Falls Prevention Awareness

September 19, 2019

Falls are the number one cause of injuries and death among older Americans, according to the CDC. As Falls Prevention Awareness Day approaches on September 23, we sought practical tips for increased mobility as well as ongoing research to bridge the gap between the science and practice of an ancient Chinese tradition.

“Falls are such a critical part of our public health concerns,” said Peter Wayne, Ph.D., Associate Professor of Medicine at Harvard Medical School and the Director of Research for the Osher Center for Integrative Medicine.

Every 11 seconds an older adult is treated in the emergency room for a fall and every 19 minutes an older adult dies from a fall, according to the National Council for Aging Care. In certain cases, mobility aids may be a practical tool to preserving autonomy and mobility.

“Mobility aids like canes and walkers provide a degree of safety from falls as well as a tremendous amount of regained freedom. We all want older adults to be able to live their best lives, and mobility aids are becoming increasingly sophisticated and useful for living life to the fullest,” said Brad Manor, Ph.D, Director of the Mobility and Brain Function Program, Marcus Institute, Hebrew SeniorLife.

According to Dr. Manor, fall prevention requires increased awareness and vigilance of patients, their health care providers, and their caregivers. And with annual statistics revealing that many older adult falls that entail a fracture result in death within six months to a year, exploration into alternative solutions to reduce incidence of falls is warranted.

“We’re not just talking about the inconvenience of falls, nicks, and bruises, but very serious implications for older adults, their families, and the financial impact that ensues,” Dr. Wayne said.

Research into the efficacy of exercise has shown promise for those of all ages. “Frankly, there is no pill to take to prevent falls,” Dr. Wayne said, “but exercise is one of the best tools out there. And Tai Chi seems to be one of the better exercise options. [One recent study] showed that Tai Chi can help older adults reduce incidence of falls between 20-50%.”

Research is ongoing into the effectiveness of Tai Chi in fall prevention, mental agility, balance improvement, and aiding in stress and anxiety reduction. “Tai Chi shows great promise for a number of reasons: It’s very adaptable, so people of all stages of function and disability can adapt and engage in this exercise,” Dr. Wayne explained. “It’s a ‘gateway exercise’ so for people who haven’t exercised much before in their life, it translates to better self-efficacy.”

According to Dr. Wayne, one of the past studies in which he was a co-author found that just three months of Tai Chi can improve balance, even for individuals well past age 65. “The average age of participants in that study was 86,” Dr. Wayne said. “There were a few subjects who turned 100 and a few in their 90s. What we learned is that it’s never too late to start.”

Additional Factors

“Some medications are linked to muscle weakness and falls,” Dr. Manor said. “Corticosteroids (such as prednisone) regularly weaken muscles. Cholesterol-lowering medicines (such as lovastatin, simvastatin, or atorvastatin) can also weaken muscles in some instances.”

Dr. Manor said that for older adults who wear prescription glasses, ensuring their vision is maintained is important for balance. Reorganizing an older adult’s home to suit their needs and being conscious of tripping hazards are practical tips to consider. Still, underlying conditions may also play a role.

“Many disorders can cause mobility decline because they affect our muscles and nerves,” Dr. Manor said. “For example, type II diabetes mellitus, peripheral neuropathy, osteoarthritis, or brain damage caused by stroke. At the same time, Alzheimer’s disease and other types of cognitive impairment can also lead to falls because they interfere with one’s ability to plan and coordinate body movements during activities of daily living.”

Older adults who have fallen before, Dr. Wayne said, may walk in a braced and tentative way, as they may be worried and anxious about falling again. Fear of falling, research shows, is one of the biggest factors that predicts a future fall.

“Balance requires healthy bodily function and communication between multiple systems: strong legs, flexibility in joints, good coordination, reflexes, and reaction time,” he explained. “A huge component of balance is proper executive functioning. Through Tai Chi, they’re not just changing the physical body, but they’re training their mind and attention.”

Clinical & Real-World Application

Dr. Wayne began practicing Tai Chi 40 years ago and since becoming a Tai Chi instructor in 1985, his students have included those with Parkinson’s disease, cancer survivors, older adults with chronic health conditions, and those with depression and anxiety. It’s been the two-way nature of academic research and application of these concepts in his classes that has him so excited for the future.

“Learning from my students about how Tai Chi helps them navigate their everyday lives gives me ideas to take back to the lab and study scientifically; our research then informs what and how we teach,” he explained. “It also gets shared with my health care colleagues who are increasingly appreciating that there’s an important place for the utilization of Tai Chi to aid in fall prevention in older adults.”