It’s that time of year when sidewalks, front porches, stairs and parking lots are all dangerously slippery.
For most of us, that means treading a bit more carefully. For the elderly, however, slick surfaces can be intimidating.
That’s because every year one in three adults age 65 and older falls. And these are no minor tumbles. According to the Centers for Disease Control and Prevention, falls are the leading cause of moderate to severe injuries such as hip fractures and head traumas, and they can also increase the likelihood of an early death.
Although problems with balance can develop at any age, most people start to notice changes in their late 60s or early 70s.
“As we age, balance deteriorates for a number of reasons, ranging from weakening eyesight, changes in blood pressure, weakening muscles, hearing lost, loss of sensation in the feet due to illnesses such as diabetes, as well as any other health issues that may cause sensory loss,” said Sarah Pohl, physical therapist and the clinic director for Excel Physical Therapy’s Dodge Street Clinic. “Lifestyle also plays a role, such as if a person is sedentary or regularly active, if they smoke or drink and maintain a healthy diet.”
Grace Knott, administrator of Hillcrest Health Services’ physical therapy and board-certified in geriatric physical therapy by the American Board of Physical Therapy Specialties, concurred.
“There are a lot of changes in our bodies. If you have a heart condition, and your heart doesn’t pump blood as effectively as it should, that affects balance,” she said. “If you get up too quickly, you can fall.”
Poor balance, however, isn’t inevitable. Staying active and doing simple exercises can make a world of difference for maintaining equilibrium.
“Exercise makes a tremendous difference in maintaining balance and avoiding falls,” Knott said. “Research indicates it makes the biggest impact on reducing falls.”
Sarah Blomenkamp, Knott’s colleague and a certified exercise expert for aging adults at Hillcrest, agreed.
“Research shows that there are benefits to strength training at any age. Strength is the key to function. If you gain strength, you will improve function. Exercise is more important than ever. Unfortunately, we see a lot of patients after they’ve already experienced a fall.”
Before hitting the gym, though, it’s important to seek guidance to find out what kind of a physical fitness regime is right for you.
“We start with a balance assessment and see if a patient is at risk of falling,” Pohl said, “and we evaluate each patient to see what their functional limitations are — whether because of surgery, aging arthritis or sports injury — anything that interferes with daily activity — and then we set up an individualized treatment plan. We talk with patients about their goals and where they want to get.”
Blomenkamp stresses that with older adults, it’s additionally essential they have an exercise program that takes into account their chronic conditions such as arthritis, heart or kidney diseases.
“Physical therapists are uniquely qualified to do this,” she said.
Pohl says an assessment includes several movements including if patients can sit and rise several times from a chair without using arm rests, stand with their feet together, stand on one foot, retrieve an object from the floor, stand with their eyes closed as well as perform a host of other activities.
She also stresses that it’s important to make sure there are no underlying health issues such as pulmonary or intestinal problems that may require treatments aside from physical therapy.
Exercises that improve balance run the gamut. For example, some exercises focus on strengthening calf and ankle muscles.
“The very first strategy to maintaining balance is ankle strength,” Knott said. “If you’re on a boat, you use your ankles to lean forward.”
To strengthen the ankles, she has worked with patients to do a single leg stance or practice standing on tiptoes.
Similarly, strong hips make it easier to move forward and backward.
“If you’re standing, and your hips are stiff,” Knott said, “you can’t move forward or backward.” Sitting or standing exercises that involve working specific leg muscles can strengthen the hips and significantly shore up the body’s core.
Blomenkamp adds that just standing still or going from sitting to standing in as many times as possible in 30 seconds can be good ways to improve balance. She said weights or exercise equipment aren’t necessary. “Body weight can be resistance,” she said.
And when our mothers reminded us to stand up straight, they knew what they were doing.
“Good posture goes a long way to improving your balance,” Knott said. “If your head is way in front of your body, your center of gravity is away from the base of support.”
For that reason, strength training and stretching to maintain good posture can additionally be very important.
Blomenkamp also works on a less quantifiable aspect of balance.
“One of the major things people face is a loss of confidence,” she said. “They can become anxious about falling and don’t want to leave the house. We work on instilling confidence by challenging them.”
Pohl agrees. “Sometimes, we just work on getting out of a chair and walking and building up their confidence.”
Results don’t happen overnight.
“It normally takes between six to eight weeks and consistency on the patient’s part,” Pohl said.
That means seniors can’t expect physical therapy sessions alone to improve their balance. They need to exercise on their own and remain active.
Pohl recounted an 82-year-old patient who had fallen twice in the month prior to coming to Excel, one who didn’t believe exercise would make a difference.
“She sat with her arms crossed in front of her and said the only reason she was there was because her son insisted,” Pohl said.
After a month of coming three times a week, however, the patient was amazed at how much her balance had improved, and she hasn’t had any falls since completing therapy.
Cleo Snyder, 87, is another prime example of how therapy and exercise can improve balance. She began physical therapy with Pohl three years ago when she developed sciatica, a painful nerve disorder.
She was referred by her doctor, who wasn’t sure physical therapy would work, but a simple exercise that involved stretching her hamstrings as well as other sitting and standing exercises improved her balance tremendously.
Pohl worked with Snyder to strengthen her lower extremities and challenged Snyder to walk sideways and in straight lines as well as to use a recumbent treadmill to improve her cardiovascular health.
“It’s amazing,” Snyder said. “For one thing, I’m a little more agile; I have more get up and go. I walk with a cane, but mainly for safety. At home I don’t.
“A friend and I went out to dinner, and I was able to walk from the restaurant to the car. My friend said, ‘Cleo, I can see you’re walking faster.’ ”
For this reason, Snyder remains dedicated to her physical fitness regime, which involves exercising for about 15 minutes twice a day.
“I certainly recognize this type of program is beneficial,” she said. “I can tell if I skip the exercises, I get stiff. I think it’s been beneficial to me and my health.”
Jim Ryals, 81, has experienced similar benefits from physical therapy. He had knee surgery several years ago before becoming one of Blomenkamp’s patients at Hillcrest.
His wife, Carol, said, “His legs were so weak, he couldn’t stand on his own. He needed help. We have a raised ranch, and he could barely get up the stairs.”
At first Ryals was resistant.
“I didn’t want to do some of the stuff,” he said. “I thought it was kind of childlike — walking around cones, for example. But it helped me with my balance and coordination.”
He also enjoyed the relationship he developed with Blomenkamp.
“Sarah’s a ‘ramrodder,’” he said. “I’d try to get out of something, but she wouldn’t budge. I can see where she helped me. She cares about the people.”
Ryals is pleased with the progress he’s made.
“I can do the dishes now,” he said. “Before I had to lean on something. Now I can just put my walker aside and do them. I can get out of a chair without holding on.”
Carol has noticed the difference, too.
“He can stand for longer lengths of time,” she said. “Before he couldn’t stand in place on his own. And now he can walk without his walker. When we go out to a restaurant, he just uses his cane.”
While Ryals no longer needs physical therapy, like Snyder, he continues exercising. In fact, he and Carol go to Hillcrest’s gym three times a week together so they can both maintain their health.
“It just makes us feel better,” he said. “I know I can do it. I see how much I can do.”
Whether someone is 65 or 85, it’s never too late to improve your balance.
“Elderly patients outdo what we expect from them all the time,” Pohl said. “They don’t always believe us, and then they see improvements.”