As we recognize National Fall Prevention Month, it's important to think about the steps we can take to protect ourselves and our loved ones from falls, especially as we get older.
Falls can have serious health consequences, leading to injuries and a decline in overall well-being. For people with osteopenia or osteoporosis who are more prone to fractures, it’s especially important to recognize the risks of falls, be proactive about lowering that risk, and try to prevent falls altogether. Wellen's personalized exercise program addresses fall prevention by including strengthening and balance exercises in every workout. But it always helps to learn more from an expert.
That's why we've enlisted the expertise of Dr. Kavita Patel, PT, DPT, a highly experienced physical therapist dedicated to helping individuals with low bone density build strength, improve balance and reduce their risk of falls.
In this Q&A with Dr. Patel, we'll explore practical tips and easy-to-implement strategies to prioritize safety and improve overall wellness during National Fall Prevention Month and beyond.
1. Why is fall prevention so important for people with osteopenia and osteoporosis?
Fall prevention is highly important for everyone, especially for people with low bone density (osteopenia and osteoporosis). Their bones are more porous and weak, making them more susceptible to fractures.
Osteoporotic fractures are often called fragility fractures or low trauma fractures. Normal, everyday forces which typically wouldn’t result in injury with optimal bone health may result in fractures in the presence of compromised bone. One example of this is sustaining a hip fracture from a fall from a standing height or less. There is an expression we often use, “Your bones should bounce, not break when you fall.”
2. What are some practical tips for avoiding falls during daily life?
People with low bone density should understand their individual risk of falls and fractures, implement simple strategies to address some of the modifiable risk factors, and participate in safe and appropriate exercises that work on muscle and bone strength, balance, aerobic capacity, and posture.
Many falls occur within our homes and some of these may be avoided by following a few simple yet important tips to make your home environment safer.
- Remove hazards that may result in tripping, such as throw rugs, cords, or clutter on the floor. Pets, toys, and backpacks left on the floor can be dangerous.
- Avoid slippery surfaces, especially in the kitchen and bathroom. Dry up wet floors immediately. Consider wearing non-slip socks around the house.
- Ensure there is proper lighting in the house especially between the bedroom and bathroom for use at night.
- Be safe in the shower. Determine if a shower chair or grab bar may be needed. Try sitting to wash and dress your legs instead of standing.
- Think about how often you use a step stool to reach for things or crouch down to take items out of the bottom cabinets. Consider rearranging your set-up to position commonly used items in easy reach, at counter level.
- Avoid house slippers – wear closed, light-weight footwear.
- Take your time. Too much multitasking, rushing through chores, and quickly climbing up/down stairs while carrying items can make you less aware of your surroundings, increasing the risk of falling.
3. Can I improve balance with exercise?
Yes, everyone can improve their balance. It’s important to understand what your balance is like to start with, so that you can begin balance training at the right challenge level. Working with a physical therapist is recommended, to determine your baseline level. A physical therapist will evaluate health factors that may be contributing to balance deficits, and design an appropriate exercise program to improve your balance and safety.
4. How do balance exercises work?
Balance training challenges your body to remain vertical and resist perturbations.
Three systems help us maintain our balance and keep us from falling: visual, vestibular (inner ear), and proprioception (sensory input from muscles, joints, tendons).
Balance exercises challenge these various systems. They can begin in static postures (where your base of support is fixed) and advance to be more dynamic (where your body is moving). Dynamic balance activities are important, as they relate to “real-world” situations that you encounter everyday, for example, stepping up a curb, walking on grassy surfaces, and negotiating over and around obstacles.
5. What is considered “bad” balance, and how do I know if I am at higher risk of falls?
Some ways to tell if your balance is impaired and if you are at an increased risk of falls include: an inability to stand and balance on one foot, an inability to rise up out of a chair without using your hands, or needing a cane or walker to walk.
Common risk factors for falls:
- Muscle weakness
- Previous falls
- Fear of falling
- Polypharmacy (taking > 4 medications may increase the risk of falls and other adverse effects in older individuals)
- Gait impairments (difficulties with walking)
- Balance impairments
- Using an assistive device
- Visual impairments, new eyeglass prescription
- Arthritis in joints resulting in pain, stiffness, weakness
- Cognitive impairment
6. I'm not at risk of falling. Do I still need to work on my balance?
I would say that no one is at a 0 risk of falls. There are always sudden and unexpected circumstances that can throw us all off-balance. For the higher level individual who may be at a low risk of falls, I encourage performing higher level balance activities that challenge agility and dynamic reflexes. Especially for individuals who participate in activities such as pickleball, hiking, dance aerobics, etc. You want to choose balance exercises that relate to the requirements of the sport or activity. For example, a lot of stop and go movements, lateral lunges, and arm movements.
It’s important that balance exercises are not only safe but also appropriately challenging, and functionally relevant to our daily activities, occupational requirements, and recreational activities.
7. If I’ve fallen in the past, am I more likely to fall again?
Having a previous fall is a risk factor for another fall. This means it is even more important to work on improving your balance. Analyzing the circumstances that led to the previous fall or falls, and undergoing a falls risk assessment by a healthcare provider can help in implementing an action plan to improve your balance and make you safer.
8. What should I do if I’m afraid of falling?
Begin working with a physical therapist who can design an individualized exercise program. A multi-component exercise program that includes strengthening, balance, and posture exercises can help to decrease your risk of falling.
9. What are your 3 tips for anyone trying to improve balance and reduce their risk of falls?
- Be aware of your environment and be realistic about your functional abilities. Setup your home, workspace, and exercise areas so that they are safe. Use an assistive device if needed to maintain good alignment and give you adequate support and stability.
- Wear proper footwear both indoors and outdoors.
- Be mindful about how you move and go about your daily activities. We tend to move in habitual ways, paying minimal attention to our surroundings, which may increase our risk of tripping, slipping, and bumping into things, throwing us off-balance.
If you are unsure where to begin, consult with a healthcare professional to get a falls risk assessment and work together on an action plan to keep you safe and minimize your risk of falls and falls-related injuries.
10. What else would you like people with low bone density to know about fall prevention?
Don't be afraid to move. Inactivity causes stiffness, weakness and negatively impacts our balance, further increasing our risk of falls. Work with a healthcare professional to get started.