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Sharp Health News

Fall prevention for older adults starts with balance therapy

Sept. 22, 2021

Mason Hearn, PT, demonstrates vestibular ocular reflex (VOR) training with patient Elizabeth Stanton.

Mason Hearn, a physical therapist at Sharp Grossmont Hospital, instructs dynamic balance training with patient, Elizabeth Stanton.

According to the Centers for Disease Control and Prevention (CDC), 1 in 4 adults over age 65 sustains a serious fall each year in the U.S. However, falling is not a normal part of aging. With the right exercises, a safe home environment and regular checkups with a physical therapist, older adults can help prevent balance-related problems.

Causes of balance problems
The vestibular system is one of three balance sensory systems that helps control balance and spatial orientation. The vestibular system is a small organ deep in the inner ear that tells the brain where your head is moving in space, so you don't get dizzy with movement.

One of the primary diagnoses that affects the vestibular system is benign paroxysmal positional vertigo, or BPPV,” says Dana Lockard, a physical therapist at Sharp Grossmont Hospital. “Within the vestibular system there are small calcium carbonate crystals that are supposed to be there. However, in some cases, they can become dislodged, resulting in a room-spinning sensation particularly with quick head and body movement."

The second balance sensory system is proprioception, or your body’s ability to feel the floor underneath it. If a part of this system is damaged, the signals from the brain to the rest of the body can't be transmitted effectively. If the brain and legs are disconnected, people start looking down to see where they are walking, which may lead to additional balance issues.

The impact of medications on balance
Medications can be lifesaving, yet some side effects and interactions between drugs may impact balance in various ways. According to a national health survey, two-thirds of people age 65 and older take three or more prescription drugs a month. Age affects how the body responds to medications, and people become more vulnerable as they get older. It’s necessary to monitor people who take medications to lower their blood pressure, particularly if they are feeling dizzy or lightheaded. A significant drop in blood pressure can lead to episodes of fainting — a significant fall risk.

Signs you may need balance therapy
Having good balance means being able to maintain control of your body’s functions, whether you are moving or still, which is important to remain mobile and independent. As people age, there are particular signs that their balance is deteriorating as they perform daily activities. One sign is if they find themselves reaching out for things while walking around the house. It doesn’t have to just be dizziness or falling; just feeling a little bit off balance can be a sign.

“As part of our evaluation, we use objective measures that can identify fall risk. Patients may only need to come for two or three visits, depending on the diagnosis,” explains Lockard. “This involves balance testing and may include prescribing a home exercise program that can be continued independently to prevent deconditioning.”

Exercises to treat balance issues
According to the CDC, 3 million older adults are treated in the emergency room for fall injuries each year, and the average health care cost per fall is $35,000. The good news is falls are preventable, and balance therapy is an important tool to reduce the risk.

The following recommended exercises are best to do while standing with your back to a corner for balance or while holding on to a flat surface, such as a table or kitchen counter.

Sit to stand
Ideally complete this without your arms. However, if needed, your arms can be stretched out in front for counterbalance or placed on the armrest of a chair. This is a great exercise to strengthen the large muscle groups of the legs that help you rise from a chair and balance while walking.

Sidestepping
Stepping sideways in one direction with your toes pointed forward helps strengthen the hips, which are commonly weak, and contributes to improved balance while walking.

Walking backward
Walking backward stretches out the front muscles of the legs, which tend to be short in people who sit a lot.

Heel raises
As we age, we tend to lose strength in our calves — the power muscles responsible for propelling us forward. Weak calves result in slower walking speed, which can increase fall risk. Heel raises can help strengthen these muscles and thus help prevent falls.

Heel-to-toe walking
For this exercise, place one heel in front of the opposite foot’s toes and repeat, either standing in place or moving forward, like walking a tightrope.

Standing on one foot
To take a step, you must be able to stand on one foot. Practice balancing on one foot to help steady your footing when walking. If you can stand on one foot reasonably well, you should be able to walk steadily.

What you can do at home to help prevent balance issues
Lockard offers the following tips to help people minimize risks of falling at home.

  • Wear comfortable shoes — Wearing flip-flops may be popular in San Diego, but a comfortable shoe with a back on it prevents a shuffling walking pattern and allows for improved walking mechanics.
     
  • Clear walking spaces — Remove loose cords, area rugs and stray items from heavily trafficked areas to avoid hazards that need to be navigated.
     
  • Install handrails as needed — Adding a grab bar in the shower and near the toilet can help you stay steady if you ever feel off balance. If you have stairs, adding railing can provide additional support.
     
  • Use night lights — Vision is one of the main sensory systems for balance. Having small lights on throughout your home ensures you can always see where you are going.

If you are concerned about balance issues, speak with your primary care doctor about Sharp Rehab’s Balance and Vestibular Program.

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