Many of you may have had an elderly family member who has suffered as a result of a bad fall. This might come as a shock but it has been reported that falls have cost NSW $500 million in 2006/2007. I do not have any more recent data. This apparently applies to direct and indirect costs, indirect being time off work and loss of function. In a more recent report, The World Health Organisation (WHO) states that it costs approximately $65 billion worldwide in direct costs. In the WHO report, they name an Active Ageing Cycle and a Fall Cycle. In the active ageing cycling it says that as people get older, falls do not have to be more likely. This is a really important point. The Fall Cycle is highlighting that once a fall has occurred, the person is scared of moving, mobilises less, deteriorates more, becoming less active, and therefore more likely to fall, it becoming a vicious cycle.
Unfortunately organic diseases such as Parkinson’s, developmental disorders with children such as sensory processing disorder, and even migraine sufferers can have a greater susceptibility to falls. It is known through research that higher level athletes have better balance than the general public. Fall risk factors can be a result of biological, environmental and behavioural means. Research has shown that lack of exercise, low Vitamin D levels (not in all cases), and some medications contribute to the increase likelihood of a fall.
According to recent research “Specifically, individuals with slower gait speeds are at a higher risk of disability, cognitive impairment, institutionalisation, falls and mortality. A meta-analysis has found that older individuals in the lowest quartile of gait speed had a threefold increased risk of mortality when compared with individuals in the highest quartile.”
“Gait speed, also often termed walking speed, has been shown to be associated with survival among older adults in individual epidemiological cohort studies 6–12 and has been shown to reflect health and functional status. Gait speed has been recommended as a potentially useful clinical indicator of well-being among the older adults.” Read here for the https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080184
In essence, gait speed could be considered a simple and accessible summary indicator of vitality.
There are some tests that can be performed to help determine the reason for a fall, or slow gait, including balance tests.
Balance is defined as the ability to maintain the body’s centre of gravity over its base of support with minimal sway or maximum steadiness. The ability to maintain balance is based on a complex interaction between sensory, vestibular (please see below for a definition) and visual functions and coordination of movements with muscle activity. As previously mentioned, balance does not have to decline as one gets older and when gait speed is reduced, balance is one of the important aspects of body function to check.
Balance measuring systems will need to include visual, proprioceptive (feedback) and vestibular systems (brain based balance centres).
One of the best non- computerised test static tests to measure the separate components of balance is called the Modified Clinical Test of Sensory Imbalance. With the person standing the test involves: eyes open (visual, vestibular, proprioceptive), eyes closed (loss of visual input so rely on vestibular and proprioceptive), standing on a foam pad with eyes open (vestibular system tested and makes proprioception no longer valid) and foam pad eyes closed (testing the vestibular system in isolation).
Dynamic tests include multiple organ systems not excluding the cardiac and the vestibular system. Walking speed is one of them, again so trying to determine the cause of the change of the gait speed is clinically significant and therefore greatly helpful in recovery! The Star excursion test is another dynamic test to assess the ankle or hip stability, two definitely important requirements for balance and stability. It essentially measures the difference between either leg on a postero-medial step back often using duck tape on the floor as a measurement comparison.
It is important to note that computerised system checks do offer a greater level of testing and would certainly be recommended for many cases.
Some other helpful medical tests to determine why a fall has taken place would be
1. Visual acuity
3. Medication review
4. Bone density
Please speak to your GP about these.
If you require more information on co-ordination, or balance problems, please contact us so we can help refer you to the appropriate people.
For more information regarding your elderly loved ones, My Aged Care is an informative site.
N.B: “The vestibular system, in most mammals, is the sensory system that provides the leading contribution to the sense of balance and spatial orientation for the purpose of coordinating movement with balance.” (Wikipedia). There are vestibular receptors in the inner ear, the connections between them and other areas in the central nervous system.
“Together with the cochlea, a part of the auditory system, it constitutes the labyrinth of the inner ear, situated in the vestibulum in the inner ear. As our movements consist of rotations and translations, the vestibular system comprises two components: the semicircular canal system, which indicates rotational movements; and the otoliths, which indicate linear translations. The vestibular system sends signals primarily to the neural structures that control our eye movements, and to the muscles that keep us upright. The projections to the former provide the anatomical basis of the vestibular – ocular reflex, which is required for clear vision; and the projections to the muscles that control our posture are necessary to keep us upright.” Taken from SPD Australia.SPD Australia supports and advocates for people with a sensory processing disorder.
Proprioception is the sense of the relative position of one’s own parts of the body and strength of effort being employed in movement. It is sometimes described as the “sixth sense”. In humans, it is provided by proprioceptors in skeletal striated muscles (muscle spindles) and tendons (Golgi tendon organ) and the fibrous membrane in joint capsules. It is distinguished from exteroception, by which one perceives the outside world, and interoception, by which one perceives pain, hunger, etc., and the movement of internal organs. The brain integrates information from proprioception and from the vestibular system into its overall sense of body position, movement, and acceleration.