Balance is an area of concern for many people as they get older. According to the Centre for Disease Control, one in every five falls causes a serious injury such as a broken bone or a head injury. Fortunately, research backed methods for identifying and addressing falls risk have developed over more recent years. In this article we cover some of the factors that are used to determine your own risk of having a fall and a quick checklist to determine your own falls risk.
In more recent years, large scale research looking into multiple studies have identified 8 consistent factors that are associated with an increased risk of having a fall. The first of those factors is related to sensation in the foot, where you experience any numbness, burning or tingling in the foot or ankle area. Having a condition such as peripheral neuropathy, which is common in people with diabetes, can reduce your body’s ability to feel the ground and therefore it’s ability to detect when you are about to lose your balance. In addition to sensation changes any other changes to the structure of the foot, such as having a bunion or hammer toes where the toes curl up, reduce your foots ability to adapt and react to the different and uneven surfaces it is walking on which influences your balance. Other elements of foot function that are associated with falls include having any conditions that cause pain in the foot or ankle area, and the need for a brace or support.
Footwear is another important factor that is linked with falls risk. Wearing shoes that have more than a 2.5cm heel shifts your pressure forward significantly which increases your risk of over-balancing. Having shoes that are too loose or too tight is also another risk factor. Wearing socks without shoes or slippers inside your house can create issues as the feet can slide on hard floors and slippers can just as easily slip off as they do slip on!
The strength of the muscles in the legs and the feet themselves is another factor that is linked to an increase in falls risk. If you find it challenging to stand up out of a chair without using your hands to push yourself up this is an indication that your leg strength as a whole is reduced. Specific to the foot and ankle area, there are 2 quick and easy tests of the main muscles that control ankle movement that you can perform to determine if their strength is sufficient. When completing these tests please make sure you have balance support nearby.
Test number one is looking at the strength of the muscles that pick up the foot each time we take a step. If you have ever tripped over due to “not lifting your feet” this is a possible area of weakness. Standing with balance support nearby and with a timer or a clock handy, try to lift the toes of one foot off the ground while keeping the heel on the ground. Repeat the same movement on the other side. Alternate this movement as fast as you safely can until you count to 5 repetitions in total (ie not 5 on each side). You should be able to perform 5 repetitions of this movement in 10 seconds.
1st number two looks at the strength of the calf muscles which are located at the back of the lower leg and join into the Achilles tendon at the back of the heel area. These muscles are very important in propelling us forward as we walk. Standing next to a wall and allowing light fingertip pressure on the wall, you should be able to perform 5 heel raises in 10 seconds. To perform a heel raise, you keep your knees straight and lift your heels up so that pressure moves onto the toe and forefoot area.
Finally, another key consideration that influences falls risk is medication use. Some medications can have side effects that cause you to be disoriented or feel more unsteady on your feet. Reading and understanding the possible side effects of your medications can ensure that you can monitor how they impact directly on your situation and whether or not you need to discuss possible alternatives with your GP.
The Centre for Disease Control has put together some of the factors discussed above into a user friendly checklist that you can apply to determine your own risk of falling. To assess your individual risk of falling, answer and score the following questions:
- I have fallen in the past year – Yes = 2 No = 0
- I use a walking stick or walker to get around safely – Yes = 2 No = 0
- Sometimes I feel unsteady while I am walking – Yes = 1 No = 0
- I steady myself by holding furniture when I am walking at home – Yes = 1 No = 0
- I am worried about falling – Yes = 1 No = 0
- I need to push with my hands to stand up from a chair – Yes = 1 No = 0
- I have some trouble stepping up onto a curb – Yes = 1 No = 0
- I often have to rush to the toilet – Yes = 1 No = 0
- I have lost some of the feeling in my feet – Yes = 1 No = 0
- I take medication that sometimes makes me feel light-headed or more tired than usual – Yes = 1 No = 0
- I take medication to help me sleep or improve my mood – Yes = 1 No = 0
- I often feel sad or depressed – Yes = 1 No = 0
If you had a score of 4 or higher, your risk of falling is elevated. If this is the case, w would recommend speaking to a qualified health professional about your specific results to determine what steps you can take to reduce your risk of falling as this needs to be personal to your circumstances and your individual risk factors.