By Maura O'Connell, SPT
The Hidden Impact of Falls in Older Adults
Falls are a leading cause of injury and disability among older adults, often resulting in fractures, hospitalizations, and decreased quality of life. According to the Centers for Disease Control and Prevention (CDC), approximately one in four older adults falls each year, leading to significant healthcare costs and long-term complications. ¹ However, physical therapy (PT) has been proven to be an effective intervention in reducing fall risk, improving mobility, and enhancing overall safety. This blog explores the role of physical therapy in fall prevention, the techniques used, and the evidence supporting its effectiveness.
What Contributes to Fall Risk?
Fall risk is influenced by a variety of intrinsic and extrinsic factors. Muscle weakness, typically characterized by decreased strength in the lower extremities, significantly increases fall risk. As we age and often become less active, muscles can atrophy very quickly. Thus, it is crucial to strengthen the lower extremities to allow for an active, safe lifestyle. Another major factor in fall risk is impaired balance and coordination. Conditions such as vestibular dysfunction, neuropathy, and stroke can significantly impair balance. A consequence of many conditions is gait abnormality. Changes in walking patterns due to aging, arthritis, or neurological disorders, to name a few, contribute to instability. Many individuals cannot identify a gait abnormality on their own, so it is crucial to have a trained eye isolate key gait abnormalities to decrease fall risk. Other factors in fall risk include medication, environmental hazards, and cognitive impairment. It is critical to be aware of these contributors to fall risk to decrease the likelihood of a fall.
A Physical Therapist’s Role in Fall Prevention
Physical therapists assess fall risk factors and create individualized programs tailored to each patient’s needs. PT interventions focus on strength training, balance improvement, gait retraining, and education to enhance confidence and safety in daily activities.
Strength Training to Combat Muscle Weakness
Muscle weakness is one of the primary contributors to falls. Resistance training, particularly for the lower limbs, has been shown to significantly improve strength and reduce fall risk. A study by Liu-Ambrose et al. demonstrated that progressive resistance training in older adults led to a 40% reduction in falls over a 12-month period.
Evidence-Based Balance Programs Like Otago
² In addition to muscle strengthening, balance exercises can enhance postural stability and proprioception, reducing the likelihood of falls. The Otago Exercise Program, an evidence-based intervention, includes balance and strength exercises designed to prevent falls in older adults. Studies have shown that participation in the Otago program can reduce fall risk by 35%.
Gait Training and Assistive Devices for Safer Movement
3 While strength and balance are straightforward factors of fall risk, it is important to recognize that physical therapists can analyze walking patterns and provide gait training to improve efficiency and safety. For individuals with more severe mobility impairments, therapists may recommend and train patients in the use of assistive devices such as canes or walkers, helping them navigate their environment more securely.
Vestibular Rehabilitation for Dizziness and Balance
4 Additionally, dizziness and vertigo, often linked to vestibular dysfunction, frequently contribute to falls. Balance consists of three main systems: vision, vestibular, and proprioception. Vestibular rehabilitation therapy (VRT) includes exercises that help retrain the brain to compensate for balance deficits by up-training dysfunctional balance systems.
Research indicates that VRT significantly improves balance and reduces dizziness-related falls5. Multitasking, such as walking while talking, can challenge an individual’s stability. Dual-task training, which involves performing cognitive and motor tasks simultaneously, has also been found to improve divided attention and reduce falls in older adults.6 Physical therapists can conduct specific tests such as the Cognitive Timed Up and Go to identify dual-tasking deficits in order to target the most beneficial rehabilitative technique to reduce fall risk.
Home Safety Evaluations to Reduce Environmental Risks
Finally, physical therapists often conduct home assessments to identify hazards that could contribute to falls. Recommendations may include removing trip hazards, improving lighting, and installing grab bars in high-risk areas such as bathrooms.7 Patient education plays a crucial role in fall prevention. Physical therapists educate individuals and caregivers on recognizing fall risks, using proper footwear, and practicing safe movement strategies in daily activities. Increasing awareness and self-efficacy significantly enhances adherence to prevention strategies.8 It is simple to say that physical therapists can help reduce the risk of falls in older adults, but the research to support the claim is robust.
Who Should Consider Fall Prevention Physical Therapy?
Physical therapy is beneficial for a wide range of individuals. Some of these individuals may include those who have a history of falls or near-falls; those who experience difficulty with balance or walking; those who have conditions affecting strength, coordination, or sensation (e.g., arthritis, stroke, Parkinson’s disease); those who take medications that cause dizziness or drowsiness; those who have undergone recent surgery affecting mobility, such as hip or knee replacements; those who live in environments with hazards that increase fall risk; or those who experience fear of falling, which can lead to reduced physical activity and deconditioning.
It is important to consider how best to implement a fall prevention strategy. Regular assessments to monitor changes in strength and balance are crucial to identify meaningful improvement or stagnation in fall risk. Supervised exercise sessions under a licensed physical therapist ensure proper technique, progression, and a safe environment. When physical therapy is deemed no longer necessary, community-based programs that provide ongoing support and motivation are vital to remaining active and safe both outside and inside the home.
Why Physical Therapy Should Be Part of Every Fall Prevention Plan
Falls pose a significant risk to older adults, but physical therapy provides a powerful intervention to mitigate this risk. By addressing strength, balance, gait, and environmental hazards, physical therapy helps individuals maintain independence and improve their quality of life. Evidence strongly supports the role of PT in fall prevention, emphasizing the need for widespread implementation of these programs in clinical and community settings. If you or a loved one are at risk of falling, consulting a physical therapist could be a crucial step in enhancing safety and well-being.
References
- Older adult fall prevention at-a-glance. Accessed February 5, 2025. https://www.cdc.gov/falls/pdf/CDC-DIP_At-a-Glance_Falls_508.pdf.
- Liu-Ambrose T, Davis JC, Best JR, et al. Effect of resistance training on physical function in older adults. JAMA. 2019;321(20):2002-2012.
- Sherrington C, Fairhall NJ, Wallbank GK, et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2017;1(1):CD012424.
- Menant JC, Maidan I, Alcock L, et al. Gait training for fall prevention in older adults with mild cognitive impairment. J Gerontol A Biol Sci Med Sci. 2020;75(5):968-975.
- Hall CD, Herdman SJ, Whitney SL, et al. Vestibular rehabilitation for dizziness and balance disorders. Arch Phys Med Rehabil. 2016;97(4):555-564.
- Verghese J, Wang C, Lipton RB, et al. Dual-task walking and risk of falls in older adults. J Am Geriatr Soc. 2019;67(8):1607-1612.
- Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2018;9(9):CD007146.
- Lacroix A, Kressig RW, Muehlbauer T, et al. Community-based physical activity interventions in preventing falls among older adults. J Aging Phys Act. 2017;25(1):126-135.
- Montero-Odasso M, Speechley M, Muir-Hunter SW. Falls in cognitively impaired older adults. J Am Geriatr Soc. 2020;68(8):1748-1756.