We talked about last week that 78% of falls were anticipated physiologic falls, meaning that if we did a risk assessment tool, there would be some factor on that tool that would indicate the individual is at risk for falls. In a normal individual, cognitive processes, the musculoskeletal system, and the sensory motor system (vestibular, somatosensory, and the visual systems) all work together in order to give a person good balance control. It is when one of these are not functioning well that we have an increased fall risk and balance issues.
Evidence from the AGS/BGS
I want to jump right into treatment. A lot of what we are going to talk about today is based on the evidence-based practice guidelines that have been developed by the American Geriatric Society (AGS) and the British Geriatric Society (BGS). They came forward and said that we need to do a multifactorial fall risk assessment, which we talked about before, and this needs to be followed by direct interventions tailored to the individual and to the identified risk factors, so very individualized type of program. Now the interventions that they found strong evidence for included exercise, environmental modification, management of hypotension, medication management, and management of foot problems and footwear. We are going to review each of those in turn, starting with exercise.
Evidence Related to Exercise
The American Geriatric Society says that we should be developing an exercise program that includes balance, gait, and strength. They also suggest that we also include flexibility and endurance in the exercise program, but those would not be sole components. While it is nice to have them, they are not going to prevent falls. The strongest evidence they have is related to Tai Chi. I do not know if any of you use Tai Chi in your practice, but we are going to pull up a study here in just a second that will show that it is incredibly effective for reducing falls.