The Importance of Balance Training to Prevent Falls in Older Adults
Maintaining and improving balance is critical as you age to prevent falls. Aging can contribute to visual, vestibular, and muscular weakness issues that can negatively impact your ability to maintain balance and lead to a fall. Each year, nearly 25% of older adults fall. Physical therapists can play a critical role in preventing falls and improving balance, function, and strength in older adults through a personalized fall prevention balance training program. A balance training program for older adults has been shown to reduce the risk of falls by 23% and enhance older adults’ independence and mobility.
Common Causes of Falls in Older Adults
A fall is defined as any event that leads to unplanned, unexpected contact with a surface such as the floor or a piece of furniture. A near-fall involves a stumble or loss of balance that would have led to a fall had you not been able to catch yourself from falling. A fall can result in injury, loss of independence, and a decreased ability to do daily activities.
Each year, nearly 25% of older adults fall each year. Falls are the leading cause of injuries in adults ages 65 and over and are the most common cause of hip fractures and traumatic brain injuries in older adults. Among those age 80 and older, up to 50% experience a fall in any given year.
Common causes of falls in older adults can include:
Aging: Aging can lead to a natural loss of muscle strength and flexibility, making it more challenging to maintain balance and stability. Sarcopenia, a gradual loss of muscle mass and strength, is a key risk factor for falling and can occur as you age.
Age-related vision changes: This can include reduced depth perception and peripheral vision and difficulty differentiating colors or contrasts, which can make it harder to navigate potential fall hazards in the environment.
Chronic health conditions: Older adults may have medical conditions like heart disease, diabetes, stroke, or Parkinson’s or Alzheimer’s disease which can affect your ability to walk with balance and strength and alter sensations in the feet.
Medications: Certain medications like blood pressure drugs or sedatives can cause dizziness, drowsiness, or drops in blood pressure that can lead to an increased risk of falling.
Sedentary lifestyle: Older adults who lead a sedentary lifestyle or have limited physical activity can experience reduced strength, flexibility, and balance.
Hearing problems: According to a research study, individuals with a 25-decibel hearing loss are three times more likely to fall than those with healthy hearing. Your hearing and balance ability is closely related to the health of the vestibular system of the inner ear. If your hearing is not working properly, it can affect your balance.
Environmental hazards: A cluttered living space, slippery floors, loose rugs, lack of handrails or grab bars on stairs or in the bathroom, and inadequate lighting are common home hazards that can lead to falls.
Fear of falling: A past fall can as much as double an individual’s chances of falling again, due to a fear of falling and hesitancy to stay active and build strength and balance.
Chronic pain: Research has shown that half of those with osteoarthritis have fallen in the last year and those with back pain are also more prone to falls. This is due to joint pain often causing individuals to move less, which can lead to muscle weakness, functional decline, and mobility limitations.
Balance Training & Fall Prevention with Physical Therapy
Physical therapists can play a critical role in preventing falls and improving balance, function, and strength in older adults through a personalized fall prevention balance training program. The therapist first conducts a fall risk evaluation that includes a review of medical history and current medications, a check of the patient’s heart rate and blood pressure at rest and when changing positions, cognitive tests, simple vision tests, feet and footwear evaluation, a home safety assessment, and a physical evaluation of the patient’s current balance, strength, and walking ability. From there, the therapist designs a customized fall prevention and balance training program to reduce fall risk and improve muscle strength, endurance, and overall balance.
A balance training program has numerous benefits including improved coordination, which enhances the communication between the brain and body so you’re better able to respond to challenging environments; increased muscle strength particularly in the core and legs which is necessary to remain upright; and stronger bones, as exercise increases the action of bone-forming cells in the body, resulting in denser bones. Research has shown that good balance can increase your mortality and help you live longer.
A physical therapist-led fall prevention and balance training program can include:
Balance training: Balance training involves both static and dynamic exercises that challenge your ability to keep your balance as well as recover from a loss of balance. This can include single-leg standing (balancing from a narrow base of support), turning in a circle, balancing on a balance board, or stair-stepping. Balance training improves your coordination and proprioception, which is the body’s ability to sense where it is in space. By practicing movements that challenge the body’s balance, the nervous system is able to learn to adjust and better coordinate movement to maintain balance. Research has shown that balance and functional exercises reduce the rate of falls by 24%.
Targeted strength training: Strength training can involve lifting weights or using resistance bands to increase muscle strength and power. The therapist targets muscles of the hips, legs, and core for strengthening, which improves your ability to maintain balance and stability, Strength training has been shown to improve walking speed and reduce fall risk.
Gait training: Physical therapists assess your walking and movement patterns and provide guidance on proper walking techniques. Gait improvement exercises can include figure eights, changes in direction, obstacle courses, and dual-task training.
Flexibility and range of motion training: Limited joint mobility and flexibility can hinder your ability to react to unexpected obstacles and shifts in balance. The therapist may implement gentle range of motion exercises and stretching of tight muscles in the lower legs and hips.
Multi-task training: Older adults who have difficulty walking and talking at the same time have a higher risk of falling. The therapist may have you complete a dual-task training program in a safe environment, challenging you to maintain walking speed or balance while talking or engaging in another task. This can involve walking and talking or balancing on a balance board and tapping cups with your foot at the same time.
Home safety education: After evaluating your current home safety situation, the therapist provides education on how to increase your home safety and reduce fall risk, such as securing loose rugs, wearing appropriate footwear with good traction, or installing grab bars or a shower chair in your bathroom.
Assistive device instruction: Using a cane or walker can be helpful for at-risk older adults to help them improve their balance and mobility and reduce the risk of falling. Therapists can help older adults learn how to properly use these assistive devices.
Lifestyle education on footwear and diet: The therapist also provides instruction on eating a nutrient-rich diet to improve your overall health, prioritizing whole foods, vegetables and fruits, healthy fats, and sufficient protein. The therapist also offers education on proper footwear to prevent falls, focusing on low-heeled rubber-soled shoes for good support and traction.
Numerous research studies have found that balance training programs are highly effective in reducing the risk of falling in older adults. One meta-analysis found that exercise training (that includes balance training exercises) led to a reduction of falls by 23%. A recent 2023 study noted that lower extremity strengthening exercises had a positive effect on the strength of the lower extremity, balance outcomes, and mobility. Balance exercises were shown to reduce the rate of injurious falls and improved static, dynamic, and reactive balance as well as lower extremity strength and mobility. Researchers stated that a multi-component exercise intervention including trunk stability exercises, stretching, strengthening exercises, and aerobic exercise combined with targeted balance training exercises improved balance and mobility in study participants for up to a year after the intervention.
Work with our physical therapists to improve your balance and prevent falls as you age!
In the video below, Mangiarelli Rehabilitation physical therapy patient Ann engages in three dynamic balance training exercises to improve her stability and balance.
