Fall Prevention: The Importance of Proactive Measures for the Elderly

Falls and related injuries constitute an urgent health problem globally, especially among those over 65, where statistics show that one in three people in this age group experience falls each year. These incidents can lead to serious consequences, including hospitalizations and in the worst cases, death, highlighting the importance of effective fall prevention measures.

Health Challenges and Economic Burden

In several Scandinavian countries, nearly 20% of the population is over 67 years old, with a significant portion experiencing fall-related injuries. The treatment of these injuries, especially hip fractures, is both resource-intensive and expensive. With average costs of approximately 500,000 Norwegian kroners in the first year after a hip fracture, it is clear that prevention can save not only lives but also economic resources.

Why Falls Happen: Risk Factors

Falls in the elderly can often be due to age-related changes such as reduced muscle strength, poorer vision, decreased balance, and reaction time. These elements often combine and significantly increase the risk of falls. It is therefore important to proactively identify and address these risk factors through targeted measures.

Exercise as a measure for fall prevention

Fall prevention measures can significantly reduce the number of falls, and physical activity is considered the most important measure. In a 2019 Cochrane study that included 108 controlled randomized studies with a total of 23,407 participants, it was concluded that exercise results in fewer overall falls and fewer individuals falling (13). Based on studies where the intervention consisted of a combination of balance training, functional training, and strength training, a probable reduction in the number of falls by up to 34% was reported. The number of individuals who fell one or more times was reduced by up to 22%. The Cochrane study reported that training (all types) could reduce the number of falls per year by 195 per 1,000 falls (13).

Thus, exercise prevents falls in the elderly, and consequently, injuries related to falls (2,13). It is reported that exercise can reduce the risk of hip fractures, but the figures vary and the evidence in current studies is low (13). Regular training of strength and balance can increase walking speed, which has been seen to be closely related to fall risk. Exercise also has a positive impact on attention, planning, and problem-solving, and prevents a variety of other diseases (2).

National recommendations suggest that those who are unsteady or have impaired walking function should engage in balance and strength exercises several times a week, in addition to the general recommendations for physical activity.

Use of digital tools in fall prevention

The use of digital aids such as training apps can make training more accessible to users, and the training can be more easily carried out at home or in institutions, both guided and unguided, individually or in groups. A study from Norway has shown that the use of a training app is a useful tool for both instructor/guide and user (14). It can also be a cost-effective alternative.

ExorLive offers several solutions that can be adapted to different users, institutions, and municipalities. Among other things, in collaboration with Ragna Skipstad from FYSIOklinikken and the National Competence Center for Aging and Health, we have developed "SeniorLive". These are training videos to music that include selected exercises from research studies on the elderly and fall prevention. Read more and see examples of the videos here.

We also have products like ExorLive Assistant where a nursing assistant/instructor can guide and record the training along with the user, as well as our own application solution ExorLive GO where the user can receive tailored training programs either through a physiotherapist or a survey tool built into the solution.

Exercise as Prevention

The main purpose of exercise for the elderly is to reduce the risk and fear of falling, reduce the risk of diseases, and to maintain or enhance functional abilities so that individuals can remain self-sufficient and live at home for a longer time. Elderly who are physically active exhibit better physical and cognitive function compared to their inactive peers (15). Inactivity in the elderly increases the risk of developing diseases like cancer, sarcopenia, and cardiovascular diseases, leading to a greater number of years lived in poor health and an increased need for healthcare (15).

Increasing age is associated with decreased balance and a higher risk of falls (16). Strength and balance training are considered primary prevention methods for falls and fall-related injuries. Training programs that include these elements have shown a significant reduction in fall incidents (35-54%) (16). Furthermore, leg muscle strength correlates with walking speed, which closely links to fall risk.

Strength and balance training interventions can be guided by healthcare professionals either individually at an elderly person's home or in a group setting. According to Robertson et al. (2001), these preventive training interventions are highly cost-effective, and that supervised training can be administered at home by various types of health staff (17). In Norway, research indicates that preventing just one hip fracture can potentially save approximately 500,000 NOK in the first year alone (18).

Recommendations

According to a 2019 consensus report on physical activity and aging, there is a positive dose-response relationship regarding training volume and intensity (15). This implies that while some risk reduction for physical declines and diseases can be achieved below current activity recommendations (150 minutes of moderate to vigorous exercise per week), doubling the recommended exercise volume can yield significantly greater health benefits.

Functional training, defined here as exercises that echo daily activities (ADLs), is crucial for maintaining the ability to manage daily demands. This might involve activities like climbing stairs, picking items off the floor, or rising from a chair. The principle of specificity suggests that training should focus on activities one needs to improve. It is also important that exercises are scaled to the individual's capability; if getting up from a chair is easy, then more challenging exercises should be undertaken to ensure continued progress.

The elderly often lack quick power development abilities. Even those over 90 can increase muscle strength through heavy strength training, mainly due to neural adaptations, not increased satellite cells or muscle cross-sectional area (19). Studies have shown that significant practical results from strength training interventions in the elderly require a high training load (≥ 80% of 1RM) (19).

The consensus report emphasizes the need for more research to establish specific guidelines on how the elderly should train in terms of load, duration, and activity type to maximize training effects (15). The elderly population is diverse, and research findings may not always be generalizeable.

An App for Safe Training at Home

The growing need for interdisciplinary home care has led to the development of the ExorLive Assistant app, a tool designed to ease communication between caregivers and therapists for more efficient collaboration. This app ensures that caregivers can safely assist elderly patients with their training routines at home, guided by therapists or through the app's assessment tools. Exercises are clearly demonstrated through videos, text, and images, with completed sessions being recorded for ongoing adjustments by therapists.