Working papers - BHF National Centre - physical activity + health

Working with older people in falls prevention CONTINUED
Risk factors for falls and injuries
The tendency to fall increases with age. Risk factors for falling tend to increase in prevalence with age, leading to more
frequent falls. Evidence from cohort studies strongly suggests that the direction of the fall (to the side rather than forward) is
critical in determining hip fracture and is also an age-related effect. Poor visual acuity, use of hypnotics, neurological disease
and slow gait speed have also been shown to be significant risk factors ix x xi .
Risk factors for falls are of most significance if they are (1) easily identifiable and if they are (2) potentially reversible.
Potentially reversible risk factors (see Table 14) are an obvious target for intervention, provided that the preventative
approach is cost-effective. Identifiable risk factors which cannot be reversed might be used to target protective devices.
Table 14. Identifiable risk factors for falls (potentially reversible)
Muscle weakness
Abnormality of gait or balance
Poor eyesight
Drug therapy – hypnotics / sedatives / diuretics / anti hypertensives
Neurological disease eg, Parkinson’s disease, stroke
Foot problems / arthritis
External environment (eg, uneven footpaths, poor lighting)
Home environment (eg, loose or slippery floor covering, baths without handles)
The role of physical activity and tailored exercise in the prevention of falls
Fitness depends on a number of attributes: aerobic fitness, local muscle endurance, muscle strength, muscle speed,
flexibility, body composition and motor skills (balance, co-ordination). All of these components of fitness decline with
age, but a fair proportion of this decline is in fact due to disuse xii . This loss of physical function is exponential and will
eventually cross a threshold level beyond which a person cannot maintain an independent life xiii .
Strength, balance and co-ordination appear to be key factors in maintaining upright posture in dynamic situations.
Speed of movement and reaction time are also vital to prevent a trip becoming a fall.
An appropriate exercise programme which helps to reduce the age related decline in fitness, and particularly training
to improve strength, balance and coordination is highly effective in reducing the incidence of falls among people in
later life xiv . Research has shown that physical activity programmes combining strength, balance and endurance training,
reduced risk of falling by 10 per cent; programmes with balance training alone reduced the risk by 25 per cent; however,
Tai Chi with individual coaching has been shown to reduce the risk of falling by 47 per cent xv .
Physical activity can slow down the rate at which bone mineral density is reduced and may therefore delay the
progression of osteoporosis xvi . The aim of a physical activity programme for those who have osteoporosis but who have
not sustained fractures is to maintain bone strength, prevent fractures, improve muscle strength balance and posture
and thus reduce the risk of falling. The types of activities recommended include weight-bearing activities and sitespecific
strength training.
Section 4 Active for later life | 101