Created by the World Health Organization to warn about the risks of falls, today, 24 June, is World Falls Prevention Day.
The Portuguese Physioterapists Order answers some questions about one of the main causes of accidental death in the world, with the contribution of the physiotherapist Maria Teresa Tomás, PhD in Physical Activity and Health.
How to prevent something that is unpredictable?
Physiotherapist Maria Teresa Tomás - Falls are commonly defined as "inadvertent or unintentional falling on the floor, or other lower level, excluding intentional change of position to rest" (WHO, 2007) and have their own classification in the International Classification of Disease.
About 28-35% of individuals aged 65 years and over fall at least once a year and if we consider individuals aged 70 years and over the frequency rises to 32-42%, being the cause of approximately 40% of deaths by injury or trauma (WHO, 2007).
Amongst the geriatric syndromes (cognitive incapacity, incontinence, postural instability, immobility and family insufficiency), postural instability is the most responsible for the risk of falls, which imply costs at different levels (physical, functional, social, financial), both for the older individual and for his/her family and/or carers and for society.
What are the risk factors for falls?
Physiotherapist Maria Teresa Tomás - As falling is something that is potentially unpredictable, it is important to know and reduce or eliminate the known risk factors involved in the fall mechanism. These risk factors can be grouped into intrinsic risk factors: dementia, vestibular dysfunction, peripheral neuropathy, orthostatic hypotension, polymedication (five or more drugs) and type of medication (psychotropic), decreased visual acuity, chronic diseases (e.g. osteoarthritis, history of stroke, anaemia, etc.); extrinsic and/or interface risk factorsobstacles in the external environment (e.g. altered pavements or asphalt) or internal environment (furniture, non-adherent carpets, pets, slippery floors, insufficient lighting), type of footwear used, physical restrictions, type of activity performed (e.g. climbing on cupboards, etc), personal risk factors: age >80 years, gait and balance alterations, depression; cognitive deterioration, muscle weakness (sarcopenia), female gender, dependence in activities of daily living, lack of exercise.
How can physiotherapy help in both prevention and rehabilitation?
Physiotherapist Maria Teresa Tomás - the multidisciplinary intervention, where the physiotherapist is essential, involves the prevention or rehabilitation of post-fall status:
- Education for greater empowerment of the individual or his/her caregivers in the management of the fall prevention and/or rehabilitation process (greater health literacy, knowledge of all the factors involved). Teaching the individuals and/or their caregivers about exercises at home (home-based exercise programs)
- Increased levels of physical activity and specifically Exercise Programmes to increase strength and muscle quality, increase aerobic capacity and increase flexibility and balance with greater or lesser autonomy, supervised or at home. Examples are walking programmes, Nordic walking, Pilates, Tai Chi, yoga programmes, among many others, as long as their implementation is directed at the functional limitations or changes of each individual
- Therapeutic reduction/optimisation
- Correction of sensory deficits (auditory, visual, proprioception, etc)
- Treatment of orthostatic hypotension
- Treatment of chronic diseases
- Vitamin D supplementation
- Correction of environmental risk factors
O physiotherapistIn addition to a full assessment, it should intervene on almost all the aspects described above, with particular emphasis on education, exercise and correction of environmental factors as well as improvement in the functional management of associated chronic diseasesoptimising the functional capacity of the older person within a multidisciplinary team. Physical exercise programmes directed to the clinical and functional particularities of each individual, particularly if associated to a multidisciplinary intervention, were associated to a lower risk of falls with injury, when compared to the usual intervention. Gear programmesand particularly Nordic walking programmes, were also associated with higher levels of autonomy and muscular strength, and better postural stability, these being community-based programmes of low financial impact and low to moderate intensity, well tolerated by this population, with higher levels of adherence and better results.