Prevention and Assessment of Fall Risks in the Elderly

Fall-related injuries continue to pose a significant health risk for older adults in terms of physical disability, diminished quality of life, increased hospitalisation costs and in severe cases, death.

The National Centre for Injury Prevention and Control, CDC reported an estimated 29 million falls in 2014 among 28.7% of the older population in the United States; of these, 7 million falls either required medical assistance or caused restriction in activity for at least a day.

With these alarming statistics, the development of effective preventative and treatment strategies become a top priority for health care providers, including the development of an assessment tool to evaluate risk factors that contribute to the increasing incidences of falls in older adults.

In an effort to identify the epidemiology, aetiology and risk factors for falls in the elderly population, Anne Felicia Ambrose, from the Department of Rehabilitation Medicine at the Mount Sinai School of Medicine, conducted an extensive review of literature pertaining to the subject.

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She categorised fall risk factors as either intrinsic or extrinsic in nature; the risk of falling being dependent on the number of risk factors present at a time in addition to the age of the individual.

Age plays a key factor because of the vast number of physiological and pathological changes occurring in the body namely a decline in musculoskeletal, cardiovascular, visual, vestibular and proprioceptive capabilities.

The onset of chronic age-related pathologies such as arthritis, diabetes and visual impairment considerably affects individual mobility while invariably acting as a mediating factor for increased falls.

Changes in foot and ankle characteristics in the form of decreased ankle flexibility, reduced muscle strength and weakened postural control also occur as a result of consistent decline in the range of motion of the lower limb joints.

This impairs balance and affects functionality in the lower limbs, increasing the incidences of falls in older patients.

Environmental conditions or extrinsic factors such as poor lighting, loose rugs, slippery floors, poorly fitting shoes and unstable furniture in the house also need to be considered in the evaluation of fall risk factors in the elderly.

The effectiveness of exercises as a means of preventing falls in the older population was investigated by Sherrington et al. in their study by using meta-regression techniques to establish whether particular features of study populations, exercise programmes and study design were associated with the size of estimates of effects of exercise on fall rates.

The findings of the study confirmed that exercise can reduce fall rates in older people with a high level of emphasis on balance training and the exclusion of walking from the exercise programme; this has important implications in the designing of active rehabilitation programmes for the prevention of falls.

MASS4D® customised foot orthotics can be used in conjunction with exercises meant for improved postural balance to build strength in the muscles of the feet by calibrating the orthotic to accommodate specific musculoskeletal changes brought about by the ageing process.

These customised foot orthotics will also provide protection to the feet from the repeated stresses and trauma of everyday life so as to increase functionality of the lower limbs, improve gait patterns and enhance mobility in the elderly population.

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