The information used is from "Evidence-Based Exercise Prescription for Balance and Falls Prevention: A Current Review of the Literature" by Tiffany Shubert, MPT & PhD. It was published in the Journal of Geriatric Physical Therapy in July 2011.
FALLS: If we start by taking a look at the statistics for falls, we will see it is a public health epidemic. 30% of people aged 65 and older, plus more than 50% of people aged 80 years or older will fall this year.
For those 65 and older, falls are more deadly than MVAs, are the leading cause of ER visits, as well as the number one cause for hospital admissions due to trauma.
The Average cost of a hospital admission due to a fall is estimated at $20 000. By 2030, it is estimated that $54 billion will be spent annually on health care costs directly and indirectly related to falls.
MEDICARE DATA: In a review of the 2002 Medicare Beneficiary data, it was found that 22% of Medicare Beneficiaries fell at least once per year and 10% had multiple falls. An interesting finding was that less than half those who fell discussed the fall with a health care provider.
How Effective are Fall Programs?
The research indicates that the most effective interventions can reduce the risk of fall by 35-40%. The author notes that regardless of intervention a certain number of older adults will still fall. Thus the term fall prevention doesn't really refer to totally eliminating falls but rather minimizing the risk. In other words, preventing the fall that have the potential to be prevented.
For community dwelling older adults, a minimum of 50 hours of exercise is needed to effectively reduce the risk and rate of falls. These hours can be accumulated over a period of 3 months or longer. Interventions that achieved this minimum dose over a six month period of less seem to be slightly more effective than those that take greater than six months, but both are effective.
It's challenging to achieve 50 hours of balance exercise solely from physical therapy settings, therefore alternative ways to achieve the goal can be seen below:
|Means of Achieving Exercise||Examples|
|Dynamic Activities||Tai Chi, reaching, turning, stair stepping, etc|
|Dynamic Gait Training||Various challenging steps such as figure 8s, directional changes on command, obstacle course, dual task training|
|Dual-Tasking Training||Walking at a set speed while carrying a cup of water|
|Strength Training||Considered a key element of any fall prevention program|
|Walking||Considered one of the safest and easiest forms of aerobic exercise|
|Perturbations and Compensatory Stepping Training||Improve reaction times and fall recovery scenarios|
|Call us at 714.528.9400 to learn more!|
Frequency and Duration of Exercise
Exact guidelines for frequency and duration for this population is still not known. Themes that are common through the research are consistency of performance, a structured progression, and a program tailored to the needs of the individual.
For example, individuals with significant functional impairments may benefit more from a functional exercise program with slow progressions, whereas an individual with cognitive impairment might benefit from more of a structured program in which the same exercises are done exactly the same way each time.
Consult Train Maintain (CTM)
We understand that changes are occurring in our health care system and insurances are cutting back in all aspects, including physical therapy. However, as discussed above, patients who are at risk for falling need longer term supervised exercise and balance training to prevent from injuries/falling. In an effort to allow patients to continue their therapy after their insurance sessions have expired, our clinic offers a new supervised gym/physical therapy program called PTS FIT. Our program offers 2 physical therapy sessions a month along with unlimited supervised gym program during business hours. This has been a successful way for patient's to progress steadily and continue to work on their individual goals.