By Emily McPherson, Physio Student at NYP Jan-Feb 2025, and Kate Turner
Falls risk
A fall is defined as “an event which causes a person to, unintentionally, rest on the ground or lower level, and is not a result of a major intrinsic event (such as a stroke) or overwhelming hazard” (Office for Health Improvement & Disparities, 2022).
Often, falls are a result of one or more risk factors and the cause is frequently multifactorial. These include:
- Age
- Mobility
- Muscle weakness
- Poor balance
- Sensory i.e. vision & hearing
- More than 4 medications – and the use of particular medications
- Environmental hazards
- Some specific medical conditions, which might make a person more likely to fall
It has also been found that additionally factors such as fear of falling, cognitive function, social isolation and support systems can interact with physical health to influence falls risk (Nicolai et al., 2014).
Background
With an ageing population, prevention and management of falls is a critical global challenge.
The NHS (2021) reports that approximately 1 in 3 adults over the age of 65 and half of people over the age of 80 will have at least one fall a year. In North Yorkshire alone, approximately 40,000 people aged 65 and over fall at least once a year and about 20,000 fall at least twice in a year (North Yorkshire Partnerships, 2024).
Within the UK, falls are the most frequently reported incident affecting hospital inpatients (Healthcare Quality Improvement Partnership, 2023) and 20-30 % of ambulance call outs relate to older people who have fallen. The most common injury from a fall in the over 65 population is a hip fracture; approximately 100,000 people in this cohort suffered hip fractures in 2017/18 in the UK. Treating hip fractures is thought to cost the NHS and Health and Social Care approximately £1 billion annually, with recovery from a fall and/or post-surgical intervention utilising over 3,600 hospital beds in England, Wales and Northern Ireland.
A survey commissioned by Age UK has found that millions of older people are worried about falling over, with 4.3 million (36%) saying it topped their list of concerns (Age UK, 2024) and there can be also be an impact on pain, depression and distress, and potential loss of confidence and independence, as well as on family members and carers (North Yorkshire Partnerships, 2024).
Evidence of the Role of Physiotherapy in Prevention
Minimising injuries sustained through falling
Balance training helps individuals catch themselves or adjust their posture during a fall, thus preventing severe injuries like fractures (Muir et al, 2010).
Postural control and gait retraining in preventing falls and reducing the severity of injuries when falls occur (Lord et al., 2007).
Strengthening and balance exercise programmes
Exercise interventions led by physiotherapists (including strength and balance exercises) were highly effective in preventing falls in older adults (Sherrington et al., 2019).
Predict and manage future risk of falling & advocating self-management
Education, alongside physical exercises, can significantly reduce fall-related injuries in older adults by teaching safe practices and environmental adjustments (Tinetti et al., 1994). This can include discussing medications, environmental factors eg. home environment, and advice on walking aids suitability and management.
How NYP can help
1:1 support
At NYP, we provide individual assessment and exercise programmes to help improve mobility, increase confidence, and reduce the risk of falling. We will discuss previous falls and try to analyse their cause, and any current fears of falling. The assessment may look at range of movement, strength, balance, any sensory impairments (eg. vision), gait pattern, and current activity level. Other co-morbidities may be considered, such as osteoarthritis, cardiac, neurological, or respiratory conditions. Discussion may revolve around the home environment, current socialisation, support and medication use. Using exercise programmes to enhance flexibility, strength, and balance, alongside advice and education, we can help prevent the risk of future falls and improve mobility and walking patterns. We can also provide bespoke advice regarding home environment, further intervention that may be required, and suggestions of support from other organisations.
Falls Prevention Exercise Classes
We host our weekly one-hour physio-led Falls Prevention Classes at The Globe in Stokesley on Wednesday mornings. An initial consultation by phone will establish your suitability for the programme, to discuss any previous falls, learn about any current medication that may play a role in falls risk, and help gauge the right level of exercise intensity for the first few weeks, and any advice that could be provided to help achieve your goals. On the first visit we may undertake a couple of assessments to determine your current level eg. the Timed Up and Go test (Podsiadlo & Richardson, 1991) or the 30 second Sit to Stand Test (Jones et al., 1999; Liu, et al., 2014; Mazzini, et al., 2017). Stuart, our experienced physio in Falls Prevention, will guide you through the class and adapt exercises as required.
Testimonials for our Class
REFERENCES
Age UK. (2024). Falls in later life: a huge concern for older people. Available at: https://www.ageuk.org.uk/latest-press/articles/2019/may/falls-in-later-life-a-huge-concern-for-older-people/.
Healthcare Quality Improvement Partnership. Data Government (2023). National Audit of Inpatient Falls 2023 annual report. Available at: https://www.data.gov.uk/dataset/bb9a630c-8378-4a14-87b9-943e091bf3b2/national-audit-of-inpatient-falls-2023-annual-report.
Jones, J., Rikli, R., & Beam, W. (1999). A 30-s Chair-Stand Test as a Measure of Lower Body Strength in Community–Residing Older Adults. Research Quarterly for Exercise and Sport, 70(2). pp. 113–119. Doi: 10.1080/02701367.1999.10608028.
Lord, R., et al. (2007). Falls in older people: Risk factors and strategies for prevention. Cambridge University Press.
Liu, C. J., et al. (2014). The 30-Second Sit-to-Stand Test and its Role in Assessing Physical Function in Older Adults: Evidence from Clinical Practice. Archives of Gerontology and Geriatrics, 59(2). pp. 322–327.
Mazzini, M., et al. (2017). The 30-second Sit-to-Stand Test and its Application in Assessing Physical Function in Older Adults: A Systematic Review. Journal of Aging and Physical Activity. 25(2). pp. 208-220.
Muir, W., et al. (2010). Balance and falls in the elderly: The role of physiotherapy in fall prevention. Physiotherapy Canada. 62(4). pp. 253-259. Doi: 10.1016/j.jclinepi.2009.06.010.
National Health Service. (2021). Overview: Falls. Available at: https://www.nhs.uk/conditions/falls/.
Nicolai, et al (2014). The Biopsychosocial Model in Fall Prevention: A Focus on the Elderly. Journal of Aging and Health, 26(7). pp. 1160-1178.
North Yorkshire Partnerships (2024). Working together: Falls. Available at: https://nypartnerships.org.uk/falls#:~:text=In%20North%20Yorkshire%20this%20means%20about%2040%2C000%20people,of%20people%20in%20nursing%20homes%20fall%20each%20year.
Office for Health Improvement & Disparities (2022). Guidance – Falls: applying All Our Health. Available at: https://www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health.
Podsiadlo, D., & Richardson, S. (1991). The Timed “Up & Go”: A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2). pp. 142–148.
Sherrington, C., et al. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. Doi: 10.1002/14651858.CD012424.pub2.
Tinetti, M. E., et al. (1994). Prevention of falls and injuries in elderly people. Journal of the American Geriatrics Society. 42(3). pp. 219-230.