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By Joan Firra, PT, PhD. Who is at risk for falling? People with Parkinson’s disease and those who have suffered from a stroke are especially vulnerable to falling because of a slow walking pace (shuffling of the feet), inattention and decreased ability to learn that occurs with Parkinson’s disease and strokes.

But even those people who do not have obvious neurologic impairment can suffer a potential injury from falling. It is good to know that physical activity has huge benefits. Not only does strengthening the legs prevent a slip from becoming a fall, physical conditioning affects the neurotransmitters of the brain so that the person is paying better attention. Distraction is a cause of falls to such an extent some researchers recommend that seniors do one thing at a time. By contrast, others recommend that they practice doing 2 or 3 things at a time while exercising to prevent falling. An example of such activity is to stand in a corner for security, and on 1 foot practice throwing and catching a weighted ball.

Another cause for falls is climbing stairs. It causes so many falls that it is considered a dangerous activity for the frail. However, the addition of light pressure on a handrail encourages a more efficient transfer of weight onto the descending foot, making the activity safer.

Researchers have found that taking 4 or more medications invites the potential for falls due to drug interaction. It is safer to get your medications from a single source so that your pharmacist may alert you and your doctor to such a potential hazard. Taking psychoactive drugs make a person a target for a fall.

Senior women, with high anxiety, and overweight with joint pain are more prone to falling than younger women who are not overweight. Increasing activity may help to reverse this risk. Anxiety about falling itself is a risk factor because it may prevent one from pursuing an active lifestyle. Those living alone may feel vulnerable because there is no one to notice if they fall, so anxiety about falling is understandable. Having someone to talk to daily, just to be sure each other is okay could help to allay such fear.

Reduced vision is a risk factor that makes a person vulnerable to falling. Macular degeneration is a frequent sight-robbing condition that can occur later in life. Lighting is important as is keeping furniture in its usual place so that the sight impaired person does not trip over a chair that is moved. Area rugs are hazardous. Paying attention and being alert is especially important for a person with decreased vision.

Lack of sensation in the feet may cause stumbling. Fortunately, balance-enhancing insoles are available that can counter age-related decline in foot-sole sensitivity. They improve lateral stability of the foot so that the ankle does not turn over. Loss of sensation in the feet due to diabetes requires the diabetic to take special care of the feet and to be alert when walking to prevent stumbling.

Two areas to focus on in preventing falls are lower extremity muscle strengthening and balance awareness. Progressive resistance exercise helps strengthen hip and knee muscles, particularly the buttock muscles, the inner thigh muscles and the quadriceps by lifting increasingly heavier weights with the legs. While high impact activities during periods of bone growth (between the ages of 10 and 20) are recommended, maintenance of weight-bearing and balance in later years are more appropriate. Catching weighted balls, especially if they are thrown randomly from different directions improves center of gravity control. Community center classes give an opportunity to exercise in the company of others who may have some of the same problems. The sharing makes the classes enjoyable.

Home exercises to improve balance can include using short, quick steps to restore equilibrium. This strategy can be practiced by moving quickly from side to side and front to back with 2 or 3 short steps. Balance training is effective only if the person is simulating what happens in life, which is, balancing while also doing other tasks.The slow movements of Tai Chi which include standing on one leg are an enjoyable way to sharpen balance. Tai Chi can be done by people into their 90’s. I recommend it to my patients for long-term exercise.

Effective prevention of falling is a goal of physical therapists by identifying those people who have the greatest potential for falling and implementing a treatment plan of exercise and posture improvement for them. Learning from a physical therapist how to become stronger and have better balance can reduce the potential for falling. But it comes down to the individual to be proactive to improve his or her capacity for activity by maintaining a positive perception of health. Studies uphold the need for performing weight-bearing activities for at least 150 minutes a week, i.e. 3 days a week of 50 minutes or 5 days a week for 30 minutes.