Preventing Falls: Balance and Strength for Older Adults

Why falls happen

Most falls result from several factors acting together rather than a single cause. Staying upright depends on muscle strength, especially in the legs and hips, on balance systems in the inner ear, on vision, on sensation in the feet, and on the brain's ability to coordinate all of these quickly. With age, inactivity and some health conditions, each of these can decline, and the margin for error narrows.

On top of that come external factors: a loose rug, poor lighting at night, a step without a rail, wet bathroom floors, slippery footwear, or icy sidewalks in an Ontario winter. A person with good strength and balance recovers from a trip; a person whose reserves have dwindled may not.

Common risk factors

The more of these that apply, the higher the risk of falling. The encouraging part is that most can be improved.

• Previous falls, especially in the past year.
• Leg weakness or difficulty rising from a chair without using your arms.
• Problems with balance or walking, or using furniture to steady yourself.
• Taking four or more medications, or medications that cause drowsiness or dizziness.
• Dizziness or light-headedness, including when standing up.
• Poor eyesight, or recently changed glasses, especially bifocals or varifocals on stairs.
• Foot pain, numbness in the feet or poorly fitting footwear.
• Fear of falling that has led to doing less.
• Needing to rush to the toilet, particularly at night.

Simple tests of your risk

Physiotherapists use several quick, standardised tests to measure fall risk and track progress. Two of the most common can be tried at home with someone nearby for safety.

In the 30-second chair stand test, sit in the middle of a firm, armless chair with arms folded across your chest, then stand fully and sit down as many times as you can in 30 seconds. Lower scores, which vary by age and sex, suggest leg weakness linked to fall risk. In the Timed Up and Go test, you stand up from a chair, walk three metres at a normal pace, turn, walk back and sit down. Taking twelve seconds or more suggests an increased risk of falling.

These tests do not replace a full assessment, but they are a useful starting point and an easy way to see improvement over time.

The exercise that works

A large body of research, summarised in Cochrane reviews, shows that exercise programmes for older adults living in the community reduce the rate of falls by around 23 percent, with programmes focused on balance and functional exercise having the strongest effect. Programmes combining balance with strength training perform well, and Tai Chi has good evidence too.

Two things make the difference. First, the balance exercises must genuinely challenge your balance — standing with feet closer together, on one leg, or reaching beyond your comfort zone, with a counter nearby for safety. Easy exercises that never make you wobble do not train the system. Second, the programme needs to be done regularly, around three hours a week in total, and continued over months. The benefit fades if exercise stops.

Well-known programmes such as the Otago Exercise Programme, developed specifically for older adults at home, combine progressive leg strengthening, balance exercises and walking, and are often started with a physiotherapist and continued independently.

Examples of balance and strength exercises

These are examples of the kind of exercises used in falls prevention programmes. Always do them next to a sturdy counter or the back of a heavy chair, and progress gradually. A physiotherapist can tailor the level so that it is safe but still challenging.

• Sit to stand: rise from a chair without using your hands, ten times, slowly.
• Heel raises: rise up onto your toes and lower slowly, holding the counter.
• Side leg raises: lift one leg out to the side and back, keeping your trunk upright.
• Tandem stance: stand with one foot directly in front of the other, heel to toe, for up to 30 seconds.
• Single-leg stance: stand on one leg, lightly touching the counter, building toward no hands.
• Heel-to-toe walking along the counter.
• Walking: a regular walk, gradually increasing time and pace.

Fear of falling

After a fall, or even a near-miss, many people become afraid of falling again. This is understandable, but it often leads to doing less — avoiding outings, stairs or walks — which weakens muscles and balance further and increases the risk of the very thing they fear. Fear of falling is itself a recognised risk factor.

Rebuilding confidence is part of treatment. Practising challenging tasks in a safe, supervised setting, learning how to get up from the floor, and having a plan for what to do if a fall does happen all reduce fear. Many people are surprised at how quickly confidence returns once they see their strength improving.

Beyond exercise

Exercise is the most effective single measure, but a full falls prevention plan considers the whole person.

• Ask your doctor or pharmacist to review all medications, including sleeping pills, blood pressure medicines and over-the-counter products.
• Have your eyes checked every one to two years, and take extra care on stairs with new glasses.
• Wear well-fitting shoes with a firm sole and a heel that holds the foot; avoid loose slippers.
• See a chiropodist or foot specialist for painful feet or nail problems.
• Ask about vitamin D if you spend little time outdoors.
• Stand up slowly, especially at night, and sit on the edge of the bed first.

Making the home safer

Simple changes reduce the hazards that turn a stumble into a fall. Remove or secure loose rugs and trailing cords. Install grab bars by the toilet and in the bath or shower, and use a non-slip mat. Put night lights between the bedroom and bathroom. Fit sturdy handrails on both sides of stairs and keep stairs clear. Store everyday items within easy reach to avoid step stools. In winter, keep salt or grit by the door and use ice cleats on footwear for outdoor walking. An occupational therapist can do a full home assessment when needs are more complex.

Dizziness is often treatable

Dizziness and vertigo are common contributors to falls, and some causes are very treatable. Benign paroxysmal positional vertigo, which causes brief spinning when you roll over in bed or look up, can often be resolved in one or two sessions with a repositioning manoeuvre. Persistent unsteadiness after an inner-ear infection responds to vestibular rehabilitation. Light-headedness on standing may relate to blood pressure or medication and should be discussed with your physician.

Falls prevention physiotherapy in Woodbridge

At Med Wellness on Ansley Grove Road in Woodbridge, our physiotherapists assess balance, strength and walking with standardised tests, check for treatable causes such as BPPV, and design a progressive home exercise programme that builds strength and confidence. For people who find travel difficult, home visits are available. The clinic has free on-site parking and a ground-floor accessible entrance.

No referral is needed in Ontario, and physiotherapy is covered by most extended health plans. Family members are welcome to attend. Call +1 (905) 605-8889 to book an assessment.