Overview
More than 25% of people aged 65 years and older will fall each year. (1) Falls are the most common cause of both traumatic brain injury and fractures in older adults and are the leading cause of unintentional death for this population. (1) In 2015, Medicare costs related to falls totaled over $31 billion. (2)
Approximately 15% of all falls are unavoidable and would happen to anyone in any age group; 15% are due to a single precipitating event, such as a stroke or an episode of syncope; and the remaining 70% are due to interacting risk factors, such as (3, 4):
Strength deficits
Balance deficits
Mobility deficits
Medication errors, mismanagement, and polypharmacy
Vision impairment
Cognitive impairment
Depression
Effects of multiple comorbidities
Management of fall risk also is complex. For effective management along the continuum of function, there may be a shift in focus from physical risk factors (leg muscle weakness, balance impairments, difficulty walking) to medical risk factors (polypharmacy, cognitive impairment) depending on the functional status of the patient. (5, 6)
A 2012 Cochrane Review (5) reported effective interventions to prevent falls in community-dwelling older adults included exercise-based interventions provided in the home or group setting. Exercise interventions that appear to have the greatest effect are those that (7):
Include primarily balance exercises performed while standing
Limit upper-extremity support
Are progressed as appropriate
Are delivered at a minimum dose of 50 hours (in direct treatment, doing independent exercises, or a combination of both)
There is evidence that general group exercise programs, which do not focus specifically on balance and strength, are not as effective as individually tailored exercise programs that focus specifically on progressive balance exercises. (7) (Source American Physical Therapy Association)