Falls Prevention and Self-Isolation: How to Keep your Balance

More Americans are staying home than ever, with 38 states banning large gatherings (as of April 8th, 2020), over half of all states closing non-essential businesses, and nearly half of all states enforcing some form of mandatory quarantine (1).  These lifestyle changes are challenging for all of us - but for older adults with balance issues, they can feel particularly difficult, as they may lose access to valuable support services and networks of friends and family that help keep them safe.  Even in a typical year, when friends and family are able to provide in-person support to older adults, balance issues resulting in falls is a significant public health problem in America, with one out of every four individuals over 65 falling each year (2).  Annually, this results in over 3 million emergency room visits for injuries sustained during falls, about 800,000 of which result in hospitalization (2).  For older adults, keeping their balance to ensure their independence and avoid a trip to an overburdened hospital system can feel more important than ever.

Balance and falls prevention is one of Dr. Alexa Cosgro, PT, DPT of Pearl Physical Therapy’s specializations.  Dr. Cosgro graduated with her doctorate in physical therapy from Rocky Mountain University of Health Professions in Provo, Utah in 2018 and went on to become a licensed Tai Chi for Arthritis Instructor in 2019.  She takes a holistic approach to balance and falls prevention for her physical therapy clients, often starting with standardized tests approved by the CDC to take baseline scores, then utilizing a range of techniques from functional exercise to Tai Chi to home assessment to improve safety.  She also teaches Tai Chi classes for both arthritis and balance regularly at Pearl Physical Therapy in Plattsburgh.  We asked her for her advice on some of the most commonly asked questions on balance we’ve heard from home-bound older adults over the past few weeks.  Though the times are hard, Dr. Cosgro’s outlook is encouraging.  “There are many things” older adults can do to help themselves, she says.

What does the latest research show is good for improving balance?

The place to start when improving your balance, Dr. Cosgro says, is to safely challenge your balance with balance exercises.  Ideally, “these should be combined with functional exercises and resistance training to achieve the maximal benefit.”  Functional exercises are those that mimic your every day routine, and can include things you do every day, such as squatting down onto a chair and standing back up.  Other functional exercises might include step ups, or reaching activities, as if you’re putting away dishes.

Current guidelines on resistance exercise for older adults state that older adults who can do so safely should work towards performing resistance exercise 2-3 times a week.  Goals should include working each major muscle group at least once per workout at a moderate intensity (3).  Older adults should, however, always consult their physician or physical therapist before starting a new exercise program.

Dr. Cosgro notes that Tai Chi is another form of exercise that has been shown to be particularly good at improving balance.  Tai Chi has grown in popularity significantly over the last couple decades.  It traces its roots back to ancient China, with heavy emphasis on slow, flowing movements coupled with deep, controlled breathing.  A significant amount of research has been performed on Tai Chi, with one recent paper citing 22 different individual studies that showed significant reductions in fall risk and improvements in balance (4).  

If you were to pick one or two balance exercises that almost anyone could try at home, what would they be?

“This is a challenging question, because this could change drastically depending on someone’s baseline function,” Dr. Cosgro says.  But, she adds, “the following 2 exercises could be a good starting point:”

1.  Sit to stands in a chair - these improve leg strength, a critical component of balance itself, while also working your balance as you stand up and sit down.  The best part?  With a chair or couch behind you, all you have to do if you feel unsteady is sit back down.

2.  Side-stepping - this is best performed at a counter or other surface, like a table, where you can hold on for balance support if needed.  Walking sideways is both a great challenge to your balance and a way to strengthen the muscles of the hips, which also help with staying steady.

“However, if either of these exercises are too challenging or you feel unsafe, do NOT perform these alone,” Dr. Cosgro recommends.

Is there anything else besides balance exercises that people can do to reduce the risk of falls around the house?

There are “many other things that people can do,” Dr. Cosgro agrees.  Her recommendations, informed from her holistic perspective, are as follows:

1)  Assess your home for tripping hazards such as throw rugs or objects on the floor such as books, toys, cords, or clutter.  Be aware that pets could pose a risk for falls as well.

2)  Have your eyes checked regularly.  Vision can play a big role in balance, and if you are having difficulty seeing, then you are at an increased risk of falling.  It is helpful to have night lights spread throughout your home as well to improve vision in the early morning, evening, or night.

3)  Talk to your doctor about your medications and vitamin D level.  Some medications can impair balance and vitamin D deficiency can impact your balance.  

4)  Talk to a healthcare provider about postural hypotension which can occur when you move from sitting to standing or from lying down to sitting.  This may make you feel dizzy immediately after changing positions.  

5)  If you have neuropathy in your feet, you may notice increased difficulty with your balance.  A physical therapist can educate you on things that you can do to help you maintain your balance when you have altered sensation.

6)  In the winter, if you are going outdoors, consider investing in a pair of microspikes to give you better traction on icy surfaces.

7)  Be sure that your footwear allows proper traction so that you do not slip on surfaces within your home.  If you are wearing socks only in your home, consider socks with non-slip grips/pads on the bottom.

8)  Consider installing various safety items in your home such as grab bars in your shower or other areas of the bathroom, non-slip items for your shower floor, and non-slip strips for the edge of stairs.

Lastly, what about people who are uncertain with their balance - can they safely work on their balance at home?

“There are many things you can do to practice your balance safely at home,” Dr. Cosgro reiterates - but this time, with a caveat.  “However, the degree of how challenging the exercise is will vary from person to person.  A physical therapist can help to determine what is safe to do at home and offer recommendations for a home exercise program. ”  

Individuals who are interested in a physical therapy evaluation but want to continue maintaining their quarantine can opt into a telehealth evaluation, where they have a video conference from the safety of their home with their therapist.  The therapist can see how they move, ask them to do certain balance tasks, and develop a safe routine of balance exercises for them to do at home.

If you’re interested in a telehealth evaluation of your balance with Dr. Alexa Cosgro, are interested in participating in Tai Chi, or have any questions for her not addressed here, click here to fill out a form with your name and contact information, or call Pearl Physical Therapy at (518) 563 - 7777.