Learn about how to minimize falls risks by maintaining healthy bones and joints through physical activity.

1. FALL PREVENTION
PHYSICAL ACTIVITY FOR BONE AND JOINTS
Michelle Clark, DPT
Senior Physical Therapist
Purchase Outpatient Clinic
Burke Rehabilitation Hospital

2. Falls and Injury Statistics
 Are you at risk for a fall?
 1 in 3 adults over the age of 65 fall each year
 Is your home a fall hazard?
 2/3 to 1/2 of falls occur in and around the home
 Among older adults, falls are the leading cause of
nonfatal injuries and hospital admissions for trauma

3. Falls and Injury Statistics
 $30 billion is spent annually on healthcare related to falls
 Hip fractures are common fall injuries that can cause a loss
of independence and lead to nursing home placement
 Falls are the leading cause of death from injury in people
age 65 or over

4. Who is at Risk?
 The risk of falling increases exponentially with age
 In 2001, the rates of fall injuries for adults 85 and older
were four to five times that of adults 65-74
 Many people who fall, even if not injured, develop a
fear of falling
 This fear may cause them to limit their activities, leading
to reduced mobility and physical fitness, and increasing
their actual risk of falling

5. Is Falling Normal in the Elderly?
 Falls are not part of the normal aging process, but
are due to an interaction of underlying physical
dysfunction, medications, and environmental
hazards
 As we age, our balance is effected and may increase
our risk for falling, but it is not normal to fall

6. Risk Factors for Falling

7. Biological & Medical Risk Factors
 Muscle weakness and reduced physical fitness
 Impaired control of balance and gait
 Vision changes
 Chronic or acute illness
 Physical disability
 Cognitive impairment
 Depression

8. Behavioral Risk Factors
 History of previous falls
 Risk-taking behavior
 Taking 3 or more prescription medications
 Excessive alcohol use
 Anticoagulant therapy
 Psychotropic and sleep/anxiety medications
 Footwear, clothing and handbags
 Inactivity and inadequate diet
 Fear of falling

9. Environmental Risk Factors
 Stairs
 Uneven or excessively high or narrow steps
 Slippery surfaces or unmarked edges
 Discontinuous or poorly-fitted handrails
 Factors in and around the house
 Loose or uneven rugs
 Inadequate or excessive lighting
 Lack of grab bars or handrails in bathrooms

10. Environmental Risk Factors
 More factors in and around the house
 Appliance cords or other obstacles in walking routes
 Items stored in high cupboards
 Low furniture such as beds or chairs
 Pets can be a tripping hazard
 Factors in the public environment
 Walks that are cracked or slippery from rain, snow or moss

11. Fear of Falling: A Vicious Circle
The fear of falling  inactivity  increased weakness
 a fall  increases the fear of falling 
inactivity…
Inactivity is not the answer to preventing falls.
Inactivity can actually cause a fall!!

12. Falls Can Be Prevented…
Environmental
Adaptations
Gait Training
Lower Extremity
Balance Exercises
Strengthening
Exercises
Safety Education

13. Gait Training

14. Gait Training for the Elderly
 When using an assistive device, make sure that you
are trained appropriately and that it is properly fit to
your height
 Make sure that your cane tips or walker wheels are
not worn down or broken

15. Falls Can Be Prevented…
Environmental
Adaptations
Gait Training
Lower Extremity
Balance Exercises
Strengthening
Exercises
Safety Education

16. Lower Extremity
Strengthening Exercises

17. Exercise Can Help Prevent Falls

18. Strength Training
 Strength training is one of the most effective and
easy ways to decrease fall risk
 Regardless of age, strength can be increased
 Increasing strength in leg muscles enables people to
continue to climb stairs and get out of chairs easily
 Increasing strength increases muscle tone and
prevents bone loss
 The stronger our legs are, the better our balance is

19. Exercise to Maintain Bone Health
 Exercise is suggested for treatment of osteoporosis
 Exercise as an intervention helps to maintain bone
mass or reduce age-related bone loss
 Weight bearing exercises and balance training helps to
prevent fractures by maintaining bone density
 Exercise preserves muscle strength and postural
stability to reduce the risk of falling and fracturing in
the later years

20. Benefits of Exercise
 Increase your muscle strength
 Improve your balance
 Make you better able to carry out daily tasks and
activities
 Maintain or improve your posture
 Relieve or decrease pain
 Improve your sense of well-being

21. Choose the Right Form of Exercise
 Before starting any exercise program for
osteoporosis, consult your doctor
 Get a bone density measurement
 Because of the varying degrees of osteoporosis and the
risk of fracture, certain exercises may be discouraged –
you need to find out what exercises are appropriate
 Exercising if you have osteoporosis means finding
the safest, most enjoyable activities for you, given
your overall health and amount of bone loss --
there's no one-size-fits-all prescription

22. Choose the Right Form of Exercise
 Strength training exercises
 Includes the use of free weights, weight machines,
resistance bands or water exercises
 Improving posture can help reduce harmful stress on your
bones and maintain bone density
 Weight-bearing aerobic activities
 Exercise on your feet with your bones supporting your
weight
 Walking, dancing, low-impact aerobics, elliptical training
machines, stair climbing and gardening

23. Choose the Right Form of Exercise
 Flexibility exercises
 Being able to move your joints through their full range of
motion helps you maintain good balance and prevent
muscle injury
 Can also help improve your posture
 Stability and balance exercises
 Fall prevention is important for those with osteoporosis
 Stability and balance exercises help your muscles work
together in a way that helps keep you more stable and
less likely to fall

24. Osteopenia and Osteoporosis
 Once diagnosed with osteopenia or osteoporosis,
we cannot reverse it, but we can prevent it from
getting worse
 When diagnosed with either of these conditions,
the likelihood of fracturing a bone when falling is
increased
 We need to prevent falls to prevent fractures

25. What to Avoid with Osteoporosis
 High-impact exercises, such as jumping, running or
jogging
 These activities increase compression in your spine and
lower extremities and can lead to fractures in weakened
bones
 Avoid jerky, rapid movements in general...choose
exercises with slow, controlled movements

26. What to Avoid with Osteoporosis
 Exercises in which you bend forward and twist your
waist, such as touching your toes or doing sit-ups
 These movements put pressure on the bones in your
spine, increasing your risk of compression fractures
 Other activities that may require you to bend or twist
forcefully at the waist are golf, tennis, bowling and some
yoga poses

27. Lower Extremity Strengthening Exercises
 Sit to stands from standard chair with arms across
chest
 Static high knee marching, hamstring curls
 Static straight leg forward, side and back kicks
 Heel/toe raises
 Walking
 Forward or side step ups
 Ascending or descending stairs

28. Falls Can Be Prevented…
Environmental
Adaptations
Gait Training
Lower Extremity
Balance Exercises
Strengthening
Exercises
Safety Education

29. Balance Exercises

30. Balance
 Balance is complex – three sensory systems (vision,
proprioception/spatial orientation, vestibular
system) work together along with our muscles to
keep us balanced
 Practice, practice, practice – balance can be
improved with practice
 The more you do it, the better you will become at it – “use
it or lose it”

31. Static Balance Exercises
 Surface type – standing on:
 Floor
 Pillow
 Base of support – standing with:
 Feet apart
 Feet together
 Tandem stance
 Single leg stance
 Additional challenges
 Eyes open, eyes closed
 Vertical and horizontal head turns
 Cross body reaching

32. Dynamic Balance Exercises
 Side stepping
 Side stepping with braiding
 Tandem walking
 Heel walking, toe walking
 Backward walking
 Walking with vertical/horizontal head turns
 Walking with eyes closed
 Walking while tossing a ball

33. Falls Can Be Prevented…
Environmental
Adaptations
Gait Training
Lower Extremity
Balance Exercises
Strengthening
Exercises
Safety Education

34. Environmental Adaptations

35. Environmental Adaptations
 Stairs
 Repair broken or worn steps
 Repair or install railings
 Keep stairs free of clutter
 Hallways
 Add more overhead lighting for poorly lit areas
 Remove throw rugs as they are a tripping hazard
 Keep walkways clear as clutter can be dangerous

36. Environmental Adaptations
 Kitchen
 Put regularly used items on shelves within easy reach
between hip and eye level
 If you must reach overhead, keep a stool handy
 A long-handled grasper can be used to reach objects on
the floor
 Wipe up spills as soon as they happen

37. Environmental Adaptations
 Bathroom
 Use night lights in bathrooms
 Always use a non-skid bath/shower mat in order to
prevent falls in the bath or shower
 Consider installing a non-skid shower chair and hand-held
shower head so you can sit while bathing
 Install grab bars or handrails in the shower, on walls
around the bathtub, and alongside the toilet, where
necessary

38. Environmental Adaptations
 Living Room
 Try to sit on furniture with good back support that you can
get into and out of easily
 Firm chairs with arm rests are easier to get out of
 Add pillows to the back of the chair so your feet can touch
the floor
 Telephones
 In case you trip and fall, help is only a phone call away.
 Keep emergency numbers readily available

39. Burke Home Assessment Program
 “Helping people stay healthy and active in their
home.”
 Evaluation includes:
 In home evaluation and report with resources by an
Occupational Therapist
 Checking safety and accessibility in all aspects of your
home
 Recommendations for easier living
 Formulating emergency care plans for client and family
members
 For additional information call 914-597-2326

40. Falls Can Be Prevented…
Environmental
Adaptations
Gait Training
Lower Extremity
Balance Exercises
Strengthening
Exercises
Safety Education

41. Safety Education

42. Safety Education – Vision
 Decreased depth perception
 Highlight step edges using contrasting colored tape
 Slowness of eyes adapting to darkness
 Give your eyes time to adjust when entering a dark room
or entering from the outdoors – do not continue walking
until your eyes have changed
 Carry a small flashlight with you
 Increased sensitivity to glare
 Wear sunglasses outdoors
 Use blinds/sheer curtains

43. Safety Education – Medications
 Know their effects
 Keep an updated list of all medications and dosages
 Review medications and possible interactions with
your doctor

44. Safety Education – Footwear, Clothing
 Poor fitting shoes can cause painful feet, poor
balance, and could increase your risk of a fall
 Get a good fit with a non-skid or rubber sole
 Wear well fitting slippers with a back
 Avoid tripping on your clothes – long dresses, coats,
even sleeves pose a risk for a fall

45. Safety Education – Body Mechanics
 When bending or lifting, use your legs, not your
back.
 This means bend your knees and keep your back straight.
 Keeping your feet shoulder width apart creates a
wide base of support and improves balance
 When lifting or carrying items, hold them close to
your body.
 Carry objects at waist level; don’t block your vision.

46. Safety Education – If you fall…
 Getting up after a fall
 DON’T PANIC! Take a deep breath and take inventory,
make sure you are not injured. Roll onto your side.
 If you are injured, use your reachable phone and call for assistance
or use your fall pendant
 Get on to hands and knees.
 Crawl, scoot, move along floor to a sturdy chair or couch.
 Place one foot flat on floor and curl the toes on the other
foot so they are gripping the floor.
 Use your arms and legs to push up and stand.
 Turn around and sit on the chair or couch.

47. Six Quick Tips to Prevent Falls
1. Make an appointment with your doctor
2. Keep moving
3. Wear sensible shoes
4. Remove home hazards
5. Light up your living space
6. Use assistive devices

48. Physical Therapy
 Don’t hesitate to call your doctor if you feel you
need one on one physical therapy to work on your
balance
 If you feel that you are falling often or that your
balance is not as good as it was, we are here to help
you!!

49. QUESTIONS??
Thank you all so
much for your time
this afternoon! It was
a pleasure!