1. FALLS PREVENTION Conor Murray
PhysioIreland
PROGRAMME Clinic
www.physioireland.ie

2. BACKGROUND Section 1

3. WHAT IS A FALL?
“unintentionally coming to rest on
the ground, floor or other lower
level!!”.

4. THE PROBLEM WITH FALLING
 Falls are a major public health problem because they are
common in people aged 65 and older and are the leading
cause of injury in this age group.
 Falls can have serious consequences:
 Trauma
 Pain
 impaired function
 loss of confidence in carrying out everyday activities,
 loss of independence and autonomy
 even death.

5. FALLS: THE FACTS
 Around one-third of generally healthy people aged 65 and
older will have at least one fall each year.
 The rate of falls and severity of the resulting complications
increase dramatically with age.
 What causes people to fall?
 leg muscle weakness
 Impaired balance
 multiple medications
 Arthritis
 Dizziness
 Heart problems
 Visual problems.

6. RISK OF FALLING Section 2

7. FALL RISKS: VISION
Macular Degeneration
Glaucoma
Cataracts
Diabetic Retinopathy
Not wearing glasses or wrong prescription in
lenses

8. FALL RISKS: ENVIRONMENT
Cluttered walk spaces
Low lighting
Slippery flooring
Lack of handrails and grab bars
Out of reach cabinets and storage spaces
Unsecured area rugs
Unsecured electrical cords
Unfamiliar environment

9. FLOORS: LOOK AT THE FLOOR IN EACH
ROOM
 Do you have to walk
around furniture?
 Do you have rugs on the
floor?
 Are there
papers, books, towels, s
hoes, magazines, boxes
, blankets, or other
objects on the floor?
 Do you have to walk
over or around wires or
cords

10. STAIRS AND STEPS
 Are there
papers, shoes, books, or
other objects on the stairs?
 Are some steps broken or
uneven?
 Are you missing a light over
the stairway?
 Do you have only one light
switch for your stairs (only at
the top or at the bottom of
the stairs)?
 Is the carpet on the steps
loose or torn?
 Are the handrails loose or
broken?

11. KITCHENS & BATHROOMS
 Are the things you use  Is the tub or shower
often on high shelves? floor slippery?
 Is your step stool  Do you need some
unsteady? support when you get in
and out of the tub or up
from the toilet?

12. BEDROOMS
Is the light near the
bed hard to reach?
Is the path from your
bed to the bathroom
dark?

13. FALL RISKS: MEDICATION
Blood pressure medications
Sedatives
Muscle relaxers
Mood medications
Diuretics
Mixing medications and alcohol
Not keeping a record of your medications

14. FALL RISKS: FEAR
Fear of falling often results in inactivity
which leads to muscle
weakness, increasing the risk of falling

15. FALL RISKS: HABITS
Lack of exercise
Getting out of bed or a chair immediately
Not putting on glasses in the middle of the
night
Alcohol abuse
Standing on chairs to reach high places

16. FALL RISKS: ASSISTIVE DEVICES
Failing to use a prescribed, necessary
assistive device may result in a fall
Inappropriate shoes

17. FALL PREVENTION Section 3

18. WHAT CAN BE DONE TO STOP FALLS?
Get in contact with the right services:
 GP visit to check your overall health and investigate your
symptoms - for example, a medication you are taking may be
causing you to feel dizzy
 Tests to check how well your heart is working
 See an occupational therapist to talk about how you cope at
home as there may be some equipment such as grab rails that
you could use to make things easier
 Have your eyes or feet checked.
 See a physiotherapist who can check your muscle strength and
balance and recommend exercises to improve these

19. The Otago Exercise Programme
 The Otago Programme is an evidence based exercise
programme proven to lower the risk of falls and
death after 12 months
 The programme comprises of both balance and
strength exercises.
 The programme can be recommended by a nurse or
delivered by a physiotherapist.
 There is a large amount of evidence to suggest that
exercise can particularly benefit older community
dwelling adults ie respite patients.
 We feel that these adults would most benefit for a
referral to begin the Otago Exercise Programme

20. BASELINE MEASUREMENTS:
CHAIR STAND TEST
 Use a straight-backed firm chair with no armrests.
 Place the chair with a wall behind for safety.
 Person is instructed to stand up and sit down as
quickly as possible five times with the arms folded.
 Time taken is recorded.
 A maximum of 2 minutes is allowed to complete the
test
Guralnik JM, et al. J Gerontol Med Sci 1994;49:M85-94

21. BASELINE MEASUREMENTS:
4-TEST BALANCE SCALE
 Feet together stand
 Semi-tandem stand
 Tandem stand
 One leg stand
Rossiter-Fornoff JE, et al. J Gerontol Med Sci 1995;50A:M291-297

22. FALLS PREVENTION EXERCISE PROGRAMME
Leg muscle strengthening and balance
retraining exercises designed specifically to
prevent falls.
Individually prescribed and delivered at home
by trained instructors.

23. GETTING STRONGER
Strengthening muscles is essential for
maintaining healthy bones and muscles
necessary for waling and being independent
Aim to do the following exercises 3 times a
weeks with a rest day in between
Lift the weight slowly through the entire range
of movement
You may feel a bit stiff after you first start to
exercise – this is normal!!

24. STRENGTHENING EXERCISES
Strengthening exercises
Knee extensor (front knee All 4 levels
stretch) Ankle cuff weights are used to provide resistance to
Knee flexor (back knee the muscles and 10 repetitions of each exercise are
stretch) carried out
Hip abductor (side hip
stretch)
Ankle plantarflexors (calf Level C Level D
raises) 10 repetitions, hold 10 repetitions, no support,
support, repeat repeat
Ankle dorsiflexors (toe 10 repetitions, hold 10 repetitions, no support,
raises) support, repeat repeat

25. 40

26. 41

27. 42

28. 43

29. 44

30. 45

31. 46

32. BALANCE
Balance is important for everyday activities.
The following balance retraining exercises
should be done every day.

33. BALANCE RETRAINING EXERCISES
Balance retraining exercises
Knee bends Level A Level B Level C Level D
10 repetitions, 10 reps no 10 reps, hold 3x10 reps, no
hold support support OR support, repeat support
10 reps, hold
support, repeat
Backwards 10 steps, 4 10 steps, 4
walking times, hold times, no
support support
Walking & Figure of 8 twice Figure of 8 twice,
turning around with walking aid no support
Sideways 10 steps x 4 with 10 steps x 4 no
walking walking aid support
Tandem 10 seconds, hold 10 seconds, no
stance support support
Tandem walk 10 steps, hold 10 steps, no
support, repeat support, repeat

34. BALANCE RETRAINING CONT’
Level A Level B Level C Level D
One leg stand 10 seconds, hold 10 seconds, no 30 seconds, no
support hold hold
Heel walking 10 steps, 4 10 steps, 4
times, hold times, no
support support
Toe walk 10 steps, 4 10 steps, 4
times, hold times, no
support support
Heel/toe Walk 10 steps,
walking no support,
backwards repeat
Sit to stand 5 stands, 2 5 stands, 1 hand 10 stands no 10 stands, no
hands for or 10 stands 2 support or 10 support repeat
support hands stands 1 hand
repeat
Stair walking As instructed As instructed
repeat

35. 48

36. 49

37. 50

38. 51

39. 52

40. 53

41. 54

42. 55

43. 56

44. 57

45. 58

46. 59

47. 61

48. 62

49. 63

50. 64

51. 65

52. 66

53. 67

54. 68

55. 69

56. WALKING PLAN
Aim for up to 30 minutes, walking at usual
pace, at least twice a week, if safe.
The walking can be broken up into shorter
sessions, for example three 10-minute
sessions.

57. TIPS FOR WALKING
 Walking is an excellent way to enhance your general
fitness.
 Try going for a walk on the days between your
exercises.
 Try to increase the distance you walk and the time
you spend walking.
 Take advantage of fine weather to go walking.
 General tips
 Wear comfortable shoes and clothing.
 Start with a warm-up – marching on the spot for two minutes.
 when you walk the shoulders are relaxed and the arms gently swing.
 Look ahead, not down.
 With each step the heel lands first, then you push off on the toes.
 Finish with a warm-down – marching on the spot for two minutes.
 Enjoy yourself!

58. DOES IT WORK?
 4 controlled trials assessed whether the programme
reduced falls and injuries in community-living older
people.
 1016 women and men aged 65 to 97 were invited by
their doctors to take part.
 Overall the exercise programme reduced by 35%
both the number of falls and the number of injuries
resulting from falls.
 It was effective when delivered by a research
physiotherapist and by trained nurses from a
community home health service and primary
healthcare practices.

59.  We have seen the common risk factors of falling and the
habits that can be formed
 We have looked at what can be done about falls, including:
 A GP check
 Have feet or eyes tested
 See a physiotherapist who can check your muscle strength
and balance recommend exercise to improve these
 Liaise with an occupational therapist
 But what can be done for residents with dementia?

60.  Many nursing home residents suf fer some form of dementia
 Exercise may benefit any resident with dementia, as it has
been established that exercise can improve quality of life.
 For the same level of brain deterioration, physically active
people exhibit higher levels of functioning than sedentary
people. It is thought that physically active people have a
'cognitive reserve' that is used when other areas of the brain
are damaged.
 An exercise routine may decrease the severity of symptoms of
dementia as well as lead to increased mobility and
independence.
 One to one exercise programmes with a physiotherapist
focussing on strength and balance can reduce risk of falls in
people with dementia

61. SAFE TRANSFERRING
 If a resident is engaged in an exercise programme
with a physiotherapist a baseline will be taken for
the level of assistance (if any) needed to make a
safe transfer – the residents progress will be
monitored and reviewed regularly.
 And of course ensuring safe manual handling allows
for a safe transfer for both the resident and yourself
 Has anybody had any trouble transferring or
mobilising any residents? What was your experience?
 Any other questions?

62. THANK YOU FOR YOUR ATTENTION
PhysioIreland clinic
Block 4, floor 3
Quayside
Mill St
Dundalk
Tel: 042 933 9302
Email:
betterhealth@physioireland.ie