A balance problem among the geriatric population has been identified as one of the major issues. Can balance training improve quality of life which may add life in geriatric population? What are your opinions?
The way life expectancy is increasing the older population – persons 65 years or older will be increasing. In US old people represented 12.4% of the population in the year 2000 but are expected to grow to be 19% of the population by 2030. This obviously require more people trained in geriatrics.
https://www.census.gov/population/socdemo/statbriefs/agebrief.html
http://www.amsa.org/AMSA/Homepage/About/Committees/Geriatrics.aspx
http://www.who.int/ageing/projects/tegeme/en/
Inevitable in any living being is to become OLD.... Once the balance is gone ... the center of gravity of the body deviates away the stability of the body posture of comfort and upbringing..I have personally seen in my family when my elders had faced this problem, especially after a HIP fracture etc., and then the untold sufferings play a disturbing part
@ Nageswara, Krishnan, greeting for valuable input.
As krishnan experienced, falls due to balance problem can lead to very serious scenario and even death of geriatrics.
My grandmother had this problem at the age of 95 and could not revive... the problem was she was not willing to eat and gather back her strength to walk... two years ago my father at the age of 83 (now) fell and broke his HIP.. after surgery he also was reducing his intake for the reason he was bedridden during those days of post operative care...but the family pressure of making him eat a balanced diet and supportive physiotherapy... got back to normalcy and good going...
@ Krishnan, you have seen the beneficial effect of diet and physiotherapy (bedside physiotherapy i suppose which might include balance training) which is very much required after every prolong bedridden case.
Ratan
I think the balance training and muscle strengthening exercises should be started earlier rather than after reaching the old age. We have so many cases of people getting toppled particularly in bathrooms because of this. Also some kind of proper design or modification of houses may be in order to reduce such problems. I have seen people losing confidence after such a fall and are bedridden for the rest of their life.
Dear Ratan, there is proverb in Greek: :"ου γαρ έρχεται μόνον το γήρας -> fear old age, for it never comes alone"! You can have balance training which can improve quality of life, but bitter truth is that come to age, bring together a lot of negative things!
Old age is like a plane flying through a storm. Once you're aboard, there's nothing you can do. - Golda Meir
@ Nageswara, as prevention is always better then cure early initiation of balance training prior to fall would be always beneficial. But after a fall also we may still implement balance traning to prevent or minimize recurrent fall and to motivate walking or physical activities...
@ Costa, I appreciate your input. Many negative things may also result (say fracture of bone due to inappropriate training) when we didn't design the balance training (BT) appropriately considering the health status (general, physical, psychological) and physical ability of the person. A well design BT programs may always reduce or minimize the negative result while achieving positive aspect of BT...
Dear Ratan, I'm not physician, but I can tell that problem of balance in late adulthood is crucial. Persons, who are aged, have other techniques of falling on ground, than young people, which exposes them to frequent fractures of limbs. So I think any balance training is very important.
As a Physiotherapist, I would say balance training is of utmost importance in the geriatric population. Balance training forms not only as a therapeutic intervention but also for the prevention of falls which is of high incidence in a geriatric population and as a rehabilitative intervention in Parkinsonism and movement disorders where balance training complements gait training. This results in improvement of not only the physical health but also instills confidence in the geriatric population thereby improving the quality of life and adds years to the lives of the respective population.
As a clinician I can guarantee that it does make a huge difference. However, many other physical and cognitive training techniques are mandatory because the geriatric population requires a holistic aproach encompassing strength, flexibility, balance, coordination, specific training (how to fall, how to climb stairs, etc.) and other techniques to improve memory and obstacle avoidance processing. This will increase wuality of life but the methods available to measure quality of life also lack consensus in literature because many variables are present, especially in elderly population.
Balance problem in elders occur as a result of many reasons, it is not a single cause for the problem, so it is important to identify what is the cause and find the solution. if the balance problem is due to muscular or neurological then we may go with the balance training programme.
Balance training is certainly essential for anyone of an 'older' age, but to truly see improvement in the skills taught I believe you should incorporate a degree of strength training as well. Even slight improvements in strength may allow a greater degree of improvement in the balance issues seen.
Dear Kimberly, I agree there is good correlation between muscles strength and balance...
Life expectancy is increasing day by day as an advances in medical science so does no of geriatric patients. If these roup get ill then it will increase the Economic burden of society. So as a PT we should try our best to maintain or improving their QOL not only by balance training but should include other aspects as well.
Add Life to Years not years to their life..
Since about 1/3 of older adults fall every year and since falls are the number one reason for accidental death and injury in this population and since that population is growing larger, of course interventions to prevent fall should be implemented for all older adults. Balance training is one very important piece. Studies have repeatedly shown that exercise that includes appropriate strengthening, flexibility, endurance and balance improves scores on balance tests and results in fewer falls.
The article you posted highlights why LE strength is a necessary element in a balance/functional mobility program. I believe a good number of PTs in the acute care setting focus on gait training (due to time constraints and need to get the patient minimally functional for discharge), but gait alone may instill a sense of false security or confidence. Gait Speed and the Short Physical Performance Battery (SPPB) are tools I have found to be meaningful in determining a patient's functional strength and confidence in walking.
I am a nurse who calls pts after they're discharged from the hospital/ ED and the incidence of falls in the geriatric population I call is tremendous. I can't tell you how many hospital visits would be prevented if there were fewer falls. One step in the right direction is Stanford Hospital's FREE home based program called, " Farewell To Falls." The focus: Medication review- Home safety Assessment and Modification and any other health issues that could be a factor. 2 visits by an OT...and a 3rd visit one year after enrollment. It's a start and a much needed program that I recommend to all of my patients who fall! More research needs to be done to prevent falls though!
Fall risk increases with advancing age. Balance and propriocpetive training are both important in geriatric patients.
Balance and fall prevention is critical in the geriatric population. Problems in this area can create a downward spiral into the healthcare system, leading to bone weakness, fractures and deconditioning. In addition, other issues like metabolic disorgers, neurologic deficits and/or decreased strength can be the tipping point for quality of life issues. I would refer you to the University of North Carolina School of Medicine's Otago Falls Prevention Program, which was developed from a New Zealand based falls prevention program. Implementation of something along these lines can help maintain function and safety among these patients, guaranteeing a better outcome for lifelong fitness.
http://www.med.unc.edu/aging/cgec/exercise-program
Dear Ratan, I'm Physiotherapist and highlight some points:
Falls are a major event to identify the healthy of the elderly.
Being multi casual its prevention strategy needs to be broad: physical activity, medications, nutrition, environment and others.
Other important concept is associated with dual task, because the falls are that the main causes are not only linked the task to remain standing in a static position, but in the realization of dynamic or concurrent tasks. These articles talk about the subject are interting.
Moghadam, M., Ashayeri, H., Salavati, M., Sarafzadeh, J., Taghipoor, K. D., Saeedi, A., SALEHI, R. Reliability of center of pressure measures of postural stability in health older adults: Effects of postural task difficulty and cognitive load. Gait & Posture, 2011.
Aragão, F. A. Karamanidis, K., Vaz, M. A., Arampatzis, A. Mini-trampoline exercise related to mechanisms of dynamic stability improves the ability to regain balance in elderly. Journal of Electromyography and Kinesiology, 2011.
Patients often present with midfoot instability, joint instabilities, and diabetic neuropathy with loss of sensation. Lack of support can be problematic for patients with ankle joint and midfoot arthritis, If the shoe is too flexible at the toe break and the person has painful arthritis (hallux rigidus/limitus) in the first MTP joint, which is compressed at that point, the shoe does not provide enough protection and can cause more pain. 90 percent of body weight normally pushes off this joint during toe-off at the end of a gait cycle, a fact that emphasizes the importance of protection and support for patients with this pathology.
http://www.oandp.com/articles/2013-11_02.asp
Very important! One of the best neurorehabilitation method for children and old people is the VILAN Method (Vera and Nikola Ilankovic)
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