Exercise to maximise postural control and reduce the risk of falls in older age

Abstract

The risk of experiencing a fall increases with advanced age, with at least one third of community-dwelling people aged 65 years and older falling annually. Falls can have a significant impact on an older person and commonly result in disability, loss of mobility, reduced quality of life and fear of falling. More serious fall-related consequences can include hip fracture, permanent disability, institutionalisation and death. Falling or loss of postural control results from a mismatch between an individual's physical ability and the demands of the environment and/or of the activity being undertaken. The physiological factors that underpin postural control decline with age, leading to a greater risk of falling. Some of these impairments, such as reduced muscle strength, can be improved with exercise, whereas others, such as poor vision, require other interventions. Targeted exercise is crucial for promoting functional independence and reducing the risk of falling in older age. Extensive research evidence strongly supports exercise as an effective single intervention to improve postural control and prevent falls in community-dwelling older people. Programmes that include exercises that challenge balance are proven to be more effective in preventing falls than programmes that do not challenge balance. Exercise should also be progressively challenging and ongoing and of sufficient dose to maximise its benefits in reducing falls. Uptake and long-term adherence to effective exercise programmes is more likely if older people's preferences and individual needs are considered. This chapter outlines the key elements of effective fall prevention exercise programmes for community-dwelling older people.