Did you know that falls are the leading cause of injury and injury death in individuals 65 years of age and older? Falls often lead to a decrease in functional ability, increased use of healthcare services, and an increase in patient anxiety. This anxiety and fear of falling again often causes these individuals to decrease their activity, resulting in impaired mobility and increased risk of morbidity and mortality due to being more sedentary (Berry and Miller, 2008).
This leads us to the question, what can we do as therapy professionals to reduce the risk of falls in the elderly population?
Older adults are the fastest growing segment of the US population. By 2060, the number of individuals 65 and older is expected to reach 98 million making up approximately 25% of the population; therefore, it is essential for us to understand and effectively dose exercise in this population in order to help them age well and decrease the risk of falls and fall-related injuries.
All too often, older adults are led to believe that they are fragile and weak, which causes them to avoid movement and more strenuous activities for fear of injuring themselves. Quite honestly, many healthcare professionals, including therapists, often believe and treat these individuals like they are incapable due to their age. This thought process is heavily flawed. Just because these individuals are older does not mean they are weaker. It is because of their age that movement and resistance training are even more critical. Each time an individual stands up from their recliner or gets up from the toilet, they are performing a squat. Every step they ascend to enter into their home is a step up. Every item they pick up off the floor is a deadlift. Every bag of groceries they carry into the home from the car is a type of carry.
So why are we not performing these exercises in the clinic?
When an older adult enters into a physical therapy clinic and the only exercises that they perform are things like straight leg raises, long arc quads, hip bridges, and banded hip abductions, we as therapy professionals are missing the boat. The exercises listed above are beneficial and have their place in the rehabilitation process; however, they should only be used as a stepping-stone to help older adults improve their ability to perform more functional tasks and to increase independence. Our interventions have to extend beyond the TheraBand and ankle weight and transition into more functional activities as the patient progresses.
Resistance training in older adults has been shown to improve blood pressure, mobility, muscle mass, strength, immune system function, blood glucose, and lipid profiles. All of which combat age-related chronic diseases that often are impacting the older adult population (Mcleod, et al. 2019).
A study performed in Australia assessed the effects of an 8-month long high-intensity resistance and impact (HiRIT) program in postmenopausal women older than 58 years of age that had low bone mass. Exercises performed throughout the study were deadlifts, back squats, overhead press, and jumping chin-ups with drop landings. The study found that the HiRIT program was superior to other lower-impact programs for enhancing bone mass at clinically relevant sites, as well as improving functional performance that impacts risk of falls (Watson, et al. 2019). Often this population avoids higher impact activities for fear that they will actually increase their risk of injury, but have we stopped to ask ourselves what the risk is if we don’t appropriately load this population?
There is greater risk of injury and functional decline from underdosing this population compared to the perceived possibility of injury from performing exercises such as squats and deadlifts that actually correlate more with tasks that are required of our older adult patients day in and day out.
If we aren’t preparing our older adults to handle the demands that are placed on them each day, we are doing them a disservice. In a healthcare system that is consistently producing fear of movement in the older adult population, I want to challenge us all to not give into this flawed system but to empower our older adults to stay active, pick up a kettlebell, dumbbell, or barbell, and take control of their health.
Makayla Palmer, PT, DPT
Refine PT and Performance
REFERENCES
Berry, S. D., & Miller, R. R. (2008). Falls: epidemiology, pathophysiology, and relationship to fracture. Current osteoporosis reports, 6(4), 149“154. https://doi.org/10.1007/s11914-008-0026-4
Mcleod, J. C., Stokes, T., & Phillips, S. M. (2019). Resistance Exercise Training as a Primary Countermeasure to Age-Related Chronic Disease. Frontiers in physiology, 10, 645. https://doi.org/10.3389/fphys.2019.00645
Watson, S., Weeks, B., Weis, L., Harding, A., Horan, S., & Beck, B. (2019). Highintensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: The liftmor randomized controlled trial. Journal of Bone and Mineral Research, 34(3), 572-572. doi:10.1002/jbmr.3659