Falls are one of the biggest health risks facing older adults. Every year, millions of older people fall and many suffer broken bones, head injuries, loss of independence, and long hospital stays.
A serious fall can also make people afraid to move around, which can lead to less physical activity, weaker muscles, and an even higher risk of falling again. For many families, preventing falls is just as important as treating diseases such as diabetes or heart problems.
Traditionally, doctors often talk about fall prevention after someone has already fallen or when they begin complaining about balance problems.
However, Dr. James Richardson, a professor of physical medicine and rehabilitation at the University of Michigan Health, believed this approach was too late. He wanted to identify people at risk before a fall happened and find practical ways to help them stay safe.
This idea led to the creation of the JEDII Fall Clinic, which stands for Judicious Early Detection of Impending Imbalance. The clinic focuses on identifying hidden problems that increase the risk of falls and providing recommendations before an injury occurs.
Previous large studies have shown that one simple test can predict fall risk surprisingly well. The test involves standing on one foot. People who cannot stand on one leg for at least 15 seconds are much more likely to experience falls over the following seven to ten years. This test, known as unipedal stance time, is already widely used by doctors.
However, Richardson realized that the test only shows who is at risk. It does not explain why a person cannot maintain their balance.
To answer this question, Richardson and his team carried out a study involving 172 participants. The study was published in Aging Clinical and Experimental Research.
The participants included people with diabetic nerve damage, people with liver disease called cirrhosis, and older adults without known medical conditions. All of these groups are generally considered to have an increased risk of falls.
The researchers discovered that three physical abilities explained much of why people had difficulty balancing on one foot. These abilities involved how well the nerves in the feet worked, how quickly the brain processed information, and how strong the body was in maintaining side-to-side stability.
The first assessment uses a simple vibrating tuning fork. The vibrating fork is placed on the patient’s big toe, and the patient tells the doctor when the vibration can no longer be felt.
This test measures how well nerves in the feet and ankles detect sensations. These nerves help people quickly notice a trip, stumble, or change in the ground beneath them. Ideally, people should be able to feel the vibration for eight to ten seconds or longer.
The second assessment uses a device called the ReacStick, which was developed by Richardson and his team. The device looks somewhat like a ruler with an electronic monitor attached. The doctor suddenly drops the device, and the patient tries to catch it as quickly as possible. The monitor measures reaction time in milliseconds.
This test is important because people usually have only a fraction of a second to respond when they trip. The researchers estimate that people have around 350 milliseconds to begin correcting their balance before a fall occurs. Ideally, patients should react in less than 200 milliseconds.
The ReacStick also measures another skill called reaction accuracy. Sometimes lights on the device turn green, and patients should catch it. At other times, no lights appear, and they should let it fall.
This assessment measures whether the brain can rapidly process information and make the correct decision. Good performance is considered greater than 75 percent accuracy.
The third assessment is a side plank exercise. Patients lie on their side and hold their body in position for as long as possible. This test measures core strength, which is extremely important for stabilizing the body and recovering from sudden loss of balance. Ideally, people should be able to hold the position for about 20 seconds or longer.
Richardson says people do not need perfect scores on every test to have a lower risk of falling. Passing at least two of the three assessments suggests that a person still has enough physical and mental capacity to recognize a dangerous situation and react appropriately.
Review and analysis: This study is important because it changes the way doctors think about falls. Instead of waiting until someone gets hurt, the researchers focus on early detection and prevention.
The tests are relatively simple and may help identify specific weaknesses that can be improved through exercise, rehabilitation, or lifestyle changes.
The study also has limitations because it involved a relatively small number of participants and more research is needed to determine how these assessments perform in larger populations. Nevertheless, the findings suggest that many falls may be preventable if risks are identified early enough.
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Source: University of Michigan.
