Balance and fall prevention

Balance and fall prevention

Poor balance and environment can often lead to falls, especially in the older population. Falls are the sixth leading cause of death for seniors and the first leading injury-related cause of death in seniors. (3) Of individuals aged 65 years and over 30% will experience at least one fall each year. Falls are responsible for 95% of hip fractures. Unfortunately after experiencing a hip fracture only 50% of older patients are able to maintain their independence. (3) The chance of falls increase as we get older due to age related risk factors but there are many contributing factors that we can control and can reduce the risk.

Intrinsic Factors

One of the main age related risk factors is balance. There are three primary body systems involved in maintaining balance; proprioception, vestibular, and vision. Proprioception refers to “body awareness” or our natural muscular response to physical stimulus in order to keep the body upright. Vestibular, or inner ear, uses head rotation and acceleration to determine the strength of the compensation reaction. Lastly vision, has less of an involvement, as visual input has a longer time delay, however it is most involved when on an unstable surface. Changes in these three body systems are inevitable as we age and therefore we classify these as age related risk factors to falls.

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External (modifiable) Risk Factors

There are many external risk factors to falling however some of the most modifiable include Environment, Muscular Strength, and Personal Behaviour. Environment can be improved by removing tripping hazards such as rugs, loose cords and making sure lighting is adequate in the home. Improving muscular strength, especially in the quadriceps or thigh muscles, is one of the most critical changes one can make. (2) Finally, personal behaviours such as wearing supportive shoes and walking with a gait aid help to minimise the risk. (3)

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Physiotherapy and Reducing the Risk of Falls

Care provided by an interdisciplinary health care team can reduce falls by approximately 50% in senior fallers. (4) As a member of this team, physiotherapists will help by analyzing what modifiable factors can be changed to minimize the risk such as balance, strength, gait, co-ordination, and strength. (5)

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Balance and fall prevention is not just for the elderly. Anyone with neurological conditions, nerve damage or muscular weakness can benefit. Other causes of falls to be aware of include but are not limited to; medication, chronic illness, acute infections, poor vision, hearing loss, and changes in metal alertness.

**The Ministry of Health, in partnership with the B.C. Injury Research and Prevention Unit has a great resource on fall prevention strategies and can be found here:


  2. Chandler, Julie, PhD et al, Is Lower Extremity Strength Gain Associated With Improvement in Physical Performance and Disability in Frail, Community-Dwelling Elders?, Arch Phys Med Rehabil, Vol 79, Jan 1998.
  3. Liu H. and Frank A., Tai chi as a balance improvement exercise for older adults: a systematic review, J Geriatr Phys Ther, 2010
  4. Liu-Ambrose T, Donaldson MG, Ahamed Y, Graf P, Cook WL, Close J, Lord SR, Khan KM: Otago home-based strength and balance retraining improves executive functioning in older fallers: a randomized controlled trial. J Amer Geriatr Society, 2008, Oct 2008.
  5. Howe T.E, et al., Exercise for improving balance in older people, Cochrane Database Syst Rev, 2011

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