The number of falls for people over 65 is increasing despite best efforts to prevent them. Giving older adults a long to-do list of ways to improve their balance is disengaging and unsuccessful, according to Kaiser. Kaiser Health News addresses what needs to be changed in senior care to actually prevent falls.
Kaiser concludes “Older adults worried about falling typically receive general advice: Take an exercise class. Get your vision checked. Stop taking medications for sleep. Install grab bars in the bathroom. … That sort of advice hasn’t proved to be very effective: Nearly three times more adults age 75 and older died from falls in 2016 than in 2000, according to a recent report in the Journal of the American Medical Association.”
Kaiser’s recommendations are:
Get a Fall Risk Assessment
Get a Personalized Plan
Be careful during transitions, especially after a hospital stay
They also conclude that doctors should communicate to older adults in a supportive, non-patronizing way that with language that reinforces the importance of independence, not fear of falling.
A recently released study by the Society for Post-Acute and Long-Term Care Medicine shows that a “cognitive intervention for fear of falling gets the same results as ‘usual’ care”. This study, conducted on patients who had recently had hip fractures, shows that fear of falling was not just an emotional state that can be reduce by behavioral therapy.
We are not surprised by this. Nymbl’s premise is that fear of falling is reduced by actual balance improvement, and the best way to improve balance is through dual-tasking cognitive and physical exercises. CBT is good at treating perceived fears, but fears derived from a real physical deficit require real change at the impairment level, not just the belief level. When a patient can noticeably detect that their balance has improved, the fear of falling is reduced because they feel more stable.
There is increasing consensus that social isolation is not only depressing for older adults, it’s also deadly. Loneliness increases the likelihood of mortality by 26 percent*, and is as damaging to health as smoking 15 cigarettes a day**. You might not make an immediate connection between fall prevention and social isolation, but not only are they linked, fall prevention programs can have a dramatic impact on loneliness and social isolation.
One of the key causes of social isolation is fear of falling. If an older adult is worried about falling, they go out less, or even stop going out altogether. This stands to reason – if you are worried about having a catastrophic fall every time you leave the house, you’re going to think twice about going out.
So fall prevention programs can have a significant impact not just on falls, but also on helping alleviate social isolation. Confidence gained from improved balance links directly to likelihood of going to that dinner with friends, family gatherings, a play or the movies.
This creates a virtuous cycle – improved balance reduces fear, which increases how much an older adult is willing to go out, and every time they go out, the exercise involved in dealing with the “real-world” helps improve balance as well.
This is true in Senior Living Communities even when a resident is surrounded by other residents. Fear of falling and lead to social isolation because residents stop going to events and meals. Improved balance will lead to more participation in Community events. So when looked at community wide, a community with better balance will have less social isolation because residents will choose to participate in more activities. Fall prevention programs have positive impact on the lives of everyone in the community.
If you are running a Senior Living Community, it makes sense to implement a fall prevention program for many reasons, social isolation being just one. If you would like to explore how to set up a successful fall prevention program in your community, we invite you to a free webinar that discusses the science behind fall prevention and how to implement it in your comunity.
Or fill out this form if you’d like to speak with us directly.
Parkinson’s Disease (PD) is a devastating brain disorder caused by the impairment of nerve cells in the part of the brain that controls movement. The combination of two characteristic symptoms of PD can be very deleterious to a person’s overall health.
One symptom is a shuffling gait, and a struggle to continue to move forward (reported as a “freezing” sensation). The other symptom is decreased balance. Their balance is no longer controlled reflexively, like it is for the rest of us. Instead, they must pay more attention while they are walking in order to not lose their balance. The collective effect of both these symptoms is an increased fall risk for Parkinson’s patients.
To improve gait and balance, people with PD typically see a physical therapist to help them increase their stride length and reduce their chance of tripping. Counter to previous beliefs in which dual-tasking while walking could be detrimental to a person’s balance, research now shows dual-tasking can be an essential intervention in improving gait and balance in people with Parkinson’s, providing an alternative to the classic physical therapy techniques.
Sandra Brauer from the University of Queensland and Meg Morris from the University of Melbourne conducted a study on how added tasks and performing working memory tasks while walking can improve PD patients’ gait.
In their study, 20 participants with mild to moderate Parkinson’s had their baseline gait measured with and without added tasks, and then underwent a training period that included dual-task training to increase their gait. Subjects performed working memory tasks and counting tasks while they were walking and instructed to “take bigger steps”. As the training went on, the difficulty of the cognitive task increased.
After the training period, the subjects’ gait with the added tasks was measured again. The results of this study fully supported the hypothesis that dual-tasking training would improve gait in Parkinson’s patients. All 20 participants showed increased gait length after their dual-tasking training because they had learned how to focus more on the task, and less on the way they were walking (“reduced attention demand of gait”).
How does this relate to Nymbl Science? Nymbl uses a similar dual-tasking approach to train balance in older adults. Just like PD patients, balance in older adults is not as effectively controlled reflexively, but is instead something they have to consciously think about while performing their day-to-day tasks, ultimately creating a lot of anxiety.
As demonstrated in both the Parkinson’s study and in Nymbl users dual-tasking shifts balancefrom the frontal cortex (the “thinking” part of the brain) back to the cerebellum for reflexive balance control. For Nymbl users, performing simple exercises while interacting with fun cognitive tasks drives their balance control back to being reflexive.
The Brauer and Morris study is further proof that dual-tasking training has the power to transform balance in a wide range of people, which in turn leads to improved health and overall lifestyle.
In a research study conducted by the MSk lab at Imperial College London and presented recently at the 8th World Congress of Biomechanics conference, Nymbl was shown to significantly improve stability in just 21 days. Sway improvements measured were:
The foundation of Nymbl Science is years of clinical research into the science of balance by Dr. JP Farcy, or Scientific Co-Founder. He determined that balance can be improved through physical exercises (such as one legged stands) as well as cognitive exercises (such as solving math problems or learning new language). But when you combine the two simultaneously, called “dual-tasking“, you get an accelerated effect.
This is because doing two things at once stimulates the brain to actually rebuild synapses in the brain. In order to maintain the posture, and concentrate on answering questions, requires opening as many synapses as possible to cope with the extra work. This is a well-known process called “neuro-plasticity”.
You can see examples of this in daily life. Often, if an older adult is walking and you ask them a question, they will stop. The brain has trouble walking and problem solving at the same time, because many of the balance and stride neurons have gotten “lazy” – the cognitive bandwidth has declined. After a few weeks of balance training, there is often a significant improvement.
In the Nymbl Training and Nymbl Class Apps, we accomplish dual tasking by providing physical exercises with mental challenges on the iPhone’s screen. In fact, because the app can simultaneously recommend isometric & cognitive exercises, time them, AND measure how well you’re doing (using the built in accelerometer), we are able to bring advance clinical tools and techniques to anyone with a smartphone – which pretty soon will literally be everyone!
If you would like to explore implementing a fall prevention program in your community, please contact us using the form below.
The Academy Senior Living Community in Boulder, Colorado, prides itself on its community and the active life style of its residents. So when Nymbl approached them to pilot an innovative program to essentially turn the Academy into a living lab for balance improvement, they said “lets do it!”.