Fall Prevention

Everyone knows balance problems can cause falls, but just how serious are falls?

In older adults, falls can be very serious. Studies by the U.S. Centers for Disease Control and Prevention (CDC) and several other investigators have reported some very alarming facts:

• Falls are the # 1 reason for injury‑related visits to an emergency room, the # 1 cause of accidental death (falls cause 70% of all accidental deaths in people 75 & over), the # 1 reason for admission to a hospital and the # 1 reason for admission to a nursing home for persons age 65 and up;
• Falls now cause nearly 1,000 hip fractures every day in the United States. And as many as 50% of the older adults who suffer a hip fracture will never regain their previous level of functioning and be able to live independently again;
• About 35% of community‑dwelling elderly persons and 60% of nursing home residents fall each year. Many of them fall repeatedly;
• 55% of the people age 75 and over who fall and sustain a serious injury will die within a year as a result of the fall.

Is it true most people do not know when they have a balance problem?

Unfortunately, it is true. Most people, particularly young to middle age people, are totally unaware that they have a balance disorder.

Maintaining balance is so important to us humans that our postural control system has built‑in "redundancies" or "back‑ups". For instance when one of the sensory inputs used in controlling balance is inadequate, the central nervous system automatically turns to other inputs to obtain similar information. In other words, a fully functioning part of the system will help do the work of a part of the system that is not fully functional.

The problem comes when people get older and have more than one part of their balance system that's not 100% functional and/or when they encounter an unusual situation and the working parts of their balance system are unable to compensate and overcome the unexpected "obstacle". For example, an older person may have had a vestibular disorder (the great majority of balance problems are vestibular in nature) for many years but may have unconsciously compensated for that problem by relying on their keen eyesight to maintain balance.

But eyesight gets worse with age, and when coupled with dim lighting, the brain also can't get from vision the information it can't get from the malfunctioning vestibular system, and the result is often a fall. That is why many falls occur at night, when there may be little or no light available.

Can falls be prevented?

As mentioned earlier, most balance disorders are caused by some benign, easily treatable condition. In fact, one of the most common forms of balance disorder, benign paroxysmal positional vertigo (BPPV), can almost always be completely cured in 1 or 2 short therapy sessions (BPPV simply means that a person sometimes gets dizzy when their head is in a certain position).

Since about 80‑85% of all balance problems respond well to specific therapeutic maneuvers and exercises, balance or gait therapy are usually indicated. This often includes gaze stabilization and eye‑tracking exercises. Other exercises involve such simple movements as getting in and out of a chair several times in succession each day.

And many balance therapy programs include exercises that can be done at home. That is why we have published a Vestibular Rehabilitation Therapy book which includes 22 reproducible handouts with exercises and easy to follow procedures.