Strength and balance exercises can help prevent falls in older people but must be focused on individual needs, reports Kathy Oxtoby…
 

Falls are a common and potentially extremely serious cause of injury, but their impact is often overlooked. Every year there are over 210,000 falls-related emergency hospital admissions among people aged 65 and older in England.1 As well as the toll on physical health, it is estimated that falls cost the NHS around £1 billion a year.2

Aside from the financial cost, falls can have a huge impact on individuals. “People can lose mobility and confidence to keep doing things on their own after having a fall, and often end up requiring more hospital and social care,” says the Centre for Aging Better.3

The consequences of falls can be “disastrous for families and carers, and most importantly, patients,” says Lila Thakerar, superintendent pharmacist, Shaftesbury Pharmacy, Harrow. “Falls cause disruption to people’s lifestyles and those who care for them. And they are a drain on social care, and on the NHS,” she says.

Older people are more likely to have a fall because they may have balance problems and muscle weakness, vision loss, or a long-term health condition such as heart disease, dementia or low blood pressure.4 The wider impacts of Covid-19 – the months of self-isolation and lockdowns – has become another contributory factor to the risk of falls in older people.

In August 2020, Public Health England’s Covid-19 cabinet commissioned a study which looked at how the wider impacts of Covid-19 have affected older people 5 The study focused on deconditioning - the loss of physical, psychological, and functional capacity due to inactivity - and falls.
Researchers predicted that 110,000 more older people will have at least one fall per year as a result of reduced strength and balance activity during the pandemic. To address this, they recommended the “promotion and increased availability of strength and balance activity for older adults, involving a gradual increase in activity in order to reduce falls risk and to enable safe and confident participation on other forms of exercise and physical activity”.5

Benefits of exercising
Older people living in the community who have a known history of recurrent falls should be referred for strength and balance training.6 According to The National Institute for Health and Care Excellence (NICE), “balance impairment and muscle weakness caused by ageing and lack of use are the most prevalent modifiable risk factors for falls”.7

NICE says: “Strength and balance training has been identified as an effective single intervention and as a component in successful multifactorial intervention programmes to reduce subsequent falls.” It recommends that a strength and balance training programme should be individually prescribed and monitored by an appropriately trained professional.7

An evidence review commissioned by Public Health England (PHE) and the Centre for Ageing Better found that muscle and bone strengthening and balance activities continue to have “great health benefits” for all adults, including older adults aged 65 years and over.8

In older adults, poor muscle strength increases the risk of a fall by 76 per cent and those who have already had a fall are three times more likely to fall again. Strengthening and balance activities not only help to prevent this, but also help improve mood, sleeping patterns, increase energy levels and reduce the risk of an early death, the review finds.8

The review concludes that adults should do strengthening and balancing exercises twice a week alongside aerobic exercise. For those at risk of falls or fracture, the review also recommends supervised structured exercise “at a pace that suits the individual to help maintain independence and support healthy ageing”.8

A study reviewing the benefits of strength training for older adults finds that strength-training exercises have the ability to “combat weakness and frailty and their debilitating consequences”.9 Done regularly, these exercises “build muscle strength and muscle mass, and preserve bone density, independence, and vitality with age”, the authors say.

Strength training can also reduce the risk of osteoporosis and the signs and symptoms of numerous chronic diseases such as heart disease, arthritis, and type 2 diabetes, while also improving sleep and reducing depression, the study found.9

“Raising awareness of the risk of falls as well as what older people can do to prevent them is an important part of engaging local populations, increasing uptake of community-based strength and balance programmes,” says the Centre for Aging Better.3

Where pharmacies fit in…

As a first point of call for healthcare, pharmacies can make their older patients aware of the advantages of strength and balance exercises. The benefits of these exercises are “invaluable”, says Ms Thakerar. However, she stresses pharmacists have to be “very cautious” when advising older patients about exercise.

“We’ve got to be careful what exercise we recommend to older patients,” says Ms Thakerar. While simple exercises such as stretching and walking may be safe to recommend, any other exercise advice should come from an expert in this area, such as a physiotherapist, she says.

Pharmacists should make sure they know their patients’ individual clinical histories. Exercises that may be appropriate for one 80-year-old may not be appropriate for another, Ms Thakerar cautions.

Activities found to have the most benefit for muscle and bone strengthening include: ball games, racket sports, dance, Nordic walking, and resistance training - usually training with weights, but including body weight exercises which can be performed anywhere.8

There's also evidence that taking part in regular tai chi sessions can reduce the risk of falls.10 Unlike other martial arts, tai chi does not involve physical contact or rapid physical movements, “making it an ideal activity for older people”, advises the NHS.

Many community centres and local gyms offer specialist training programmes for older people, while exercises that can be carried out at home are also available. Pharmacists can signpost older patients to training programmes in their area. It’s important that a strength and balance training programme is tailored to the individual and monitored by an appropriately trained professional.

By building on aerobic activities, strengthening and balance activities can help prevent older people from having falls and help them to enjoy ageing well. As Ms Thakerar says: “Importantly these exercises will boost their morale and help build their self-confidence.”
 

References 

1. Public Health England. (2018) Falls: applying All Our Health. https://www.gov.uk/government/publications/ falls-applying-all-our-health/falls-applying-all-ourhealth
2. Leal J, et al. (2016) ‘Impact of hip fracture on hospital care costs: a population-based study’, Osteoporosis International, Vol. 27(No.2), pp. 549-558.
3. Centre for Ageing Better. (2019) Raising the bar on strength and balance. The importance of community based provision. https://ageing-better.org.uk/sites/default/files/2019-02/Raising-the-bar-on-strength-and-balance_0.pdf
4. NHS. (2021) Overview: Falls. https://www.nhs.uk/conditions/falls/
5.  Public Health England Wider impacts of COVID-19 on physical activity, deconditioning and falls in older adults. (2021) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1010501/HEMT_Wider_Impacts_Falls.pdf
6. College of Occupational Therapists. (2015) Occupational therapy in the prevention and management of falls in adults. Recommendation 15. https://www.rcot.co.uk/practice-resources/rcot-publications/member/practice-guidelines-publications
7. NICE. (2017) Falls in older people. Quality statement 8: Strength and balance training. https://www.nice.org.uk/guidance/qs86/chapter/Quality-statement-8-Strength-and-balance-training
8. Public Health England. (2018) Major health benefits from strengthening and balance activity. https://www.gov.uk/government/news/major-health-benefits-from-strengthening-and-balance-activity
9 Seguin R, Nelson ME. (2003)  The benefits of strength training for older adults. American Journal of Preventive Medicine. Volume 25, Issue 3, Supplement 2, 141-149, October 1 2003. https://www.ajpmonline.org/article/S0749-3797(03)00177-6/fulltext
10. NHS. (2021) Prevention: Falls. https://www.nhs.uk/conditions/falls/prevention/