Be Active Your Way Blog - Older adults

Physical Activity and the Prevention of Falls in Older Adults

LCulver — Wed, 13 Apr 2011 12:26:00 -0400

With the recent activities of the American Public Health Association's "Safety is No Accident: Live Injury-free" campaign during the week of April 4-10, we would like to continue to raise awareness about falls prevention. Falls are a major health concern among older adults. More than one-third of older adults fall each year, and fall rates increase with advancing age.¹ Falls are the leading cause of injury deaths, the most common cause of non-fatal injuries, and the most common reason for hospital admission due to trauma in older adults.² Every hour, there is one death and 183 emergency department visits for falls-related injuries among older adults and more than 95% of hip fractures are caused by falls.³

These facts are a scary reality; however, we know the most common risk factors⁴ of falling. They include the following:

Conditions associated with aging
Muscle weakness
Difficulty with balance or walking
Vision problems
Pre-existing medical conditions that limit mobility, such as Parkinson's disease, stroke or diabetes
Conditions that cause confusion
Being on more than four medications at the same time
Use of assistive walking device
Environmental hazards (e.g. throw rugs or pets)
Difficulty completing daily living activities
Low blood pressure
Fear of falling
History of fears

We also know that maintaining physical activity is critical in helping to prevent falls and can have a significant impact on many of the risk factors listed above. Performing physical activities of any fitness level - including programs, Tai Chi, aerobics and yoga - can help improve balance, strength and flexibility, and get patients moving again. In fact, effective interventions to prevent falls in community-dwelling older adults included exercise-based interventions provided in the home or group setting.⁵ Exercise interventions that appear to have the greatest impact are balance activities performed in standing (limit upper-extremity support), and exercise programs that are progressed based on the individual person. General exercise programs on the other hand, which do not focus specifically on balance and strength, are not as effective as individually tailored exercise.⁶ Finally, there has been strong evidence that supports a multifactorial approach to preventing falls with programs that include not just exercise but also appropriate screening, gait training and environmental assessments.⁷

According to the American Geriatrics Society's (AGS) Clinical Practice Guidelines, all should be screened for risk of falling. The AGS recommends a brief screening tool that includes three questions:

1) Have you ever fallen in the past year?

2) Has the patient had an acute fall?

3) Does the patient have difficulty with walking or balance?

If inviduals aged 65 years and older state that they have experienced two or more falls or has sustained an injury from a fall, they are considered to be at risk for falling. Likewise, if the person has difficulty with balance or walking, they may be at higher risk.

All professionals working with older adults should be aware of the risk for falls and the factors associated with a higher risk. With greater vigilance, we can prevent the injuries related to falls in older adults, as well as the related loss of function and participation in daily activities.

Are you screening older adults for falls? What community fall prevention programs are available for older adults in your community?

You can find more consumer resources about risk factors, testing balance, and where to find a physical therapist by visiting Move Forward.

Six Barriers to Physical Activity Participation

CMilner — Wed, 06 Apr 2011 13:20:00 -0400

Research published in the British scientific journal Age and Ageing found that older adults are highly knowledgeable about the health benefits of physical activity, yet many remain inactive due to the many barriers to participation. This article examines these barriers and suggests ways in which you and your organization can reduce or eliminate their impact on the physical activity levels of older adults.

1. Lack of interest (by far the #1 factor)

Prior to starting a program, have your older customer examine all their options. Would they prefer taking a class or going solo? Are they a morning or night person? Does indoor fitness appeal to them, or would they prefer to play outside? Could they dedicate large blocks of time to physical activity or could they fit only shorter, more frequent intervals into their schedule? What are their real world goals?

Young or old, people tend to enjoy things that interest them, that help them reach a goal or that is fun and social. By simply asking what they like to do you can break this barrier down one program at a time.

2. Shortness of breath

Shortness of breath can be due to a variety of health issues. It can also be that they are simply out of shape. Meet with their healthcare provider to see whether you'll need to consider any special modifications before starting an exercise program. If necessary, get clearance to begin a program. Educate members that there are ways to address issues to improve their quality of life.

3. Joint pain

According to the Arthritis Foundation, regular, moderate exercise offers a whole host of benefits to people with arthritis. By exercising, your member can reduce joint pain and stiffness, build strong muscle around the joints, and increase flexibility and endurance.

4. Perceived lack of fitness

Education is the key here. Ensure that your members know they can start slowly, i.e. with 5-10-minute walks in the morning, at lunchtime and after dinner. With their resistance training, start them with only a couple of exercises and build up. DO NOT OVERWORK them or you will never see them again. Set long-term goals and show them how they will build their fitness level or workout over time.

5. Lack of energy

In many cases, this barrier is reversible and can be due to a low fitness level. It could also be from the interaction of multiple prescription drugs. The first step to a solution is to establish why they are lacking energy, then explain how being active will actually give them more energy. For many it can even reduce the number of expensive drugs they take.

6. Doubting that exercise can lengthen life

Ask your older customers about their quality of life. Are they able to do the things they want to do? Explain how exercise can improve their quality of life, no matter how long they live. What exercise will offer them is the ability to age on their own terms.

How are you reducing barriers that limit participation levels among your older customers?

Gymnasiums, Early Hours, and Empty Nesters

JKauffman — Tue, 08 Mar 2011 16:03:00 -0400

Empty nesters are a unique group. We all know who these people are: folks who spent the last 20+ years of their lives raising their children, who are now experiencing life without the responsibilities of their kids living under their roof. Like many parents, Empty Nesters put their growing children first, and found themselves getting less and less physical activity, while supporting their children's activities and interests. But now with the children gone, Empty Nesters, while still working full-time, have the opportunity to re-engage in the activities and sports they enjoyed years ago. They also make a great group to bring into a gymnasium at 6 a.m.

The Y took a unique approach to re-engage Nesters in physical activity and help them meet the PA guidelines. We looked at many theories of change, and created a program framework specifically for Empty Nesters to encourage their renewed interest in their own health and their pursuit of fitness. This framework and unique approach includes: establishing the feelings of support in a group setting, being active with people similar to each other, and recognizing the competence and skill each person gains while being more active.

The program framework that the Y created to help Nesters meet the PA guidelines looks like this:

Program focuses on activities or sports that Nesters participated in when they were younger (a "re-Beginner" instead of "new" Beginner).
Participants were recruited by age, re-beginner status and physical condition.
Two staff led the program - one as the "coach" and the other asthe "facilitator."
The facilitator's responsibility is to build group unity, create a sense of belonging, help in individual goal setting, and recognize group and individual achievement.
The coach's responsibility is to lead the physical activity (be it dance, basketball, cycling, etc.) at a level that is safe and appropriate to the group's skill and physical activity, while keeping the class fun and inspirational. Both the coach and the facilitator mirror the participant's age, life experiences, etc. as much as possible.
The program plan is to transition the group to be self-supporting.

This framework has resulted in some pretty interesting groups, including a dozen "slightly" obese, 50-55 year old ex-high school basketball stars, doing 60 minutes of basic ball handling drills, conditioning exercises, and half court games at 6 a.m., to a like-group of female ex-dancers, re-learning ballet routines, while also hitting the weight room. This works too for just about any activity many of us may have played as kids or in high school.

This framework is bringing attention to the PA guidelines, giving coaches, facilitators, and Nesters the ability to be creative in designing activities that meet the PA guidelines, and are fun to them.

Would this framework work in other settings, or with other groups?

Could you be a coach or facilitator yourself, and bring the PA guidelines to life in yet another group of re-Beginners?

What might you add?