Falling Among Seniors: Studied but Not Solved

Fear of falling makes it happen?

Falling among older adults—it's a problem. You would think that with all of the available information and technology, there would simply be fewer falls among older adults each year. But you would be an optimist. According to the CDC, each year 40% of seniors fall (up from 30% ten years ago). I was thinking about this during a few visits to assisted living communities this past week when the tour guide mentioned the personal, carefully designed "chair exercise" program.

Let's just scan a few much-syndicated items from the past one week—all from newly published studies that researchers initiated under the theory (I'll bet), that behavioral change among seniors and the senior-related industries could apply. Each study is linked in its title.

• Falling indoors: A study done by the Institute for Aging Research concludes that "Indoor falls are associated with an inactive lifestyle, disability and poor health, while outdoor falls are associated with higher levels of activity and average or better-than-average health. Older adults who fell outdoors were somewhat younger than those who fell indoors, more likely to be male and better educated, and had lifestyle characteristics of better health. Those who fell indoors had more physical disabilities, took more medications and had lower cognitive function."
• Fear of falling makes it happen: In this Neuroscience Research Australia study, participants who were "off the mark" in perceiving their actual physical risk of falling were tracked over a one-year period. "Eleven percent, whom the research team dubbed the 'anxious' group, had a higher perceived risk than was physiologically warranted. Twenty percent, labeled 'stoics,' actually were at risk physiologically—but didn’t rate their risk as high. Followed over a year, the anxious folks did fall more than the group as a whole: 40 percent suffered multiple or injurious falls. But only about a third of the stoics fell, despite their higher physical risk." Conclusion? "Older people who have a fear of falling are at increased risk for future falls, regardless of their actual risk—and working with them to reduce their fears doesn't increase the risk by making them overly confident."
• Basic physical capability relates directly to mortality: This MRC Unit for Lifelong Health and Ageing study tracked the correlation between physical capabilities of seniors and corresponding death rates. "From 14 studies (including 53,476 participants) that dealt with grip strength, the death rate among the weakest people was 1.67 times greater than among the strongest people, after taking age, sex, and body size into account. In terms of walking speed, death rates among the slowest was 2.87 times greater than those deemed able to walk faster. As for the ability to rise from a chair, death rate among the slowest was twice that of those who could rise more quickly."

Pave a few obvious pathways to a better life: Some conclusions are obvious. First of all, for those who can walk when they move into senior housing, especially independent living communities, they just need to do more walking—whether it's group walking, mall walking, or even supervised treadmill use. Second, some strength training of legs as well as arms would seem to be included sensibly in a program beyond just chair exercises. Finally, seniors should be encouraged to practice standing and sitting to improve speed. Group practice could also reveal dizziness and medication issues. (And I am not talking about handing folks 1-pound weights three times per week to raise one arm up and down.)

Not so obvious: How about correlating skill improvement with fear reduction? What I'd like to see, though, is research based on before-and-after studies to see if practicing a skill mitigates fear of falling as well as improves "basic physical capability." If it's the case that exercise generally improves perceived well-being, then does improving basic capability improve a sense of security and confidence among the elderly who are fearful? And are most of the fearful actually women who spend most of their time indoors?

Relate tech use, fear mitigation, and improved health: To my knowledge, no actual study has been published about the relationship between use of technologies—e.g., PERS, sensor-based monitoring, fall detection devices—and reduction in a senior's fear of falling. If people are at the lower end of the risk curve but worry about falling, one aspect of that worry must be based on fear of not being able to get up on their own or perhaps not be found for hours or days. Vendors have anecdotal commentary from users of technology that they "feel safer" with it than without, but those are anecdotes. Researchers could partner with vendors in studies, not just about whether individuals are safer with the technology activated, but whether they feel safer. And finally, if technology vendors want to promote the benefits of their technology in the context of safety, wouldn't it make sense to combine "reduction in fear of falling" with advice about how physical capabilities can be improved to really reduce mortality risk?

By Laurie Orlov
Aging in Place Technology Watch Blog

[First posted September 12, 2010, at Laurie's Aging in Place Technology Watch Web site.]