Fall in old age

Introduction

As a result of demographic developments, Germany’s population structure has been changing for decades. Declining birth rates and rising life expectancy are shifting the generational balance in favor of senior citizens. According to a study by the Federal Institute for Building, Urban Affairs and Spatial Research, the average age in Germany will rise from 43 to 47 years in 2030, and the population group of 80-year-olds is expected to increase by 60% by 2030.

The increase in the proportion of older people in the total population poses new, major challenges for science and politics. Prevention (prevention) and rehabilitation of the elderly will become increasingly important in the health and care system (rising costs, care shortages, lack of assisted living facilities, etc.). The preservation of independence with the best possible health and quality of life is one of the major goals of today’s senior citizens.

However, increasing life expectancy is often accompanied by multiple physical limitations. In addition to the fear of illness or dementia, a particular focus is on the concern of senior citizens to experience a permanent limitation due to a fall with injury and its consequences (possible invalidity, restriction of self-determined life, reduction of life expectancy). Approximately 30% of people over 60 fall several times a year, while the risk of falling is already 50% among people aged 80.

The risk of injury to seniors from a fall in old age depends on various factors: are the most common causes of falls in old age. The most feared complication of a fall in old age is the fracture of the neck of the femur, which can often lead to disability or, in the worst case, death due to complications after surgery and lying down.

Dizziness and impaired balance
Heart disease link
Swindle
Eye Problems
Osteoporosis
Reduced strength, mobility and responsiveness
Lack of or excessive self-confidence

The fear of a fall alone, stirred up by media information, own experiences or by “fall experiences” in the circle of friends or family, can cause considerable insecurity for seniors in everyday activities.

The term “Post Fall Syndrome” describes the interaction between fear and fall, after those affected have already experienced a fall trauma (accident) with or without consequences. The insecurity resulting from the traumatic experience leads to and, as a consequence, further increases the risk of falling in old age. An anxiety and avoidance spiral develops with loss of functional abilities, self-confidence and independence.

The “young at heart” differ from the seniors who are rather overcautious due to fears, who are characterized by an excessive willingness to take risks and overestimation of their physical abilities. They carry out high-risk senior sports and like to do repairs, gardening and household chores on ladders themselves. On the one hand, this behavior promotes physical and mental fitness and mobility, but on the other hand also carries an increased risk of falling in old age.

Uneconomic, anxious movements
Avoidance strategies and reduced everyday activities (crowds of people, climbing stairs, hiking or high-risk household activities)
Muscular breakdown (as a result of inactivity)
Reduced coordination and reaction performance

Avoiding falls is a balancing act between excessive caution and risk taking. The best possible prevention to avoid a fall in old age brings targeted physical activity and adaptation of the public and private environment to the needs of older people.

Apartments suitable for senior citizens
Marking of public stairs
Sufficient lighting
Snow removal and gritting in icy conditions
Lowering of kerbs
Avoidance of cobblestone pavement
Signal lights (optical and acoustic)
Handrails on dangerous paths
Help handles on stairs, toilets and toilet elevations in public buildings and restaurants
Avoidance of tripping hazards (objects lying around, smooth, wet floors)
Sufficient lighting everywhere
Sure-footed footwear inside and outside the apartment
Walking aids + stepladders in reach
Toilet seat booster
Help handles on stairs, toilets, shower
Handrails in long corridors
Sturdy seating furniture with armrests, beds for senior citizens
Vitamin D supply
Sufficient drinking quantity (1-2l liquid intake daily)
Installation of a home emergency call system
Organization of external support
Training program for fall prevention

Maintaining balance means controlling the body’s center of gravity over a supporting surface (e.g. the feet) despite a wide variety of external influences that are not always predictable.

Controllable, predictable influences on the regulation of balance are consciously performed activities such as lifting a leg to take a step, bending down from a standing position, reaching for a distant object or climbing a ladder. We can adjust/prepare for these predictable influences (anticipation, proactive balance regulation); we shift our weight on one leg in a controlled manner to lift the other leg. 2. reactive balance regulation is extremely important for unforeseeable disturbing influences.

(e.g., misjudging a distance, a blow from behind or black ice can throw us off balance). The body reacts to disturbances of the balance with different responses: In older people these reactions are often delayed due to slower support and defense reflexes. In addition, due to a lack of leg strength and mobility, it is usually not possible to absorb a fall in old age.

Spontaneous increase of muscle activity in legs and trunk (to keep the body’s center of gravity balanced)
Balancing steps
Reflective grasping after a firm hold

In controlling our balance, our brain relies on messages from interlocking balance systems: 1. somatosensory system: By processing information from the skin, muscle and joint receptors, whose sensors are distributed throughout the body (in addition to the sensory organs of the eyes, nose, mouth and ears), the somatosensory system enables the perception of pressure, touch, vibration, pain and temperature. It has close anatomical and functional links with the motor system (nerves, joints, muscles). All sensory perceptions other than sight, smell, taste and hearing are recorded by the somatosensory system and transformed into perceptions.

In cooperation with a certain part of the cerebral cortex, whose main task is to record movement information, three-dimensional structures are recognized, movement information is recorded and the position of the body, arm and hand positions in space are determined and perceived without looking. 2nd vestibular system: The vestibular system consists of the vestibular organ (organ of equilibrium = archways, ventricle and saccule) in the inner ear. It measures the rotational acceleration of the head in all planes, head tilt and head position in relation to the body and in space, as well as horizontal acceleration (faster walking) and up and down movements (jumping).

This information is reported to the brain and processed in various regions of the brain, especially the cerebellum, which initiates reactions to control balance when disturbances are reported. Afterwards, the vestibular system receives feedback as to whether the correction of the balance has been carried out successfully. 3rd Visual System: The visual system comprises the eye with retina and optic nerve, as well as the corresponding areas of the brain.

The visual system acts in constant exchange with the other balance systems. In the event of disturbances in the somatosensory and vestibular system, the affected person must compensate via the visual system. In everyday life, they look for fixed points with their eyes to compensate for the limited regulation of balance.

This compensation via the eyes is not sufficiently efficient and poses a risk to balance in many everyday activities.

Somatosensory system (tactile information about muscles, tendons and joints)
Vestibular system (organ of balance in the inner ear)
Visual system (visual control over the eyes)

The assessment of the individual risk of falling is carried out by the physician and physiotherapist: The examination begins with a detailed questioning of the patient about the current situation and the previous history. (Taking the medical history) Balance test procedure: 1st Mountain Balance Scale:In order to be able to assess balance and fall risk and to develop a treatment concept based on the test results, the Mountain Balance Scale can be used.

The balance is examined in various everyday situations. The movement transitions are examined: Based on the test results, the exact balance deficits can be assessed and narrowed down to different areas. According to a certain point scheme, the level of risk of falling can be assessed.

The exercise program is put together according to the deficits and as individually as possible. Repetition of the test to assess the risk of falling in old age after 3 months of balance and strength training. 2. stool standing test: Assesses the time and safety required for a person to stand up from an ordinary chair 5 times in a row without supporting their hands.

This test should also be used as a comparison criterion after 3 months of balance and strength training to measure success and as a motivational stimulus. 3. standing tests: During the standing tests, the following exercises must be performed with different frequency and repetitions: Assess if the person is able to perform the different stand positions and to hold them over time. A retest should be done after 3 months of the exercise program.

4. strength test: During the strength tests, the muscles of the trunk and legs are examined. A repetition of the strength tests should be carried out after 3 months as a prophylaxis against falls in old age to confirm the success of the training.

From lying to the seat
From seat to stand
Standing with large or small support surface (with eyes closed)
Starting and stopping
Picking up objects
Turning while standing
One-legged stand
Standing barefoot with closed feet10 sec.
Standing barefoot when one foot is slightly forward/10sec.
Stand barefoot, when both feet are behind each other (goosefoot)/10sec.
Standing barefoot on one leg/30sec
Standing with eyes closed

1. exercise program to reduce the risk of falling: In physiotherapy, fall prevention (reduction of the risk of falling) represents a broad field of work and an increasing challenge. Information and counselling, as well as the teaching of a preventive exercise program can be done either in individual treatment or in groups. Individual treatment is particularly recommended for patients who have already suffered a fall with consequences, such as patients after a femoral neck fracture who have been treated with osteosynthesis or hip TEP (artificial hip joint).

Elderly people who are no longer able to take up and implement instructions in a group due to impaired hearing, vision or mental impairment should also receive individual treatment. The exercise program includes balance exercises, strength training, and reaction training. 2. fitness training Fitness training is understood as part of an exercise program to prevent falls in old age The exercise program and daily fitness training should become a regular routine of everyday life, like brushing your teeth.

After approx. 3 months of training, a significant reduction in the risk of falling can be expected (various studies indicate between 30 and 50%). The success depends on age and existing physical limitations.

3. balance exercises to prevent falls:

Tight walks of 30-45 minutes per day
Nordic Walking
Climbing stairs
Do your shopping on foot with the shopping trolley
Garden work or the walk through the garden
Forest walks on uneven ground
You should carry out the exercise program that you have learned in the individual treatment or group 3 times/week regularly, spreading the exercises over the day.
You don’t have to do all the exercises in one session, set different priorities for each exercise.
Allow yourself breaks between the individual exercises in which you can breathe deeply and calmly. These breaks can be done sitting down, the breathing exercises e.g. in the carriage seat. -photo
The longer and more continuously you carry out your exercise program, the easier it will be to execute.
Initially possible complaints such asB. Feeling of stiffness in the muscles after the exercises disappears with increasing strength and fitness.
Take care of your safety! During the balance exercises a fixed object (armchair backrest, railing) should be within reach.
In case of dizziness you should sit down. In case of chest pain or shortness of breath during the exercises, please contact your doctor.
Carry out the exercise slowly and in a controlled manner
Pay attention to even breathing
Perform each exercise for 20-30 seconds with 3 repetitions
Take a break of about 10-20s after each exercise

Starting position lateral position right in bed Exercise fast rolling from the right to the left side and back Starting position supine position in bed Exercise to the right or left Return is also via the lateral positionStarting position seat on the edge of the bed Exercise Execution Stretch arm far away from you with raised thumb and move it in different directions (up/down, right/left), gaze fixation exercises: Follow the movement of the thumb with the eyesStarting position seat on the edge of the bed with the feet upright (the hands are crossed behind the head, the elbows are pressed outwards) Exercise execution upper body lateral inclination from right to left (like a clock pendulum)Starting position seat on the edge of the bed with the feet upright (the hands are crossed behind the head, the elbows pressed outwards) Exercise Movements Turning movements of the head and upper body to re/liStarting position Seat on the edge of the bed, feet on the floor on Exercise Movement Weight of the upper body with arms outstretched forward, backward, shift sideways Exercise position: Standing up from the edge of the bed with the arms supported by shifting the weight forwardExercise position: Seated on a pezziballExercise position: Arms outstretched to the side, shifting the weight forward, backward, sidewaysExercise position: Standing upright, hip-wide

Walk on the spot with open/closed eyes
Turn around on the spot with small steps, eyes open (increase: eyes closed)
Stand with eyes closed for 20-30sec; stand on your toes, hold for 20-30sec (increase: close eyes briefly)
Shift body weight from behind to the heels, forward to the toes and backward, with the arms in counter-movement (to secure an armchair within reach)

Starting position: upright, hip-wide stance Exercise performance: shift body weight to the right/left leg, lift the free foot slightly, do not hold for longer than 30 sec (armchair!) (Increase: stretch the arms to the ceiling)Starting position: from a standing position Exercise performance: shift body weight to the right/left leg, spread the free leg outwards, then cross over the other leg, (armchair!) )Starting position: standing upright, a chair to support nearby Exercise performance: going into the crotch position, supporting on the chair with one hand, picking up an object from the floor with the free handStarting position: standing on various supports Exercise performance: mats, foam cushions, air pad, tipping board, spinning top, mini trampoline, (safety!) Step up: closed eyes In addition: rocking in the rocking chair