More than 700,000 people are hospitalized for fall injuries each year in the U.S. Falls are the most common cause of traumatic brain injury and hip fractures, and cost $34 billion annually in direct medical costs. University of Illinois kinesiology and community health professor Jacob Sosnoff studies the many factors that can contribute to falls. He spoke to U. of. I. News Bureau life sciences editor Diana Yates about how to prevent them.
Humans have been walking on two legs for millions of years. Why do we still have so much trouble keeping our balance?
Keeping our balance while standing or moving is very challenging for several reasons. The human body is configured in such a way that we are naturally unstable. For instance, the majority of our weight is far away from the ground, we have a limited base of support and numerous moveable joints.
In part due to these structural challenges, we rely on three sensory inputs – vision, body awareness and specialized sensors in the inner ear that tell us if our head is moving – to maintain our balance. We use those inputs to select appropriate muscle commands to keep us upright. Changes in any of these “sensorimotor” processes are fairly common as we get older and can result in impairments in balance and even a fall.
What causes falls?
Falls happen for a variety of reasons, and everyone’s risk factors are unique to them. However, there are several common risk factors. These include impairments in balance and walking, visual impairments and side effects of medication. Poor-fitting shoes, cluttered living spaces and poor lighting can add to the risk.
Most fall risk factors can be targeted with specific strategies. It is important that individuals have a good understanding of their own risk factors so they can be appropriately managed.
Are public health and medical authorities doing a good job with respect to falls?
The current approach to falls tends to be reactive in nature. The medical community is really good at helping individuals recover from fall-related injuries. Unfortunately, very little attention is paid to preventing falls.
A 2016 study of best practices in fall prevention revealed that more than 75 percent of physicians report that time constraints and competing medical priorities are significant barriers to implementing fall screenings.
A 2015 study of a large New York health system reported that less than 20 percent of doctors screen older adults for fall risk and make appropriate fall-prevention plans. Given the “graying of America,” it is essential that we adopt a preventive approach. It is in this light that we have set up the Illini Fall Prevention Clinic as a community outreach effort to minimize falls in the Champaign-Urbana area. We hope that it will become a model for other communities.
What kinds of interventions have proved to work?
More than 80,000 older adults have taken part in more than 150 randomized control trials examining fall prevention. Overall, these studies suggest that that interventions that target more than one risk factor can reduce the incidence of falls in older adults.
The U.S. Centers for Disease Control and Prevention promotes more than 10 evidence-based fall-prevention interventions that have been shown to work for older adults. These range from traditional exercise programs focusing on leg strength and balance to the use of tai chi. Some occur in group settings and others are performed at home. Such programs have been found to reduce falls by more than 30 percent.
It is important that individuals select programs that target their individual risk factors. Indeed, the goal of our outreach clinic is to identify where a person needs help (using state-of-the-art technology) and provide them with an individualized plan to help minimize fall risks.
Should people who are most at risk of falling be active or avoid activities that put them at risk?
Whenever I talk about avoiding risky activities, I think of my grandfather, who relied on a cane but would climb a ladder to clean his gutters, leaving the cane behind. If someone needs a cane, they really shouldn’t be on a ladder.
People should remain active, but they may need to make adjustments to their activities to minimize their risk of falls. There obviously are some activities that should be avoided.
Most activities can be modified to reduce risks. For instance, if someone enjoys gardening, a raised garden bed may reduce their risk of falling (since they won’t have to bend over as far) while maintaining their favorite activity. If you are aware of your own fall risks, you can modify the way you engage in the activities you enjoy.
(U. of I. News Bureau)