As the body ages, the body system ages. The major components of the body that ensure we are up and maintain our balance are: the sensory system (which include visual, somatosensory and vestibular), the Central Nervous System and the Neuromuscular.
The visual components include visual acuity, depth perception, contrast sensitivity, and peripheral vision. Visual acuity, contrast sensitivity and depth perception are impaired typically by ageing. It is well known that the use of bifocals can increase the chances of falling, so this risk can be mitigated by using different eye glasses for far and near visual impairments. The use of tinted glasses and prisms can help with contrast sensitivity and depth perception respectively.
The rate of worsening of some visual impairments like glaucoma can be slowed by working with an ophthalmologist. It is imperative that you undergo frequent eye exams. Therapists will also ask questions relating to eye health and vision as part of fall history taking.
The somatosensory system also ages and can result in decreased ability to know the position of the joints in space (decreased proprioception), decreased vibration sense, decreased light touch e.t.c. Apart from ageing, certain health conditions can also lead to somatosensory impairment e.g Mutiple Sclerosis, Diabetic neuropathy, stroke e.tc.
The vestibular systems include the Vestibuloocular reflex(VOR) and the vestibulospinal reflex. They both help with providing the central nervous system with information about nodding/shaking of the head and leaning of the body to one side. This information is key for postural control. Ageing will lead to decreased VOR, decreased vestibular hair cells and nerve fibres. Certain diseases can lead to impairment e.g Meniere disease, Benign paroxysmal positional vertigo (BPPV), vestibular neuritis e.t.c and some of these conditions can be treated or managed effectively.
The Central Nervous System receives the sensory inputs, integrates them and directs the neuromuscular system to respond appropriately to the stimuli. Essientially, the 3 systems work in sync to keep us upright.
Other factors responsible for falls in the elderly include the environment and these can be tripping hazards, or lack of environmental assistive devices. Examples of environmental factors responsible for falls include poor lighting, clutters on the floor, low toilet seats, lack of railing on stairs, lack of grab bars in tub showers, no seats inside tubs, e.t.c. The ideal way to deal with environmental factors are to fix them or work around them. For example, for difficulty with transitioning from sitting to standing, instead of using low toilet seat, the toilet can be raised with modifications. Grab bars, stair lifts and rails can be installed if there is an increased risking of falls on stairs.
Polypharmacy is also a major factor responsible for falls. Seniors should have their medications regularly checked and reviewed from time to time. This includes and is not limited to the blood pressure and diabetic medications.
Vitamin D and calcium play important roles in reducing the possiblity of fractures in the elderly.
Falls can be prevented by doing the following:
Get assessed, by your physical therapist, for your risk of falling
Get your medications reviewed
Do balance and strengthening exercises as prescribed by your physical therapist
Make your home safer by removing or modifying enviromental causes of falls
At Onward Home Physical Therapy, we carry out highly comprehensive assessments to determine your risk of falling, causes of falls and create an indiviualized treatment plan.
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