Different measures to recommend
Walking speed and the significance of slowing down
The slowing-down process of later life affects balance and also muscle strength, both of which are important in preventing falling.
The three tests
The Walking Speed Test can be done by the patients themselves and measures, in seconds, how long it takes them to walk four metres. Taking longer than five seconds indicates that they are affected by the slowing-down process. Walking slowly may be due to other reasons, such as arthritis, but the test gives a good indication of general fitness
The Timed Up and Go Test measures, in seconds, the time taken to stand up from a standard chair, walk a distance of three metres, turn, walk back to the chair and sit down. Research indicates that a score of 12-15 seconds or more has been shown to indicate high risk of falls in older people
The Turn 180 Degree Test asks the person to stand up and step around until they are facing the opposite direction. If the person takes more than four steps, further assessment should be considered.
Footwear
Shoes that fit well protect and support the feet and can preserve and improve balance and stability. Poorly-fitting shoes or slippers can cause trips and falls. Lace-up or Velcro fastening shoes give more support than slip-ons. Advice to patients on footwear is as follows:
- Make sure shoes fit well and do not have a tendency to slip off
- Well-cushioned shoes offer comfort and support
- Avoid sandals with little support and shoes with high heels
- In the house, wear slippers that have a good grip and that fasten and stay on properly
- Always wear shoes or slippers, and never walk indoors in bare feet, socks or tights
- Wear boots or shoes with good grip on the soles. Rubber snow/ice grips that attach to outdoor shoes are very effective.
Eyesight and balance
Eyesight is an important factor in maintaining balance and co-ordination. The prevalence of some eye conditions such as macular degeneration, glaucoma and cataracts increases with age and highlights the importance of early detection. Eyes and glasses should be checked at least every two years. Combined sight and hearing problems can make it more difficult to maintain balance.
Keeping physically active
Impaired balance and muscle weakness caused by ageing and lack of use are the most prevalent modifiable risk factors for falls. Therapeutic exercise is the best-tested intervention. There is strong evidence from randomised controlled trials that group exercise classes and exercises individually delivered at home, usually containing some balance and strength training, reduce falls, as does Tai Chi.
Falls prevention exercises need to focus on strengthening leg and ankle muscles and challenging balance. Activities should include resistance movements using the upper body and exercises done while standing. Falls prevention cannot be achieved solely through chair-based programmes and seated gym machines.
To get started, minimising the amount of time spent sitting down for extended periods is crucial. Some older people may spend nine hours or more each day sitting. Advice to get up every 30 minutes and spend a few minutes standing or walking is a simple intervention. Measures to achieve greater mobility should be tailored to the current level of activity and the patient’s individual situation. Patients should regard them as part of their normal routine. These include:
- Standing or walking around when on the phone
- Taking a short walk with every coffee/tea break
- Getting off the bus one stop early to build in a few minutes of walking
- Standing up and moving during TV ad breaks
- Going outside and doing short bursts of weeding or plant watering.
The aim should be to build up to about 30 minutes’ activity on three to five occasions a week that gently raises heart rate and breathing rate and makes the person feel warmer. As well as cardiovascular exercise it is important to improve muscle strength by resistance exercises on at least two days a week, such as:
- Carrying or moving loads such as groceries
- Gardening jobs such as pushing a lawn mower, digging or collecting grass and leaves
- Activities that involve stepping and jumping, such as dancing
- Chair-based exercises.
Inform patients about local opportunities for suitable exercise including walking/rambling groups, Tai Chi and exercise classes designed for older people.