INJURIES IN ELDERLY PEOPLE

Many of us have experienced the anxiety of having to deal with an older member of the family or a friend who incurred an injury as a result of a fall.

Falls among older individuals have been accepted and viewed as unavoidable accidents. But this is not necessarily so. The physical and psychological damage done as a result of the fall can be averted if proper precautions are taken.

Hip, and fracture neck of femur are the most devastating, especially in older women with osteoporosis. Even if the physical injury is not debilitating, the damage to the psyche is tremendous, leading to fear and self imposed exile from any kind of activity which in itself leads to a decrease in health and fitness. It is like a self-fulfilling prophecy — they are afraid they will fall, restrict activity, incur muscle atrophy, loss of strength and balance and therefore fall once again when they try to get around even to navigate the most minor tasks.

Some of the most common causes for falls are: the immediate physical environment; poor fitness levels in terms of strength, balance, gait, agility and speed and reaction time; intake of sedating medication or anything that alters cognition; middle ear imbalance leading to vertigo and dizziness; vision problems; other medical problems like Parkinson’s, Diabetes, Multiple Sclerosis; and improper footwear
Simple modifications

Many of the above factors can be addressed by making simple modifications to the immediate environment and intervention to improve fitness levels, strength and balance

Use antiskid tiles wherever possible. Fix railings in the bathrooms for support. Steer clear of carpets that may be tripped on, sharp edges and corners, flimsy stools and chairs, wet areas, stairs without railings and poorly designed or ill fitting footwear.

Some forms of medication, like sedatives, antihistamines, some antihypertensives can lead to dizziness, postural hypotension and hence a tendency to lose balance.

Older individuals who have been active all their lives, participated regularly in fitness programmes and maintained their weight within the optimum range while also maintaining optimum muscle mass have a lower incidence of falls and injury when compared to the unfit, overweight, person.

This may be one reason to encourage people to keep exercising throughout their lives with alterations in routine depending on the age and their state of health.

An exercise programme for the elderly should include balance and strength besides a basic cardio routine. The "principle of specificity" of exercise indicates that in order to improve the condition of a particular system; the exercise should target that system.

"Use it or lose it". This is the dictum for any aspect of fitness including muscle mass/strength. Deterioration is evident with disuse and sedentary living. A strength training programme that targets the major muscle groups can improve leg and hip extensor strength. This improves ability to walk easier, climb stairs, arise from a seated position in a chair or on the floor or bend to pick up something from the floor.
Strength training

Upper body strength (which tends to diminish rapidly due to neglect) is required to perform simple tasks like lifting, reaching and carrying.

Strength training can be performed using resistance bands that are colour coded to differentiate levels of strength, or with other forms of external weights like ankle weights, wrist bands or even dumbbells under guidance.

Is muscle strength related directly to balance? Not necessarily so, according to some studies. Large bulky muscles and enormous strength do not directly translate to great physical balance.

However, weak muscles definitely render an individual more prone to falling down as a result of poor balance and the inability to support ones own body weight properly. Movements of the body mandate a certain level of equilibrium and the ability to accommodate this shift in centre of gravity.

For instance, getting up from a seated position changes the centre of gravity from a lower to a higher level from the floor, thereby decreasing stability. Adequate balance and strength of leg muscles will ensure that one doesn’t tip over during the process.

In order to improve balance, ensure good vision, absence of a vestibular problems and an optimum somatosensory system. This system enables the body to understand its position in relation to its environment through a sophisticated neuromuscular network. The body is constantly kept informed of its position and contact with other objects like the floor or a chair. If there is any compromise in this mechanism (and it has been found that the sensory system diminishes with age), balance may be affected.
Simple moves

Simple tasks like standing on one foot for as long as possible, standing with feet as close together as possible, with heel to toe, putting on pants while standing up, walking on a straight line, getting up from a chair and walking forward, turning and coming back to sit in the chair as fast as possible can be practiced to improve balance.

Specific tests are available to assess balance, strength and proprioception. Some examples of the tests include one leg balance test, "get up and go" test. These act as guidelines to structure the routine for the individual client.

Please note that older adults with poor balance should never be allowed to exercise or perform any of these moves unsupervised.


Some common causes

The immediate physical environment

Poor fitness levels in terms of strength, balance, gait, agility and speed and reaction time

Intake of sedatives, medication or anything that alters cognition.

Middle ear imbalance leading to vertigo and dizziness

Vision problems

Other medical problems like Parkinson’s, Diabetes, Multiple Sclerosis

Improper footwear

To improve balancce

Stand on one foot for as long as possible

Stand with feet as close together as possible, with heel to toe

Put on pants while standing

Walk on a straight line

Get up from a chair and walk forward

Turn and come back to sit in the chair as fast as possible