Exercise and Fall Prevention in Seniors

Exercise and Fall Prevention among Seniors

Angele Beaulieu

Nipissing University

Exercise and Fall Prevention among seniors

In 2011, seniors aged 65 and older represented 15% of the Canadian population, approximately 5 million Canadians (Public Health Agency of Canada [PHAC], 2014).  This number is expected to double by the year 2036, reaching an estimated 10.47 million seniors in Canada (PHAC, 2014).  An estimated 20 to 30% of seniors living in the community will fall this year, and approximately half of these seniors who fall, will fall more than once (PHAC, 2014).  When examining the frequency of falls among seniors in care facilities, approximately 50 to 75%  will experience a fall this year, with an average of 2.6 falls per person per year (Centers for Disease Control and Prevention [CDC], 2014).  With falls among seniors costing the healthcare system an estimated 2 billion dollars annually, fall prevention aimed at seniors needs to be a priority if our healthcare system is to survive (PHAC, 2014).

Literature review

Better data collection is required in order to put the problem in proper perspective and to allow a more accurate analysis of both the problem and the effectiveness of interventions.  Many studies continue to use discharge counts to track occurrences of hospitalizations due to falls, whereas an episode of care analysis would better reflect the data concerning the prevalence of hospitalizations related to falls (Scott, Wagar, Sum, Metcalfe, & Wagar, 2010).

Most studies agree that muscle weakness, gait disturbances, and imbalance play an important role in the occurrence of falls (Michael, Whitlock, Lin, Fu, & O’Connor, 2012).  According to research, exercise, as a single intervention, was as effective in preventing falls among seniors living in the community, as multifactorial interventions (Sherrington, Tiedemann, Fairhall, Close, & Lord, 2011).  Seniors residing in the community, who are generally healthy, demonstrate a reduction in their risk of falling as a result of exercise; more specifically, exercise that targets balance, strength and gait, which may be executed within a group, or on an individual basis (Gillespie et al., 2013).  Some of the benefits associated with exercise include increased mobility, physical capacity, balance and bone density, and a reduction in the effects of age-related muscle loss.  

An exercise program should, in order to provide the most benefit to individuals, include strength training, and walking training, in addition to challenging the individual's balance.  Tai chi, which promotes balance and strength training, has, in most cases, been found to benefit seniors with reduced risks of falls.  Individuals at high risk of falls should not participate in brisk walking activities as this could potentially result in an increased risk of falls.  Exercise should be undertaken regularly and for an extended period of time, whether in a group or at home (Gillespie et al., 2013).  Fall prevention exercise programs should include all seniors within the community, as well as those who are at high risk of falls.

The frail elderly may benefit from an exercise program such as the Victorian Order of Nurses SMART In-Home Exercise Program, which has shown improvement in balance, strength, and flexibility, as well as self-reported activities of daily living among this population (Stolee, Zaza, & Schuchlein, 2012).

Problem

An elderly man falls during the night.  He is in excruciating pain.  The family calls for an ambulance.  The man is taken to a nearby hospital where he is kept comfortable throughout the night.  In the morning, radiological studies are conducted and the family and concerns are confirmed:  he has suffered a broken hip.  Telephone calls are placed and appointments are scheduled, transportation is arranged.  The patient leaves the facility to be transferred to a district hospital where he will undergo internal fixation.  A week goes by and the patient returns to the local facility, he is healing, but the process takes time.  A few days later, while the incision is healing, the patient develops pneumonia as a result of inactivity and immobility.  He is no longer able to fight the infection… he passes on…

This is a scenario that occurs altogether too often.  The fastest growing segment of our population is at increased risk of fall-related injuries, hospitalization and death.  One-third of seniors residing in the community will experience a fall this year, and half of them will fall more than once (PHAC, 2014), while more than half of seniors residing in care facilities will fall this year, with an average of 2.6 falls per person per year (CDC, 2014).  Falls cause seniors personal suffering, affect their quality of life (PHAC, 2014), have a negative impact on seniors’ functional ability, impair their mobility (McDonald, 2011), cost seniors their independence and, sometimes, cost them their life.  Seniors injured in a fall seldom recover fully.