Reviewed by Hansa D. Bhargava, MD on October 02, 2018

Oct. 2, 2018 -- Duane Partain was 71 years old when he took a couple of spills in his flower garden in Eugene, OR. He has vertigo and sometimes feels lightheaded and wobbly, but he hadn’t fallen before. So, after he went crashing into the bushes, he stopped spending as much time in the garden, worried he’d take a tumble again.

When older adults fall, fear of falling again often keeps them from getting back to their usual activities. The lack of exercise then takes its toll on balance and strength, which only makes a person more vulnerable to another, more serious spill. Poor vision, slower reflexes, and medications or conditions that make you dizzy also make falls more likely.

More than one in four adults age 65 or older fall every year, and falls are the leading cause of injury-related deaths in that age group, the CDC says. Once you fall, your risk of going down again doubles. When a bone breaks -- particularly a hip -- falls can harm your quality of life, make you more disabled, and raise your risk of death. More than 95% of broken hips are the result of a fall. When an adult between the ages of 65 and 84 breaks a hip, their risk of dying in the next 2 years triples.

“I’ve had friends, acquaintances, and neighbors who’ve fallen, and when they broke something, that started a serious decline in their activities. I wanted to avoid that as long as possible,” Partain said.

In fact, most falls can be avoided. But while many people try to get rid of things that can make them fall in their homes, they don’t consider the risks within their own bodies.

“Picking up throw rugs and installing grab-bars is a great start, but if you don’t have a balance impairment, you can catch yourself when you trip over a rug,” says Lori Schrodt, PhD, a physical therapist at Western Carolina University’s Balance and Fall Prevention Clinic. “It’s that environmental hazard combined with some other risk factor, such as balance impairment, that is the real recipe for disaster.”

But how do you restore lost balance -- and confidence -- after age 65? Studies show it is possible.

Moving for Better Balance: Tai Chi and Other Proven Programs

The National Council on Aging (NCOA) recognizes 14 programs for their proven record to lessen falls. One of the most effective is Tai Ji Quan: Moving for Better Balance, a course that researchers adapted from traditional tai chi (short for tai ji quan or tai chi chuan). Tai chi, an ancient Chinese practice, includes slow, focused, fluid movement along with deep breathing.

Part of the benefit of many fall prevention programs is the exercise they provide. But not all exercise is equal. In a study of 670 adults age 70 or older who had fallen at least once in the last year, tai chi adapted for fall prevention was more effective than a generic exercise program or a stretching routine. Adults who practiced tai chi 2 hours per week for 6 months were 31% less likely than those in the exercise group to fall again and 58% less likely to fall than those in the stretching group.

“[Tai Ji Quan: Moving for Better Balance] starts to reactivate the neuromuscular pathways that underpin your ability to control your body as it falls through space,” says Peter Harmer, PhD, a professor of exercise science at Willamette University in Salem, OR. Harmer and program creator Fuzhong Li have collaborated for nearly 3 decades to develop and refine Moving for Better Balance. They are co-authors of the study of 670 older adults.

Duane Partain was one of them. He responded to an ad recruiting people for the study at Oregon Research Institute 3 years ago, and he’s been practicing tai chi ever since. “It helps prevent falls because your body seems to become more aware,” Partain says. “The fall doesn’t catch you unawares. It doesn’t just come out of the blue. You can tell what is going on, and you can be proactive to stop it.”

That’s because, Harmer says, the class provides exercises that mimic balance challenges people face in everyday life.

Since Partain started tai chi, he hasn’t fallen, his bouts of vertigo are less frequent and less severe, and he’s gotten back into the garden. “After I started the classes, I felt more confident, so the garden isn’t a problem anymore.”

Talk It Out

Structured fall prevention courses aren’t only about exercise. They offer education and problem-solving, too. “It’s not just about learning a tai chi move,” says Schrodt. “It’s about learning your risks and how to manage them.”  

A Matter of Balance, another of the 14 programs recognized by the NCOA, helps people face their fear of falling, support-group style. “We talk about situations in which you might be invited to do something, but you are afraid you could fall, so we discuss what you could do so that you could go to this particular activity,” says Diane Frankel, RN, a population health navigator at the YMCA of Western North Carolina. She helps older adults with multiple health issues -- such as diabetes, arthritis, and the risk of falling -- find programs at the Y that can help them improve their condition.

Frankel, 64, got involved with fall prevention at the Y after she fell herself. Only 60 at the time, she lost her footing in a parking lot while carrying several bags. “I stepped into a tiny hole, so I can’t really blame the hole. I fell, and I wasn’t injured badly, but it shocked me.” She was physically fit, had done yoga for a long time, and didn’t expect that she would be at risk for a fall. After completing the tai chi course at the Y, she found that her balance was better in yoga, too.

Learning to Fall

Some experimental approaches to fall prevention include practicing not falling when you lose your balance.

“Regardless of age, we are capable of learning,” says Clive Pai, a retired professor and director of the department of physical therapy at the University of Illinois-Chicago. “You can quickly learn how to adjust and not fall in the future.”

That was the basis for a fall prevention study Pai conducted. In the experiment, older adults walked on a treadmill at their preferred speed. They were warned that something could cause them to fall, and they wore safety harnesses to prevent them from hitting the ground. The treadmills tripped the elders 24 times. “It doesn’t take many times -- only once or twice -- before you are fully capable of making an adjustment, controlling your stability, and not falling.”

People in a control group spent the same amount of time on the treadmill, but researchers tripped them only once.

In the year after the study, those in the control group were more than twice as likely to fall as they had been the year before. Those who had intensive fall practice were 50% less likely to fall. What’s more, the training had lasting effects. When elders returned to the treadmill 3, 6, and 12 months after the initial session, they kept their balance when the treadmill tripped them.

In a Dutch program, seniors face numerous fall hazards, including uneven and unstable surfaces, set up in a school gym. The seniors practice staying stable as they get to each hazard, and they learn how to fall when they do. The program gives elders confidence to keep moving without fear of falling.

Next Steps

When the study ended at Oregon Research Institute, Partain wasted no time finding a tai chi class at the local parks department. “I go three times a week now,” he says. “It’s very beneficial.” You can find fall prevention programs at parks departments, senior centers, health care facilities, and the YMCA (which does not always require membership if you want to take part).

While there are many types of programs to choose from, they have a few things in common: movement, education, and a social environment. These seem to work together to give older adults the balance and the confidence to get moving again without fear of falling. “People just light up. They feel like they can manage better,” says Schrodt, the Western Carolina University physical therapist. “It’s like they get more spring in their step.”

Show Sources

Duane Partain, retiree and tai chi practitioner, Eugene, OR.

Journal of Physical Therapy Science: “The association between fear of falling and physical activity in older women.”

CDC: “Important Facts about Falls.”

Journal of Orthopedic Trauma: “Mortality risk after hip fracture.”

Lori Schrodt, PhD, professor, department of physical therapy, Western Carolina University, Cullowhee, NC.

National Council on Aging: “Evidence-based falls prevention programs.”

Peter A. Harmer, PhD, professor, exercise and health science, Willamette University, Salem, OR.

Journal of the American Medical Association: “Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling: A Randomized Clinical Trial.”

Diane Frankel, RN, patient navigator, YMCA of Western North Carolina.

Clive Pai, director, department of physical therapy, University of Illinois-Chicago.

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