As We Age: Balance and Falls

Reducing Falls and Improving Balance
Falls are the leading cause of hospitalization and accidents in people over 65 years old. While aging can contribute to an increased risk of falling, there are many preventative steps that can be taken to reduce the risk of a fall and to improve balance.

“Falling is not a natural part of aging,” says Theresa L. Jacobs, PT, DPT, Board Certified Geriatric Clinical Specialist and Clinical Education Coordinator of Rehabilitation Services at Newton-Wellesley Hospital. “There are certain factors that occur as we age that increase our risk, but they can be modified to create a safer environment to help prevent the chance of falling.”

Theresa describes a fall as any unintentional contact with the floor or a lower surface such as a chair, counter top or stair.

Treatment at Rehab Services
“When older patients come to see us in Rehabilitation Services at Newton-Wellesley we work with them on various ways to reduce their risk of falling,” says Theresa. “Some of the factors affecting balance include strength, range of motion, vision, inner ear conditions and loss of sensation especially in the feet. We work with each individual patient to determine where their impairments are and create action plans to improve function.”

The Department of Rehabilitation Services works with each patient to increase strength, range of motion and compensate for problems that we can’t change such as vision and lack of sensation. The team works to educate the patient about the factors that are contributing to their risk of falling, which ultimately will increase their balance confidence and reduce their fall risk. The Department is committed to bringing patients the most high-quality and personalized care. With a dedication to excellence and state-of-the-art facilities, Newton-Wellesley is a leading provider of rehabilitation services in the greater Boston area.

“Research has demonstrated that balance confidence is a strong predictor of falls in the older population,” says Theresa. “We work with them and create balance tasks that become increasingly more challenging in order to help them regain their confidence.”

Patients are assigned a primary therapist to ensure continuity of care and undergo a thorough evaluation to determine their individualized treatment plan. This therapist works with the patient and the referring physician to design and implement a therapeutic strategy with appropriate individualized rehabilitation goals.

Educating Patients
Theresa and the Rehab team educate their patients about environmental factors that contribute to increased fall risk. “About half of all falls happen at home,” she adds. “We advise older adults to make some easy changes within their home to make it a safer place.”

Some of these recommendations include:

  • Removing area rugs and other tripping hazards;
  • Using nightlights as falls often occur at night;
  • Installing grab bars next to the toilet and in the shower or tub and using non-slip mats;
  • Improving lighting within the home;
  • Moving commonly used items to lower shelves;
  • Installing handrails;
  • Wearing shoes inside and outside the house instead of going barefoot or wearing slippers.

“I also encourage people to stay active. Doing less means the less you can do,” says Theresa. “As we age our reaction time slows and inactivity compounds these changes. Being active and participating in a regular exercise program greatly improves strength, balance and coordination. We can help patients determine the correct level and type of exercise.”

Risks from Medications
Another factor that puts older adults at great risk is being on multiple medications. It is important for older adults to review their comprehensive medication list with their physician.

“As we age, medications can have different effects on our bodies,” says Theresa. “Some medications – both prescription and over the counter – can create sleepiness or dizziness and increase fall risk. Before making any changes to their medications, patients should consult their physician, but there might be ways of lessening the impact.”

Dizziness and Vertigo
Dizziness also increases with age and is more common in those over age 65. Organs in the inner ear called the vestibular system contribute to balance. Just as changes occur in hearing as we get older, changes also occur in the vestibular system. These changes can lead to feelings of dizziness or unsteadiness especially with head movements, known as positional vertigo.

“Positional vertigo increases as we age and is very treatable,” says Theresa. “This condition causes the sudden sensation of spinning and usually occurs when the head is in a certain position or moves to a certain position such as lying down, turning in bed, looking up or looking down. It can cause patients to feel off balance and lightheaded.”

The Rehabilitation Services team works with patients to treat their positional vertigo by using a repositioning procedure. The department utilizes video goggles – an enhanced technology to ensure that the therapist is able to assess which canal is involved and perform the appropriate treatment based on this assessment. The video goggles allow therapists to record the sign of positional vertigo (eye movement called nystagmus) as it can often be missed under direct observation. Additionally, evidence of more serious problems can be captured and sent to the patient’s referring physician.

Restoring Balance Confidence
“We want people to know that falling doesn’t have to be an inevitable part of getting older,” says Theresa. “There are many factors that affect the chance of falling and we can help people work through each of these and restore their balance confidence. Our team is qualified to address the concerns of each patient we see and develop individualized plans to meet their needs. ”

Theresa L. Jacobs, PT, DPT, GCS
Clinical Education Coordinator, Rehabilitation Services
Newton-Wellesley Hospital
Theresa received her master's of science in physical therapy from Long Island University and her doctor of physical therapy from the MGH Institute of Health Professions. She is a board certified geriatric clinical specialist. Theresa's clinical interests include working with people with issues related to balance/falls, vertigo, Parkinson's and multiple sclerosis.

For more information about Rehabilitation Services at Newton-Wellesley Hospital, call CareFinder at 1-866-NWH-DOCS (694-3627) or visit www.nwh.org/rehab
.

Welcome
Timothy Foster, MD
Chief of Orthopaedics, Newton-Wellesley Hospital


Dr. Foster recently joined Newton-Wellesley Hospital as the Chair of Orthopaedics. He received his medical degree from Boston University School of Medicine and completed his general surgery residency at Dartmouth-Hitchcock Medical Center and his orthopaedic surgery residency at Boston University Medical Center. Dr. Foster completed his fellowship in sports medicine at Harvard University and Massachusetts General Hospital and his pediatric sports fellowship at Harvard University and Children’s Hospital. He is board certified in orthopaedic surgery.

Dr. Foster is an Associate Professor at Boston University School of Medicine. He is also orthopaedic director and co-founder of the post-doctoral sports fellowship at Boston University. Dr. Foster is the author of multiple peer review articles and book chapters and served as the Associate Editor of the American Journal of Sports Medicine for the past 15 years. He is also a member of the American Board of Orthopaedic Surgery, American Academy of Orthopaedic Surgeons and the American Orthopaedic Society for Sports Medicine. Dr. Foster’s special interests include sports medicine and arthroscopic surgery including surgery of the shoulder, knee and ankle.

For more information about orthopaedic services offered at Newton-Wellesley Hospital, please visit
www.nwh.org
or call 617-243-6566.  

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