasso, M., van der Velde, N., Martin, F.C., Petrovic, M., Pin Tan, M., Ryg, J, et al. (2022). Worldwide guidelines for falls prevention and management for older adults: a global initiative. Age and Aging, 51 (9). https://doi.org/10.1093/ageing/afac205
Montero-Odasso, M., Kamkar, N., Pieruccini-Faria, Frederico et al. (2021). Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review. JAMA Network Open 2021;4(12):e2138911. doi:10.1001/jamanetworkopen.2021.38911
