Maintaining mobility and preventing falls as you age

January 5, 2020

thank you very much it’s a great
pleasure to be here and I am the director of the FBI but in our case it’s the Falls Balance and Injury Research Center at NeuRA. Now we have two main purposes in our group as the FBI we want to understand why people fall and more importantly devise strategies for actually preventing Falls in older
people and other groups so I’m going to start off now with the problem of Falls
and why we study this issue because we really do need to prevent Falls as we
age and some important statistics here are one in three people aged 65 and over is
likely to fall one or more times in a year and when we look at that in terms
of injuries Falls account for about four percent of all hospital admissions in
people aged 65 years and over and this is only going to get worse in terms of a
Health Service resource because by 2051 1/4 of Australian people will be
aged 65 and over so it’s a huge percentage of people in the older age
group so what are the consequences of falls then well 10 to 15 percent of
falls do result in major injuries this can be soft tissue damage like cuts and
abrasions but also head trauma dislocations and fractures so major
serious health conditions falls can also reduce quality of life and independence
due to disability a loss of confidence and activity restriction and they can
even result in people needing to live in nursing homes and in the ultimate
statistic falls lead to many deaths in fact 1,000 people died in Australia
every year from a fall related injury so where the Falls occur this is important
to know about 50 percent of Falls occur in and around a person’s home so it’s in
places where people spend their time also in public places and also in other
people’s homes most Falls occur on level surfaces in commonly used rooms such as
the bedroom the living room and the kitchen but of course also Falls involve
a number of environmental hazards including loose rugs, slippery surfaces
and using letters so what about Falls risk factors I’m going to show you this
next slide and it’s deliberately complex because it shows many risk factors for
Falls and this is all evidence-based all come from the scientific literature and
it’s a complex slide but the purpose in showing this is that with
knowledge of all of these risk factors it gives us some information that about
how we might be able to intervene or treat the problem so without going
through it in detail you can see in the top left box a lot of medical conditions
that increase Falls risk including stroke and Parkinson’s disease
medications some medications increase Falls risk and the bottom line a number
of social factors also associated with falling the environment important but I
draw attention to the top right box the sensory matter imbalance box because
that’s one we really tackle at the Falls and balance Research Center in NeuRA
where we’re really interested in these factors like weakness poor vision poor
sensation poor speed and poor balance because if we can intervene here
irrespective of the medical condition we might be able to make a difference and
that’s our focus to prevent Falls so what do we do a couple of examples of
the work we do at NeuRA we have a study underway looking at falls from ladders
now these are in particularly important Falls because they occur from a height
and as a result the chances of having an injury are greatly increased they occur
a lot too in men and particularly in men early in retirement and for fall occurs
it can have a devastating effect including a head trauma if you might
remember the fall that Molly Meldrum had a few years back or also a fracture
including the fractured hip so we’re trying to understand what are the
factors that are associated with good ladder climbing ability thing common
things like changing a light bulb cleaning the gutter or washing outside
windows and we’re interested not only in ability but perceived ability so we have
this study underway at the moment at NeuRA another area we’re looking at is
training people to recover quickly and appropriately from trips and slips and
this is what I’ve our more high-tech studies that were undertaking in the
laboratory at neuro we have people in a very safe harness and we have them walk
on what is in effect a booby-trapped walkway so the way this works is people
walk on the tiles and often nothing happens but from time to time one of the
boards in the walkway will flip up and make the person trip or one of the vinyl
tiles will move with them and make them slip and it’s a way of really training
up the ability to take a quick and an accurate step if we hear a hazard and we
found from our initial work that people actually improve significantly in three
short sessions over two days so they recover better if they’re exposed to the
hazard and they fall less into the harness so the next step I’m going to go
on to is talk about recommendations for fall prevention that we know from the
evidence base that we’ve acquired at NeuRA but also from the rest of
Australia and around the world I’m going to start with exercise and I’ve got a
couple of cartoons here so the one on the left the doctor says I see you’ve
doubled the amount of daily exercise but unfortunately two times nothing is still
nothing and the one on the right again the doctor says the handle on your
recliner does not qualify as an exercise machine now I’m starting with these two
because as we get older there’s a tendency to do less to become more
sedentary and to think that a little might be enough so what do we really
need to do to avoid Falls so I’m gonna start with balance exercises because
these key they’ll come out right up front and say
walking is not enough we need to do balance exercises so what does that mean
we have to do exercises in standing people have to be standing on their feet
we have to minimize upland support we have to do our balance exercises with
our feet close together possibly standing on one leg or taking
steps so we need to have exercises with balance, leaning exercises and stepping
exercises so one way you can go about this to make sure it’s an evidence-based
program is to look at the active and healthy website it’s from New South
Wales help New South Wales health which was established in association with us a
few years back but it’s a way to find an exercise program in your area that’s
evidence-based for fall prevention just by clicking on the tab these exercise
classes are located right through Sydney and in fact right throughout New South
Wales and so they’re readily available and have an evidence-based balanced
component within them another way is to exercise at home and step training is a
key factor we need to be able to take quick and active steps to avoid falling
and also to think about where we step when we do so so this is a program we’ve
got well underway where we’re actively recruiting people to take part in this
program where the active part of the program people do exercises where they
think on their feet so basically we provide this mat it can be connected up
to the person’s TV and they can play interesting and exciting
games the one I’m showing here on the screen here is a cockroach
stomping game but there are other games such as Tetris and pac-man and space
invaders that are all fun to play but all done while a person is thinking and
stepping terms of medication care move on to the next area and the curtain this
time says it’s the patient’s speaking and she says I feel a lot better since I
ran out of those pills you gave me and unfortunately this can be true and so
it’s important to maintain regular visits to your GP for treatment of any
conditions that can lead Falls and also very important to manage
medications to avoid medication creep and particularly minimize the use of
sleeping tablets and tranquilizers because these can double the risk of
Falls moving to vision and eyesight so another key physiological factor we use
to avoid falling in maintain our mobility so some important practical
tips have cataracts removed if recommended by an eye specialist this
remote improves vision it improves quality of life and it prevents Falls
have eyes checked every 12 months and where your most recently prescribed
glasses, wear a hat or sunglasses when out if it’s glarry and make sure your
home is well-lit especially getting up at night and finally if you’re active
and out and about where single-lens glasses rather than bifocals or
multifocal now why is this the case why do multifocal lead to Falls so the thing
is that no matter what type if it’s a bifocal a multifocal a trifocal or a
progressive they’ve all got one thing in common the bottom part of the glasses is
designed for near vision that is for reading a book so when you’re out in the
street and looking ahead the bottom part of your visual field will be blurred for
any hazard in the environment so I’ve got a simulated street scene here and
you can see the top section there is very clear that’s the top part of the
lens but through the bottom part it’s blurred and in the bottom part there’s a
big shadow from the tree and there’s a footpath misalignment and that’s the
number one reported environmental cause of Falls we have so if a person fails to
detect that and that’s added to by blurred vision you can see it’s going to
be an extra risk factor for Falls in fact these type of glasses double falls
risk moving on to unsteady balance and foot problems the doctor in this case
says it took me three hours but I finally discovered why you’re limping
you have lost he’ll off your shoe so clearly we’re
safe shoes make sure you’ve been tested for diabetes this reduces sensation in
the feet and as a consequence can in impaired balance and increase Falls risk
take care of off ground avoid dim-witted errors and see a podiatrist particularly
forgot painful feet while the studies shown that in itself can prevent Falls
so high heels we can see here a sequence of fashion we go from high heel to high
heel to high heel to high heel to the cast so you can see the last ones not a
fashion statement so in elective disability out the high
heeled shoe so what is a good shoe and I know it looks a little unfashionable but
do these are the things you should maximize a nice firm heel collar a low
heel height an outer sole at slip-resistant a firm midsole and a firm
fit so those are the characteristics make good sense if you’ve got a nice
sturdy shoe you’ll have better balance finally the environment and the cartoon
says you mustn’t play with grandpa’s chair so you’ve got a different number
of risk factors out there but lots of sensible things people can do ensure the
home is well-lit mop-up spillages on floors to avoid slips install handrails
if you near stairs if necessary and report those hazards in an environment
particularly the correct footpath to councils so they can be make the place
safe for everybody so I’m going to finish there’s lots of information stay
finished with top 5 tips so the take home message is what are the key things
you can do to avoid Falls so number one by far is to exercise and include a
balanced training component within it has to be balance exercises remember
walking is not enough have regular eye checks and wear the correct glasses manage any
painful feet and wear safe shoes have regular health checks including
medication reviews and finally take care in hazardous environments and when
climbing ladders thank you very much you

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