When caring for homebound patients, we frequently see a number of whom are unsteady on their feet and may have experienced falls. Falling or the risk of falling is a real concern due to the impact on patient independence even within the home setting. One third of adults aged 65 and older fall each year, with 20% – 30% of these patients experiencing moderate to severe injuries, including lacerations, hip fractures, or head traumas. The cost of falls was between $19 Billion – $179 Billion for fatal and nonfatal falls in 2000 (last year for which data available). The prevention of such life threatening falls can be accomplished by exercise (to be discussed further in this article), medication review and reconciliation to identify medications increasing fall risk, examine eye sight and cognition, and complete environmental assessment to identify, educate, and remove potential fall hazards.
Exercise, specifically balancing exercises, can be used to decrease the risk of falling especially when moving up in difficulty as basic exercises become too easy or easily accomplished. Tai Chi has been found to be effective in decreasing the risk of falling, however a number of daily activities have also been found to be effective and easily integrated into the daily life, although severe balance problems and orthopedic conditions should first be cleared with the patients physician. Some daily activities improving balance such as walking, balancing on one foot while brushing teeth or standing in front of kitchen sink; standing from a sitting position, and sitting from a standing position without using your hands; while sitting in a chair close your eyes and stretch your arms out to either side, then attempt touching your nose with the tip of your index finger first with the right hand and then with the left hand.
There are additional exercises which can be introduced to improve balance such as the following which can also be started by standing next to a wall and holding if balancing is difficult:
Weight Shift
- Start with feet hip-width apart and weight equally distributed on both legs
- Shift weight to one leg and raise the opposite leg away from the body
Single Leg Balance
- Start with feet hip-width apart and weight equally distributed on both legs
- Place hands on hips
- Lift left leg off the floor and bend back at the knee as much as possible and hold as long as comfortable
There are numerous other exercises some of which can be found at the following 2 websites
http://www.mayoclinic.com/health/balance-exercises/sm00049
Sources
Centers for Disease Control and Prevention. Falls Among Older Adults: An Overview – http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html
Stevens JA. Fatalities and injuries from falls among older adults – United States, 1993–2003 and 2001–2005.
Mayo Clinic – http://www.mayoclinic.com/health/balance-exercises/sm00049
Buzzle.com – http://www.buzzle.com/articles/balance-exercises-for-seniors.html
