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Understanding risk factors related to aging and falls

What are physiological, environmental, sociological factors that cause elderly to become fall risks?

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Primary risk factors [1]:

Muscle weakness: muscle weakness leads to decreased function

History of falls: if someone has fallen once, they will most likely fall again based on the same situation or factors. They are also vulnerable because their previous fall may have caused injury and decreased function.

Gait deficit: inability to walk properly may cause one to trip and fall

Balance deficit: decreased balance may cause inability to catch one’s self from falling.

Use of assistive device (cane, walker): reliance on a cane or walker indicates that a person has decreased ability to withstand test to balance

Visual deficit: vision is directly correlated with vestibular function, leading to balance impairment

Arthritis: pain is associated with decreased functional activity

Impaired activities of daily living: indicator for decreased physical ability to perform activities indpendently

Depression: inability to cope/improve one’s situation leads to decreased activity/function

Cognitive impairment: decreased attention span, inability to make good decisions may lead to higher occurrence of accidents, falls.

Age >80 years: generally with increased age comes decline of physical and mental capabilities


Using the list above, I came up with 3 main categories (physiological, environmental, sociological).

Physiological factors:

  • Loss of vision
  • Decreased proprioception/balance
  • Sudden physical impairment (leading to use of an assistive device, physical impairment = musculoskeletal or neurological)
  • Arthritis, leading to chronic pain, decreased physical activity


Environmental factors:

  • Poor design/layout of environment
  • Lighting - is the area well lit or dark?
  • Ground/surface - stable or unstable? Is the ground they are walking or standing on a level surface?
  • Force - was there a physical force that caused the person to lose their balance?If they were using a assistive device, was the assistive device adjusted properly for ease of use?


Sociological factors:

  • Fear of falling
  • Decreased independence
  • Task/activity at the time of fall? What kind of activity was the person involved in at the time of the fall?
  • Refusal or resistance to use an assistive device
  • Refusal or resistance to limit one’s independent life style
  • Refusal or resistance to exercise (take initiative of one’s health and well-being)


From my personal observations, patients with balance deficits fell into many of the following categories: 

  • Lower extremity weakness
  • Lumbar spine symptoms
  • Decline in physical activity/exercise, sedentary lifestyle
  • Reliance on an assistive device
  • Inability to find the time or safe/convenient environment to work on exercise


References:
[1] p. 259: Kisner, Carolyn and Lynn Allen Colby. <em>Therapeutic Exercise: Foundations and Techniques</em> Philadelphia: F.A. Davis, 2002. Print.

What is a provocation or insight that might inspire others during this challenge?

Pick an activity of daily living (cooking, driving, brushing hair) that is extremely necessary to you and try to imagine what your life would be like if you couldn't participate in that activity any longer due to a disability. How would your daily routine change? Who or what resources would you have to rely on in order to cope?

Tell us about your work experience:

Currently a stay-at-home mom. I am a licensed physical therapy assistant who has experience in outpatient orthopedics. Formerly worked in digital content management and print production.

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Photo of Kate Rushton

Hi Kumi!

Thank you for sharing. Based on your experience, which one of these risk factors should we prioritize? Is it the same as the ones in Observed Risk Factors For Falls or Risk Factors of Older Adults' Falling ?

Photo of Kumi

Hi Kate,
If I could only pick one factor to work on with a patient, it would be balance. Yes, muscle weakness is extremely important. If we don't have strength, we really can't function at all. But if someone is a fall risk, it is implied that they are (or were) able to ambulate independently to some extent, whether it be with a assistive device or with a poor, unsafe gait pattern. If they are able to walk, then I know that they have functional strength. Working on muscle strengthening exclusively is not going to correct poor gait patterns or improve one's ability to balance on one foot. I could have a patient perform leg strengthening exercises in a seated position twice a day, but I don't think that will truly help them improve their risk for falling. I would much rather get them in a standing position, work on weight shifting, have them stand on an uneven surface to challenge their senses, have them close their eyes, etc.
Ideally, I would work on both muscle strengthening and balance. If muscle strength is improved, there is the possibility to challenge the balance training even more. With advanced balance training, one would hope that the risk of falls diminishes greatly. However, balance training is not an activity that is improved simply because one improves muscle strength. Balance training needs dedicated practice on its own. Balance training also needs to be challenging for the individual. Once it gets easy, we need to move them onto something more difficult. The idea is to keep challenging their sensory system.