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Avoiding the dreaded fall: Tips for improving balance

Jessica Neiss

Sep 22, 2022

Balance can improve over time with the right amount and type of practice.

“I’m not going to do that because I’m afraid I am going to fall.”

I have heard this phrase countless times during my years as a physical therapist. Many people have given up their treasured activities in fear of the dreaded fall. Often when I hear “I’m too old” to do something, it really means “I’m too scared.”

It’s true that our bodies change with age, but we can be empowered to fight those declines. Balance can improve over time with the right amount and type of practice.Falls are the leading cause of both fatal and nonfatal injuries in adults over 65. Falls are also responsible for significant disability, hospitalization, loss of independence and reduced quality of life, costing more than $34 billion annually according to the Center for Disease Control. These scary statistics are constantly barraging our aging population. Fearmongering is common, with many clinicians advising against engaging in certain activities “because you could fall.”

The reality, though, is that you can do something to maintain activity and balance throughout your life. It’s important to understand the components of balance and how they change organically with age. That way, you can identify any deficits and practice strengthening them to set yourself up to win.

Several factors contribute to your balance: vision, sensation, your vestibular system, environment, medicine interactions and strength.

Our vision naturally declines with age, according to the National Institute of Aging. We lose the ability to see up close and to distinguish between colors, and we need more time to adjust to changing light levels. It’s also more common for older adults to require bifocal lenses. While convenient to use, bifocals do reduce your peripheral vision. If you rely on vision for balance, this can cause a serious problem. I recommend that people with bifocals and balance issues switch to single vision glasses to maximize their visual field beyond just the midriff level up.

It’s also extremely important to have good lighting in every environment, especially at night. If you awaken and move at night, make sure your entire pathway is well lit, not just the destination. It’s easy to become disoriented when rising after sleep, so it’s important to clearly see your path at all times, including having well-lit stairways.

Sensation, especially feeling the ground, is another factor. Even if you experience loss of sensation, you can visualize the ground beneath your feet. Imagine your foot as a triangle with three contact points to the ground: the ball of your big toe, the ball of your baby toe, and your heel.

Practice grounding yourself with these three points, and notice what happens as you shift your weight. If you feel anxious about your balance, widen your stance, ground yourself with the above technique and take a deep breath. Pausing for those few moments will help you to regain your sense of balance and will allow you to clearly think of your next move.

Your vestibular system consists of your inner ear, vision and parts of the brain; together they manage how you feel your head in relation to your body. You may have difficulty turning your head quickly, walking in crowded places or looking around while walking. If you have a true vestibular issue, see a vestibular physical therapist. But minor deficits can improve with practice. First, start seated and turn your head while focusing on an object. Once that becomes easy, stand during the exercise. Progress to standing on one foot while turning your head and focusing, and then progress to walking while turning your head and focusing.

Your home environment is often an overlooked balance factor. Make sure to remove throw rugs, which could pose tripping hazards. If you do keep any small rugs, tape down all edges and corners. Install handrails on ALL stairs — even that single step up to the porch. Set yourself up to win! You may not need handrails now, but having them there on an off day will make all the difference. Declutter your spaces. If you have been a collector (i.e. hoarder), have that yard sale or start donating. More clutter requires more agility and equals more tripping hazards.

The medicines you take may affect your balance. Physicians may prescribe meds that have unintended negative interactions. Ask your pharmacist to run a simple, free interaction screen. Some meds may also cause your blood pressure to drop when changing positions (e.g, standing up), which may cause dizziness. If this happens, ask your doctor to evaluate your blood pressure in many positions and see if a med change is recommended.

Lastly, and very importantly: Strength declines as we age. Walking is not enough — even five miles every day. You still need to lift weights. Muscles naturally lose strength every decade, starting in our 40s, according to the APTA. Lifting weights is vital to maintain the muscle strength needed for everyday activities. Otherwise, you end up living a “1-REP lifestyle” — meaning that you use your maximum effort and expend all your energy on a single task like standing up from a chair or walking to the kitchen. If you’re not a gym person, contact a physical therapist or trainer to help create an appropriate home fitness program. But do make sure that you progressively increase the weights over time. My rule of thumb is if you can complete 15 repetitions with ease, it’s time to increase the weights. I like to train people at about 60-80% of their 1-REP max, meaning they can complete six to eight reps of a certain weight at a time.

There are some simple balance exercises that you can practice at home. First, start with static balance. With your back against a corner, stand with the heel of one foot touching the toes of the other and a chair in front. Once that becomes easy, make it harder by moving and trailing along a wall. Then progress to add head turns. Finally, progress to uneven surfaces. Just remember to set yourself up to win. If you don’t feel comfortable practicing balance on your own, contact a physical therapist to help. And remember, there’s no stigma in using an assistive device. If you are having an off-balance day, use a walker or two canes to help. It is much better than the alternative!

With these techniques, you can manage your fear of falling and become more confident in your balance so that you can fully enjoy your life. PJC

Jessica Neiss is a physical therapist with 20 years of experience.She owns To Life! Therapy & Wellness, a new Center in Squirrel Hill that offers physical therapy, occupational therapy and exercise classes for older adults and people with neurological conditions such as Parkinson’s or Multiple Sclerosis.

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