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Holistic Fall Prevention

July 27, 2012 Written by JP       [Font too small?]

According to the Centers for Disease Control and Prevention (CDC), over 30% of adults over the age 65 experience a fall each year. Not only are falls the leading cause of injury related deaths in seniors, but they’re also the most prevalent cause of hospital admissions due to physical trauma. Thankfully, there’s quite a lot that can be done to prevent falls. And, as with most health care and safety issues, a combination of conventional and holistic strategies is likely to yield the best results.

A good place to begin is to follow several common sense guidelines advocated by the CDC. They recommend: a) exercising regularly to improve balance, coordination and leg strength; b) reviewing eyeglasses and medications to determine whether they’re out of date or otherwise causing dizziness or drowsiness; c) evaluating living spaces and making necessary changes to improve safety including the addition of better lighting, grab bars and railing in potentially hazardous areas such as bathtubs and stairs.

In terms of complementary approaches, twice-weekly Tai Chi practice has been shown to reduce fall risk, fear of falling and lower limb weakness. In addition, Tai Chi supports healthier bone remodeling which may, in the long term, reduce the likelihood of fractures which frequently result from falls. Other mind-body therapies, including Feldenkrais exercises, have also demonstrated promise in terms of benefiting attention, balance and mobility in older adults. Feldenkrais exercises and Tai Chi differ from standard exercise programs in that they emphasize mindfulness and the connection between the body and mind.

A recent review in the Journal of Neuroengineering and Rehabilitation recommends establishing or maintaining “a minimum serum Vitamin D concentration of 60 nmol/L” in order to reduce fall risk by 23%. One of the mechanisms underlying Vitamin D’s important role in fall prevention is that it improves neuromuscular function. Some of the research in this arena goes one step further by suggesting calcium supplementation in addition to Vitamin D. Once again, the idea here is not only to reduce fall risk, but also to protect bones in the event that a fall occurs. Finally, one intriguing study points out that older women with higher DHEA levels, an adrenal hormone that tends to decline with age, respond better to calcium and Vitamin D therapy. Daily mediation is a natural means of increasing DHEA production and may, thereby, have a yet undiscovered role in fall prevention.

Other holistic approaches to avoiding falls include the regular use of a multivitamin supplement and the inclusion of lavender aromatherapy in your daily routine. Ideally, these natural alternatives should be applied as part of a comprehensive treatment protocol. What’s more, if a tendency towards falling increases unexpectedly, a consultation with a physician is absolutely essential. It’s estimated that more than half of all falls go unreported. This is a dangerous and unwarranted trend. There is absolutely no shame in reporting a fall and much to gain by sharing this pertinent medical information with your health care team.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - Effectiveness of Tai Chi as a Community-Based Falls Prevention (link)

Study 2 - Impact of Tai Chi Exercise on Multiple Fracture-Related Risk Factors(link)

Study 3 - The Effect of Supervised Tai Chi Intervention Compared to (link)

Study 4 - Effects of Feldenkrais Exercises on Balance, Mobility, Balance (link)

Study 5 - Fall Prevention and Vitamin D in the Elderly: An Overview of the Key … (link)

Study 6 – Does Daily Vitamin D 800IU and Calcium 1000mg Supplementation (link)

Study 7 – Vitamin D Supplementation Improves Neuromuscular Function in Older (link)

Study 8 - Effect of Calcium Supplementation on Fracture Risk: A Double-Blind (link)

Study 9 - Additive Benefit of Higher Testosterone Levels and Vitamin D Plus (link)

Study 10 - Elevated Serum Dehydroepiandrosterone Sulfate Levels in (link)

Tai Chi Practice May Improve Bone Remodeling

Source: BMC Complement Altern Med. 2012 Jan 30;12:7. (link)

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7 Comments & Updates to “Holistic Fall Prevention”

  1. JP Says:

    Update – Tai Chi supports balance in MS patients:

    http://www.ctcpjournal.com/article/S1744-3881%2814%2900063-2/fulltext

    Highlights:

    • Tai Chi exercise is helpful to MS patients’ movement balance.
    • Tai Chi exercise reduces the risk of fall.
    • Nurses can use Tai Chi as a preventive technique.

    Objective:

    To examine the effect of Tai Chi Chuan on balance in women with multiple sclerosis in Iran.

    Design:

    36 women with multiple sclerosis who were members of the Iranian Multiple Sclerosis Society participated in this study. 18 participants were allocated to the intervention group and 18 allocated to the control group. The intervention consisted of Yang style Tai Chi Chuan exercise sessions twice a week for 12 weeks.

    Main outcome measures:

    This study used a demographic questionnaire and the Berg Balance Scale (BBS) to collect data.

    Results:

    After 12 weeks, the mean score of the BBS in the intervention group demonstrated a statistically significant improvement in comparison with baseline status.

    Conclusions:

    The results suggest that Tai Chi Chuan could be used as a safe complementary intervention to increase balance in patients with multiple sclerosis.

    Be well!

    JP

  2. JP Says:

    Update 06/06/15:

    http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322015000300157&lng=en&nrm=iso&tlng=en

    Clinics (Sao Paulo). 2015 Mar;70(3):157-61.

    Analysis of static and dynamic balance in healthy elderly practitioners of Tai Chi Chuan versus ballroom dancing.

    OBJECTIVE: To determine whether Tai Chi Chuan or ballroom dancing promotes better performance with respect to postural balance, gait, and postural transfer among elderly people.

    METHODS: We evaluated 76 elderly individuals who were divided into two groups: the Tai Chi Chuan Group and the Dance Group. The subjects were tested using the NeuroCom Balance Master¯ force platform system with the following protocols: static balance tests (the Modified Clinical Tests of Sensory Interaction on Balance and Unilateral Stance) and dynamic balance tests (the Walk Across Test and Sit-to-stand Transfer Test).

    RESULTS: In the Modified Clinical Test of Sensory Interaction on Balance, the Tai Chi Chuan Group presented a lower sway velocity on a firm surface with open and closed eyes, as well as on a foam surface with closed eyes. In the Modified Clinical Test of Sensory Interaction on Unilateral Stance, the Tai Chi Chuan Group presented a lower sway velocity with open eyes, whereas the Dance Group presented a lower sway velocity with closed eyes. In the Walk Across Test, the Tai Chi Chuan Group presented faster walking speeds than those of the Dance Group. In the Sit-to-stand Transfer Test, the Tai Chi Chuan Group presented shorter transfer times from the sitting to the standing position, with less sway in the final standing position.

    CONCLUSION: The elderly individuals who practiced Tai Chi Chuan had better bilateral balance with eyes open on both types of surfaces compared with the Dance Group. The Dance Group had better unilateral postural balance with eyes closed. The Tai Chi Chuan Group had faster walking speeds, shorter transfer times, and better postural balance in the final standing position during the Sit-to-stand Test.

    Be well!

    JP

  3. JP Says:

    Updated 12/29/15:

    http://ageing.oxfordjournals.org/content/early/2015/12/25/ageing.afv175.abstract

    Age Ageing. 2015 Dec 25.

    Yoga-based exercise improves balance and mobility in people aged 60 and over: a systematic review and meta-analysis.

    OBJECTIVE: One-third of community-dwelling older adults fall annually. Exercise that challenges balance is proven to prevent falls. We conducted a systematic review with meta-analysis to determine the impact of yoga-based exercise on balance and physical mobility in people aged 60+ years.

    METHODS: Searches for relevant trials were conducted on the following electronic databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Allied and Complementary Medicine Database and the Physiotherapy Evidence Database (PEDro) from inception to February 2015. Trials were included if they evaluated the effect of physical yoga (excluding meditation and breathing exercises alone) on balance in people aged 60+ years. We extracted data on balance and the secondary outcome of physical mobility. Standardised mean differences and 95% confidence intervals (CI) were calculated using random-effects models. Methodological quality of trials was assessed using the 10-point Physiotherapy Evidence Database (PEDro) Scale.

    RESULTS: Six trials of relatively high methodological quality, totalling 307 participants, were identified and had data that could be included in a meta-analysis. Overall, yoga interventions had a small effect on balance performance (Hedges’ g = 0.40, 95% CI 0.15-0.65, 6 trials) and a medium effect on physical mobility (Hedges’ g = 0.50, 95% CI 0.06-0.95, 3 trials).

    CONCLUSION: Yoga interventions resulted in small improvements in balance and medium improvements in physical mobility in people aged 60+ years. Further research is required to determine whether yoga-related improvements in balance and mobility translate to prevention of falls in older people.

    Be well!

    JP

  4. JP Says:

    Updated 04/07/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27050038

    J Manipulative Physiol Ther. 2016 Apr 2.

    Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated With Falls Risk in Older People: A Randomized Controlled Trial.

    OBJECTIVE: This study assessed whether 12 weeks of chiropractic care was effective in improving sensorimotor function associated with fall risk, compared with no intervention, in community-dwelling older adults living in Auckland, New Zealand.

    METHODS: Sixty community-dwelling adults older than 65 years were enrolled in the study. Outcome measures were assessed at baseline, 4 weeks, and 12 weeks and included proprioception (ankle joint position sense), postural stability (static posturography), sensorimotor function (choice stepping reaction time), multisensory integration (sound-induced flash illusion), and health-related quality of life (SF-36).

    RESULTS: Over 12 weeks, the chiropractic group improved compared with the control group in choice stepping reaction time (119 milliseconds; 95% confidence interval [CI], 26-212 milliseconds; P = .01) and sound-induced flash illusion (13.5%; 95% CI, 2.9%-24.0%; P = .01). Ankle joint position sense improved across the 4- and 12-week assessments (0.20°; 95% CI, 0.01°-0.39°; P = .049). Improvements were also seen between weeks 4 and 12 in the SF-36 physical component of quality of life (2.4; 95% CI, 0.04-4.8; P = .04) compared with control.

    CONCLUSION: Sensorimotor function and multisensory integration associated with fall risk and the physical component of quality of life improved in older adults receiving chiropractic care compared with control. Future research is needed to investigate the mechanisms of action that contributed to the observed changes in this study and whether chiropractic care has an impact on actual falls risk in older adults.

    Be well!

    JP

  5. JP Says:

    Updated 06/26/16:

    http://link.springer.com/article/10.1007%2Fs40520-016-0593-7

    Aging Clin Exp Res. 2016 Jun 18.

    The interrelationship between balance, Tai Chi and depression in Latino older adults.

    Falls and associated injuries are the most serious medical problem affecting the functional independence among both White non-Hispanics and Latino older adults. Studies have shown the effectiveness of Tai Chi exercise in reducing falls but have primarily focused on White non-Hispanic older adults. There is limited research that examines the effectiveness of this exercise on balance among different racial/ethnic minority older adults. This study focused on the interrelationship between functional status (balance performance) and psychosocial status (depression) before and after a 12-week Tai Chi program among Latinos in a Midwestern metropolitan city. Results indicated that at baseline, prior to the start of the Tai Chi program, participants who were more depressed had poorer functional status. Participants who had higher depression at baseline, experienced greater improvement in functional status, following the 12-week Tai Chi exercise program, compared with those who had lower levels of depression.

    Be well!

    JP

  6. JP Says:

    Updated 08/30/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27552489

    J Women Aging. 2016 Aug 23:1-8.

    The effect of dance therapy on the balance of women over 60 years of age: The influence of dance therapy for the elderly.

    Dance therapy is a physical activity that can lead to balance improvement in older adults. The aim of the study was to evaluate the effects of dance therapy on balance and risk of falls in older women. Twenty-four older women (mean age 66.4 years old) attended dance sessions for three months. Pretest/posttests were completed using the Postural Stability Test, the Limits of Stability Test, and the Fall Risk Test M-CTSIB. Results showed the Limits of Stability Test was significantly higher (17.5%) after dance classes. Regular use of dance therapy shows promise in improving balance by increasing the limits of stability.

    Be well!

    JP

  7. JP Says:

    Updated 09/23/16:

    http://www.ncbi.nlm.nih.gov/pubmed/27621124

    Biomed J. 2016 Jun;39(3):214-22.

    Low vegetable intake increases the risk of fall-related fragility fracture in postmenopausal Taiwanese women, a prospective pilot study in the community.

    BACKGROUND: The aim of this prospective study was to investigate the relationship between lifestyle factors including nutrition intake and the incidence of fall-related fragility fractures in postmenopausal women.

    METHODS: A total of 1169 female volunteers were recruited from participants at the morning health examinations held at each local public health center in the West Chiayi County of Taiwan at the beginning of the study. Laboratory examinations, anthropometric measurements, and questionnaire interviews inquiring about lifestyle factors, including weekly nutrition intake, were performed. Subsequently, four follow-up telephone interviews at intervals of about 6-12 months were performed to inquire about instances of falls and fractures.

    RESULTS: Nine hundred and fifty-three subjects responded at least once to the four telephone interviews, and there were 183 postmenopausal women, with a mean age of 68.8 ± 8.3 (49-87) years, reporting falls. Of the 183 women, 25 had incurred new fractures from low-energy impacts. Statistical analysis revealed that older age and hypertension were associated with increased risks of falling. Intake of other deep-colored (nondark-green) vegetables and light-colored vegetables as well as total vegetable intake were associated with reduced risk of fall-related fragility fracture.

    CONCLUSION: Among postmenopausal women, older age and the presence of hypertension were associated with increased risks of falls. Increased vegetable intake might be helpful to reduce the incidence of fall-related fragility fractures.

    Be well!

    JP

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