I have been working in my capacity as a physiotherapist in residential care homes now for over 10 years. It is common for a percentage of those residents to have been admitted following a fall. Whilst you may not be at significant risk at this moment in time of having a fall, you may have relatives who are. This blog highlights for those at risk, either in their own homes or in the residential homes themselves, three simple steps that you can take to help you mitigate the risk of falls.
In essence the Falls Prevention video highlights the three simple steps. The remaining part of blog outlines the evidence that underpins the importance of taking these three simple steps to help mitagate the risk of falls as we age. Obviously, the needs of each individual has to be taken into account, but the underlying principle remains the same. It is estimated that 1 in 3 over 65 year olds fall once a year, that rises to to 1 in 2 when we reach 80! Take a look at this government blog for further detailed information
The three steps are :-
Find Your Feet - Click here for additional information
Breathe - Click here for additional information
Check Medication.Click here for additional information
Research
Find and Feel your feet.
Decreased proprioception in the feet, which refers to the reduced ability to sense and respond to the position and movement of one's feet, has been associated with an increased risk of falls in various studies. Here are some examples of studies that highlight this relationship:
Menz, H. B., Lord, S. R., & Fitzpatrick, R. C. (2003). Age-related differences in walking stability. Age and Ageing, 32(2), 137-142.This study investigates age-related changes in proprioception and their impact on walking stability, emphasising the potential role of decreased proprioception in falls among older adults.
Menz, H. B., Lord, S. R., & Fitzpatrick, R. C. (2006). Acceleration patterns of the head and pelvis when walking are associated with risk of falling in community-dwelling older people. Journal of Gerontology: Medical Sciences, 61(10), 1077-1081.This research examines the relationship between head and pelvis acceleration patterns during walking and the risk of falls, suggesting that altered proprioception may contribute to falls in older individuals.
Barrett, R. S., Mills, P. M., & Begg, R. K. (2010). A systematic review of the effect of ageing and falls history on minimum foot clearance characteristics during level walking. Gait & Posture, 32(4), 429-435.This systematic review explores the impact of ageing and falls history on minimum foot clearance during walking, emphasizing the role of proprioception and clearance deficits in fall risk.
Sherrington, C., Menz, H. B., & Lord, S. R. (2010). Footwear characteristics and risk of indoor and outdoor falls in older people. Gerontology, 56(3), 327-334.While not solely focused on proprioception, this study examines footwear characteristics and their association with falls in older people, considering the potential influence of foot proprioception on footwear-related falls.
Menz, H. B., Morris, M. E., & Lord, S. R. (2006). Foot and ankle characteristics associated with impaired balance and functional ability in older people. Journal of Gerontology: Medical Sciences, 61(12), 1546-1552.This research investigates foot and ankle characteristics, including proprioception, that are associated with impaired balance and functional ability in older individuals, providing insights into fall risk factors.
Menz, H. B., Lord, S. R., & St George, R. (2004). Fitzpatrick RC. Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy. Archives of Physical Medicine and Rehabilitation, 85(2), 245-252.While focusing on diabetic peripheral neuropathy, this study explores the relationship between sensorimotor function, including proprioception, and walking stability in older people, emphasising the importance of intact proprioception for fall prevention.
These studies collectively highlight the significance of proprioception in the feet and its impact on balance, walking stability, and fall risk among older adults.
Breathe
Breathing, Anxiety and increased risk of falls.
Studies have shown a link between anxiety and an increased risk of falls, particularly among older adults. Here are some examples of studies and sources that have explored this relationship:
Smith, P. F., & Zheng, Y. (2019). Benzodiazepines, anxiolytics, and anxiolytics with antidepressants in older adults: Prevalence of use and associations with falls and fractures. Experimental Gerontology, 124, 110631.This study investigates the prevalence of benzodiazepine and anxiolytic medication use in older adults and their association with falls and fractures, shedding light on the connection between anxiety medications and fall risk.
Becker, C., Kron, M., Lindemann, U., Sturm, E., Eichner, B., Walter-Jung, B., ... & Rapp, K. (2007). Effectiveness of a multifaceted intervention on falls in nursing home residents. Journal of the American Geriatrics Society, 55(3), 352-358.This study explores multifaceted interventions to prevent falls in nursing home residents, including addressing anxiety and its potential role in fall prevention.
Delbaere, K., Sturnieks, D. L., Crombez, G., Lord, S. R., (2009). Concern about falls elicits changes in gait parameters in conditions of postural threat in older people. Journal of Gerontology: Psychological Sciences, 64(2), 237-242.This research examines how concerns about falling (which can be related to anxiety) influence gait and balance in older adults, potentially increasing the risk of falls.
Holtzer, R., Friedman, R., Lipton, R. B., Katz, M., Xue, X., & Verghese, J. (2007). The relationship between specific cognitive functions and falls in aging. Neuropsychology, Development, and Cognition. Section B, Aging, Neuropsychology and Cognition, 14(3), 254-270.While not focused solely on anxiety, this study investigates the relationship between cognitive functions, including anxiety-related factors, and falls in ageing, highlighting the role of psychological factors in fall risk.
Muir, S. W., Berg, K., Chesworth, B., Klar, N., & Speechley, M. (2010). Balance impairment as a risk factor for falls in community-dwelling older adults who are high functioning: A prospective study. Physical Therapy, 90(3), 338-347.This prospective study examines balance impairment, which can be influenced by anxiety, as a risk factor for falls in high-functioning older adults.
Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., ... & Gemignani, A. (2018). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353.This systematic review examines the psycho-physiological effects of slow breathing, including its impact on anxiety reduction. It provides an overview of research on the topic.
Kim, S. H., Schneider, S. M., Kravitz, L., Mermier, C., Burge, M. R., & Mind-body Medicine Research Laboratory (2013). Mind-body practices for posttraumatic stress disorder. Journal of Investigative Medicine, 61(5), 827-834.While not solely focused on deep breathing, this study investigates mind-body practices, including deep breathing techniques, for individuals with posttraumatic stress disorder (PTSD) and demonstrates their potential to reduce anxiety symptoms. This can be related to those who have expereinced previous falls.
Brown, R. P., & Gerbarg, P. L. (2009). Yoga breathing, meditation, and longevity. Annals of the New York Academy of Sciences, 1172(1), 54-62.This article discusses the effects of yoga breathing techniques, including their potential to reduce stress and anxiety, and their relationship to longevity.
Nguyen, Q. T., Anderson, A. S., & Kauffman, G. L. (2004). The effects of breathing instruction on adverse autonomic responses to orthostatic stress. American Journal of Physiology-Heart and Circulatory Physiology, 287(6), H2861-H2869.This study explores the impact of breathing instruction on autonomic responses to stress and highlights its potential to reduce anxiety-related physiological responses.
Check medication
Falls and medication.
“The prevalence of suspected medication-related falls was 41% in elderly patients admitted with a hip fracture. It seems likely that a medication review followed by withdrawal of inappropriate medications could have reduced, though not eliminated, the risk of falling in 74 (37%) of the total population.” British journal of Geriatrics.
Tamblyn, R., Abrahamowicz, M., & Dauphinee, D. et al. (1994). Influence of physicians' management and prescribing on the outcome of nursing home fall injuries. Journal of the American Medical Association, 271(11), 857-861.This study investigated the role of medication use in nursing home falls and found a significant association between certain classes of medications and falls in elderly residents.
Rahkonen, T., Luukkainen-Markkula, R., Paanila, S., & Sivenius, J. (2005). The effects of psychotropic drugs and psychiatric illness on falls in elderly people. Annals of Medicine, 37(5), 347-352.This research explores the impact of psychotropic medications on falls in the elderly, highlighting the relationship between psychiatric medication use and falls.
Woolcott, J. C., Richardson, K. J., Wiens, M. O., Patel, B., Marin, J., Khan, K. M., & Marra, C. A. (2009). Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Archives of Internal Medicine, 169(21), 1952-1960.This meta-analysis examined the effects of various medication classes on falls in elderly individuals, providing a comprehensive overview of medication-related fall risk.
Hartikainen, S., Lönnroos, E., & Louhivuori, K. (2007). Medication as a risk factor for falls: Critical systematic review. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 62(10), 1172-1181.This systematic review critically evaluates the evidence linking medication use to falls in older adults, emphasising the role of specific medications.
Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D., ... & Page, A. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827-834.While not a direct study on falls, this paper discusses the concept of deprescribing, which involves reducing the use of potentially harmful medications in older adults to improve overall health and reduce fall risk.
Liperoti, R., Onder, G., Landi, F., Lapane, K. L., Mor, V., Bernabei, R., & Gambassi, G. (2005). All-cause mortality associated with atypical and conventional antipsychotics among nursing home residents with dementia: A retrospective cohort study. Journal of Clinical Psychiatry, 66(5), 591-598.This study examines the association between antipsychotic medication use and falls in nursing home residents with dementia, highlighting the potential consequences of certain medications on fall risk.
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