Accidental falls are common, and the risk of falling rises with age. Recognition of the problem is now universal, but exactly when people (or their doctors) choose to intervene is highly variable.

Timed-Up-and-Go Test Predicts Fall Risk

There are many tests to assess fall risk among people age 65+. The most commonly recommended one is the Timed-Up-and-Go Test.(1) However, research suggests that, for certain people, there may be a much easier way to gauge fall risk. In the Timed-Up-and-Go Test (TUGT), you start seated in a chair with no arms. When the timer starts, you rise from the chair, walk three meters, turn around, walk back to the chair, and sit down. If you use a cane or walker, you are expected to use that during the test as well. People often take this test because they have experienced an accidental fall. The purpose is to see if there is rehab potential to prevent future falls, injury, or death. Among seniors who have already experienced an accidental fall, a time of 12 to 15 seconds correlates with a 47% increase in one-year fall risk. A time of over 15 seconds correlates with a 138% increase in the rate of falls. More specifically, 90.6% of seniors who take 15 seconds on the TUGT fall again in the next year, while 38% of seniors taking 11 seconds or less fall again.(2)  

Simple Walking Speed Predicts Fall Risk, Too

Interestingly, one research study found that all that rising, turning, and sitting may be superfluous.(2) You might not even need the chair. Among seniors who had already experienced an accidental fall, simple gait speed predicted future falls as well as the TUGT. A walking speed of 0.6 to 1.0 meters per second correlated with a 51% increase in one-year fall risk. A gait speed of 0.6 m/s or less correlates with a 145% greater chance of falling.

How to Reduce Fall Risk

When to start reducing the chance of a fall is a matter of personal risk tolerance. Once a problem is recognized, a comprehensive program including physiotherapy can do a lot to protect seniors. Professionally-supervised therapeutic exercise alone is known to reduce the risk of accidental falls by 35%.(3) Seeing other healthcare providers for services such as vision checks and medication reviews as well as home safety improvements may further reduce the risk of fall injuries.(4) Among people age 70+ who are at risk of falling, even taking vitamin D supplements can prevent fall injuries.  

At Advanced Physiotherapy, a comprehensive fall-injury prevention program can include:

• Care planning from both qualified physiotherapists and an accredited exercise physiologist
• Gait training (including retraining on foot height and stride length)
• Balance training – proprioceptive training
• Transfer training (training for getting up and down from furniture)
• Strengthening (lower & upper body)
• Posture assessment and training
• Consultation about home modifications
• Evaluation for and training with adaptive equipment such as canes or walkers
• Range of motion (arms, legs, and core)

References

1. Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc. 2001; 49: 664-672.
2. Viccaro L, Parera S, Studenski S. Is timed up and go better than gait speed in predicting health, function, and falls in older adults? J Am Geriatr Soc. 2011; 59 (5): 887-892.
3. Carande-Kulis V, Stevens JA, Florence CS, Beattie BL, Arias I. A cost–benefit analysis of three older adult fall prevention interventions. Journal of Safety Research. 2015 Feb 1;52:65-70.
4. Centers for Disease Control and Prevention,  National Center for Injury Prevention and Control,  Division of Unintentional Injury Prevention. Keep them STEADI: preventing older adult falls in hospital-based settings. Sept 2016. Available at: cdc.gov/steadi/stories/hospital.html.