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To Fall, Or Not To Fall?

Falling affects people of all ages. Typically you fall, you get back up. Maybe a visit to the doctor with ridiculously long waits is ahead. But what about people living in rural areas who are much farther away from a clinic with the right resources? In severe cases, they could be waiting hours for emergency services to reach them or struggle to get themselves up. It is extremely important that rural communities are provided with resources to ensure they do not feel stranded when falls occur. But what can be even more helpful is preventing those falls in the first place.

Ellah, a recent Master’s graduate in Rehabilitation Science, asked rural residents the question “how far would you be willing to travel to access healthcare?” as part of her thesis. Most people stated that unless their condition was life-threatening, they would not expend their time, money, and energy to get the help they need. This often results in people not getting the care and treatment they need.

But then why do people choose to live in rural areas if it means limited access? As people age and begin to retire, they are more likely to want to escape busy city life. To get away, they choose quiet and calm areas that are typically remote. In addition, Alberta has a large agricultural sector and many Indigenous residents, so living more rurally is just a way of life for some families. But regardless of why people live outside of urban centres, they should still have the same access to care as anyone who lives in a city.

Now, back to falling.

Although not all falls are serious, they can result in many injuries which impact everyday life. Fractures to the wrist, arm, ankles, or hip, or head injuries may occur, and these can have a huge impact on quality of life. So, how can the chances of falling be reduced?

Let’s start by breaking down the three phases of a fall. Stage 1 is balance disruption, meaning something or someone has thrown us off balance. This could include slipping, tripping, or being knocked over. Certain medications may have side effects such as dizziness which can cause loss of balance and control. Other factors may include poor lighting, environmental conditions like ice, or using the wrong assistive devices.

Eliminating external factors, like the ones above, can be an easy fix. Be aware of the environment: avoid slippery areas or potential tripping objects. Another alternative would be to use a mobility aid, whether it’s a cane or walker to help stabilize you.

Stage 2 is a failure of the body to restore balance: either the muscles do not react in time, or processing to the brain takes too long. The time it takes for you to process a signal and respond to it is called your reaction time. Younger individuals have faster reaction time and typically use their hands to brace for falls. This results in either stopping the fall completely or minor injury to the shoulders or arms. On the other hand, older adults have slower reaction times and are more likely to fall on vulnerable areas, such as the spine, hip, or stomach, and may injure vital organs.

Lastly, Stage 3 of a fall is ground contact, where the force of the impact is transmitted throughout the body and the organs. There’s not much to do about this stage except for prevention and providing treatment afterwards for injuries. You really want to avoid falling if at all possible! If falling is a persistent concern, completing a falls risk assessment can be useful.

In the early days of the pandemic, Ellah (our Master’s graduate) realized that assessments over Zoom or Google Meet weren’t practical for clinicians as there was no way to obtain information on physical measures. Without this type of data, it is extremely hard to correctly diagnose an individual and start their treatment. Working with the technology in the lab and revising pre-existing fall risk assessment tools, Ellah worked on completing a virtual fall risk assessment that allows for both patient accessibility and clinician practicality. Falls risk assessments can help prescribe mobility aids, change medications that are interacting, and identify any other factors that could increase the chances of falling, like poor balance. They can also identify postural and gait issues, and assess arm swaying.

Arm swaying improves coordination while walking, with the opposite arm and leg swinging at the same time. Patients with reduced arm swaying will most likely feel more unstable when they walk.

Gait is a fancy word for describing how someone walks. Clinicians specifically look for patterns, paying attention to when the heel and toe leave or make contact with the ground. These cycles can show any deficiencies or abnormalities of the legs while walking. This data can then be used to strengthen the leg or hip muscles and improve walking.

Posture is another key element when identifying how someone will fall. Sometimes, individuals will hunch their backs due to excess strain on their backs. In an upright posture, the axis of the centre of gravity goes through the top of the head. When in a hunched position, the centre of gravity is more forward, which increases the chances of someone falling on their face. Have a look at the diagram below to help you understand!

After assessing all the above variables, a clinician may recommend starting an exercise program to strengthen the muscles in your body. Currently, the lab is working with the Evergreens Foundation, a non-profit organization that offers seniors housing, to establish fall risk assessments for seniors. With their support, we will not only continue to develop our falls risk protocol but will also begin to create personalized falls prevention exercise plans for the seniors. This work will hopefully help the Evergreens residents feel safer and stronger!

We are living in an aging population. While falling is by no means isolated to older adults, proportionally older adults fall more each year than any other group. By completing a fall risk assessment, clinicians and patients can work together to ensure increased safety in all sorts of environments. If you know someone who might be at risk of falling (this could even be you!), consider a falls risk assessment - and consider giving our new virtual model a try!

We hope you learned a bit about falling and falls risk assessments today. Stay tuned for our February update at the end of the month - and stay safe! Until next time!!

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