Balancing Act: An Upright Approach to Falls Prevention

MARILYN R. GUGLIUCCI, MA,PHD, AGHEF, GSAF, AGSF

PROFESSOR & DIRECTOR, GERIATRICS EDUCATION AND RESEARCH

UNIVERSITY OF NEW ENGLAND COLLEGE OF OSTEOPATHIC MEDICINE

GERONTOLOGICAL SOCIETY OF AMERICA, HEALTH SCIENCES , PAST CHAIR

ASSOCIATION FOR GERONTOLOGY IN HIGHER EDUCATION,

PAST PRESIDENT

MEAPAFEBRUARY 6, 2015

GOAL: Introduce the intricacies and nuances of aging while walking the fine line of balance

OBJECTIVES:

Know and Understand…Various definitions and concepts related to

FallsProprioception and BalanceKey points to enhance falls prevention

Have fun!

Learning By Living Project

HOSPICE Immersion Project

• 48 Hour Immersion Project• Enter on Friday at Noon• Discharge on Sunday at 1:00pm• Qualitative Ethnographic Research • Journals = Data

Functional Fitness Concept & Falls

The body should be trained and developed to

make the performance of everyday activities

easier, smoother, safer and more efficient.

Focus =Training the core (torso, hips, and

thighs) for stability Associated with movements used in everyday life.

Functional Fitness:The Magic of Activity

Maintain/Improve strength of arms, legs, and core Core muscles: abdomen, back, and hips

Climbing flight of stairs, walking Gardening, golfing, anything with movement

Upper Body Strength Lifting groceries, vacuuming, scrubbing

Keep endurance Walk longer Do activities longer – increase by a minute

Aging isn’t to blame – Inactivity is! Inactivity over time = Faster aging

Inactivity and Poor Nutrition...

in # of Older Adults demands on:

Public Health System

Medical Service

Social Services

obesity (older and younger)

falls

AGS

CAUSES of Older Adult FALLS

Rarely due to a single cause

May be due to the accumulated effect of impairments in multiple domains (such as other geriatric syndromes)

Complex interaction of:

Intrinsic factors (eg, chronic disease)

Challenges to postural control (eg, changing position)

Mediating factors (eg, risk taking)

Environmental factors (eg, rugs, steps, cords)

Grieving

FALLS…

Falls

Definition Coming to rest inadvertently on the ground or at a

lower level

One of the most common things to happen (40+ y/o)

$54 Billion costs –Direct and Indirect Costs (2030)

50% who fall are unable to get up w/o help (“long lie”) A “long lie” predicts lasting functional decline

Fall Prevention: Many Factors

Exercise/Fitness: Physical health/disease (Dis-Ease)

Environmental Issues: Scan the home (rugs, pets, cords, door thresholds,

furniture placement, etc)

Medications: May want to ask how many are taken; if on any new

medications or med changes

Assistive Devices: Furniture walking/cane/walker

Behavioral /Mental Health Issues: Depression causes falls

1. Intrinsic Factors2. Postural Control3. Mediating Factors4. Environment Factors

A CDC Compendium ofEffective Fall Interventions:What Works for Community-

Dwelling Older Adults2nd Edition

Exercise-based InterventionsHome Modification Interventions

National Center for Injury Prevention and Controlhttp://www.cdc.gov/HomeandRecreationalSafety/pdf/CDC_Falls_Compendium_lowres.pdf

Improving Patient Safety in Long-Term Care Facilities Student Workbook

Prepared by: RAND Health Santa Monica, CA Stephanie L. Taylor, PhD, MPH Debra Saliba, MD, MPH

AHRQ Publication No. 12-0001-4 June 2012

Community-Based Programsin Maine

MATTER OF BALANCE

& U-EXCEL

BALANCING ACT

Matter of Balance

Participants learn:To view falls and fear of falling as controllableTo set realistic goals to increase activityTo change their environment to reduce fall risk

factorsFormat:Group programLay leader modelLearn about exercising and its effect on strength

and balance

U-ExCEL Balancing

Act

Winner2012 Maine Governor’s

Fitness Award

U-ExCEL UNECOM –Exercise and Conditioning for Easier Living

Community-based comprehensive health promotion program (1995)

Serves older adults and their caregivers Provides an array of group or individually designed programs focused on fitness,

wellness and nutrition. Supports the academic mission of the University health professions programs and is a

support service of UNECOM Department of Geriatric Medicine. Follows rigorous health and safety guidelines set forth by the American College of

Sports Medicine (ACSM) Supports the research and education mission of UNECOM in that this population

voluntarily serves as research participants and standardized patients.

U-ExCEL MOTTO: “Exercise does not discriminate; anyone willing to try can exercise.”

Benefits of Balance Training

Performing balance exercises 3-5 days per week can provide HUGE benefits, such as:

Increases joint stability, muscle strength, muscle mass, and flexibility

Improves muscle enduranceIncreases performance for all physical activityStimulates brain activityReduces serious injury should a fall occur

Balancing Act

An individual balance enhancement program Designed for anyone who would like to improve

balance and reduce falls

Can be self-taughtInstructions tested for clarity by older adultsAdapted for people with vision impairment

NIH Grant being tested nowEvidenced-based – Assisted Living Residents w/ mild

cognitive impairment

Balancing Act - Portability

Physicians and Health Practitioners Over 40 – have you fallen? Tinetti or Timed Get Up and Go Assessment

Emergency Medical Services Folks not wanting transport to ER

Senior and Community Centers, Churches, etc. Group or Individual approach – check in services

Families and Individuals At home, LTC Facilities, Anywhere!

U-ExCEL Balancing Act Manual

The U-ExCEL Balancing Act Manual can be purchased directly from the University of New England College of Osteopathic Medicine, Institute of Geriatric Medicine: Ask for Ami Phone: 207-602-2134 Address: University of New England College of Osteopathic

Medicine; 11 Hills Beach Road; Biddeford, ME 04005 Email: aesquivel@une.edu

Copyright © 2014 University of New England

First Encounter: Using This Manual

This manual is designed to be very straight forward and easy to use. Review this manual before beginning the U-ExCEL

Balancing Act program, it is important to be familiar with the various instructions.

This manual is organized to: (1) introduce the U-ExCEL Balancing Act Program, (2) offer step by step instructions to perform and practice a

variety of balance specific exercises in order to maintain or improve balance and stability, and

(3) check performance at the end of the Beginner, Intermediate, and Advanced level exercises.

Visual impairments 

Important Points

Getting Started ~ IMPORTANT! Begin the exercises within this manual at any time.   Follow the instructions to ensure safety. Face a stable object or piece of furniture (i.e. – hand rail, counter,

heavy chair or table) Start with the beginner exercises eventually build up to advanced

exercises Be sure to review the hand positions Hold each exercise for 5 seconds and build up to holding each

exercise for 30 seconds. At first all exercises should be performed with eyes open.

Checklist NOTE: Know your own limitations!

 

Getting Started: Hand Positions

Hand Position #1 Hand Position #2 Hand Position #3

Doing the Exercises

Find place where exercises can be done safely

Waist HeightKitchen sinkCounter topBack of CouchBack of non-reclining ‘solid ‘chair

Point of Focus

Balancing Act Exercises

PROGRESSIONS

U-ExCEL Balancing Act

Level I (Beginner) Exercises wider base of support (stance), assistive device/wall

Level II (Intermediate) Exercises narrower base of support (stance), graduated release

of external support (wall/chair) & visual cues

Level III (Advanced) Exercises narrow base and/or one foot, altered center line,

graduated release of external support & visual cues

Beginner Progression

Wide Stance Feet 6 inches apart Feet Close Together

Progression

Foot Forward Heel Forward Heel UpBeginner Intermediate Advanced

Progression

Foot Forward Toe Back Toe UpBeginner Intermediate Advanced

Progression

Foot Forward Heel to Toe (broad stance) Heel to Toe (touching)

Beginner Intermediate Advanced

Exercise #1

1. Wide Stance Stand facing the back of a chair,

counter or stable object Stand with back straight, hips

forward, knees slightly bent Feet hip width apart Hold position…. Repeat 3 times

Challenge 1: progress through the various hand positions Challenge 2: perform with eyes closed (only if you feel comfortable)

Exercise #2

2. Feet 6 inches apart Stand facing the back of a chair, counter

or stable object Stand with back straight, hips forward,

knees slightly bent Feet hip width apart, which is about 6

inches apart Hold position… Repeat 3 times

Challenge 1: progress through the various hand positions Challenge 2: perform with eyes closed (only if you feel comfortable)

Exercise #3

3. Feet Close Together Stand facing the back of a chair, counter

or stable object Stand with back straight, hips forward,

knees slightly bent, weight even on both feet

Both feet close together (few inches apart at ankles)

Hold position… Repeat 3 times

Challenge 1: progress through the various hand positions Challenge 2: perform with eyes closed (only if you feel comfortable)

Exercise #4

4. Foot Forward (feet flat) Stand facing the back of a chair, counter

or stable object Stand with back straight, hips forward,

knees slightly bent Step forward with right foot, keeping

both feet flat on the ground Distribute weight evenly on both feet Switch and repeat – step forward with

left foot…..Repeat 3 times each side Challenge 1: progress through the various

hand positions Challenge 2: perform with eyes closed (only

if you feel comfortable)

Exercise #5

5. Weight Shift Stand facing the back of a chair, counter or

stable object Stand with back straight, hips forward, knees

slightly bent, weight even on both feet Stand with feet hip-width apart, about 6 inches,

and toes pointing forward Shift weight to right side, keeping both feet on

the floor Switch and repeat on the left side Repeat 3 times each side

Challenge 1: progress through the various hand positions Challenge 2: perform with eyes closed (only if you feel comfortable)

 

STOP Page

Stop! Before moving on to the next level of balancing exercises, be sure you can answer yes to the following statements for each exercise in the CHECKLIST below:

I can confidently perform this exercise I can perform this exercise for 30 seconds I can perform this exercise using Hand Position #3 (see page 3)

 U-ExCEL Balancing Act: Beginner Exercises Checklist1.Wide Stance2. Feet 6 inches apart3. Feet Close Together4. Foot Forward (feet flat)

Right Foot Forward Left Foot Forward

5. Weight Shift Right Side Left Side

How to Keep Track

U-ExCEL Balancing Act Exercise DiaryNAME: ____________Today’s Date: ________Exercise #: Fill in the number of the exercise you are doing (1-

20). Repeat each exercise 3 times and do them at least 3

days per week. In each box, record how many seconds you performed

the balance exercise. Exercise #

Exercise #

Exercise #

Exercise #

Exercise #

Week 1 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

Day 1

Day 2

Day 3

Social Support Identifier

Please answer all questions as best you can. 1. Who can you really count on to be dependable when you need

help?2. Who can you really count on to help you feel more relaxed when

you are under pressure or tense?3. Who accepts you totally, including both your worst and your

best points?4. Who do you talk with most frequently either by phone or in

person?5. If you do not feel well, who can you really count on to check in

on you and assist you if you need help?6. If you travel or will be away from home, who can you count on

to water your plants, check your mail, take care of your pet, or check on your home?

Review Key Terms

Balance: even distribution of weight enabling someone to remain upright and steady.

Base of Support: the location on the body where most of the weight is supported; the legs and feet make up the body’s base of support, acting as the base or foundation to standing erect so as to keep from falling, sinking, or slipping.

Center of Gravity: the point at which the entire weight of a body is concentrated so that at this point the body maintains its equilibrium (balance) in any position.

Points of Contact: the area in contact with the floor or another stable object (feet, hands holding on, touch with finger tips).

Postural Sway: the body sway induced by performing balance exercises. To sway is to move rhythmically back and forth or to influence body position.

Proprioception: the ability to sense the position, location, orientation, and movement of one’s body.

Stability: the state or quality of being stable, especially being resistant to change. 

Visual Point of Reference: a constant visual cue or focal point that the eyes concentrate on to aid balance and stability; best visual points of reference are at eye level when standing tall.

References

American Geriatrics Society WebSite: http://www.americangeriatrics.org/ Chodzko-Zajko, W. "Physiology of Aging and Exercise" (in Cotton, R.T. (ed.)

(2005) Exercise for Older Adults: American Council on Exercise's (ACE) Guide for Fitness Professionals (2nd ed.). Champaign, IL: Human Kinetics, pp. 4, 5 and 8.

3 Rowe, J.W., and Kahn, R.L. (1998) Successful Aging. New York, NY: Pantheon, p. 102.

4 U.S. Department of Health & Human Services (2001) The Surgeon General's Report on Physical Activity and Health (SGR), p. 141. Available at CDC on the World Wide Web: www.cdc.gov/nccdphp/sgr/sgr.htm.

5 Cotton, R.T. (ed.) (2005) Exercise for Older Adults: American Council on Exercise's (ACE) Guide for Fitness Professionals(2nd ed.). Champaign, IL: Human Kinetics, p. 102.

Live Well, Live Long: Health Promotion and Disease Prevention for Older Adults (2002-06) American Society on Aging,, Washing ton , DC.