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1st May

2013

Fall Prevention in the Aging Population

As we age, we lose strength and balance, which frequently leads to falls in the elderly. Since bone weakness, or osteoporosis, is also very common in the elderly, falls often cause fractures, which can seriously affect an older person’s health.

Sarcopenia, or progressive loss of muscle mass and strength, has been reported to affect approximately a quarter of people over the age of 70, and almost half of the people 80 years old in relatively active populations such as Scandinavians. Whereas the typical 25 year old man has twice as much lean muscle mass as intramuscular fat, this relationship is reversed in the typical 75 year old man. However, the person who trains into old age can still maintain much lean muscle mass relative to fat mass.

As we age, we also selectively lose more fast twitch muscle fibers, responsible for strength and speed, than slow twitch fibers, the endurance muscles. This directly affects a person’s functional capacity, balance and agility with normal daily activities.

A 2006 study on the US population showed that every third American over the age 65 falls each year, and falling is the number one cause of injury-related death for this population.

Factors which can increase a person’s fall risk, and can be measured, include previous falls, weakness in big muscle groups such as in the front thigh and buttock, decreased ability to balance on one leg, and reduced ability and speed to perform functional activities such as repeatedly getting up and down from sitting in a chair, and walking a certain distance.

There have been numerous studies which have shown that exercise training in the elderly can significantly improve a person’s strength, balance and agility, and decrease the risk of falling. This is in particular the case in the frail and untrained individual.

Whereas improvement in balance and strength has been recorded with more traditional low to moderate intensity exercise programs, more recent studies have shown greater test scores, including with functional tasks, with higher intensity strength training and faster power training with reduced resistance. A new Australian study furthermore showed good results of reducing falls after the participants were taught to every day perform normal daily activities in ways that would promote increased balance and strength, such as standing with one foot in front of the other while working at a counter top, and by always squatting to e.g. close a drawer or pick up objects.

Several studies have also shown the importance of providing the participants with regular encouragement and feedback on their effort and progress, in order to improve exercise compliance. Therefore, a supervised exercise program, which can be progressed and transitioned to a home exercise program, is likely to produce the best results.

Since falling in the elderly is a significant health risk, Medicare reimburses for physical therapy to reduce a person’s fall risk and improve his or her independence and mobility with daily activities. In our clinic, we have for the past several years provided such exercise training, with very good results, which can be measured with testing.

My co-workers and I wish you continued good health.

Best wishes,

Gunnar

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