Bill Klaproth (Host): According to the NIH, each year more than two million older Americans go to the emergency room because of fall-related injuries. And here to talk with us about balance and falls prevention is, Sandra Fox, a Tidelands Health Physical Therapist. Sandra, thank you for your time today. So, this is a real problem, around what age does this start to develop?

Sandra Fox (Guest): It seems to be more common as age advances, so the cut off that they normally start to talk about is at age 65, but their risk can continue to increase with aging beyond that point.

Bill: So, are there certain symptoms or things that people might feel when they should think about ways to improve their balance?

Sandra: Yes. So, when people start to notice that they become more hesitant to maybe walk in the dark, getting up at night in their home or in a dim parking lot in the evenings, or if they start to notice that they're not picking up their feet. Someone might point out that they're shuffling a little bit. If they start reaching for countertops and chairs as they're walking by for that little extra bit of stability, it's really time to start to consider investigating ways to improve their balance.

Bill: And the good news is, balance exercises can help prevent falls, and avoid the disability that may result from falling, right? People can actively work on this and get better at balance.

Sandra: Yes. So, balance does decline with aging, but that does not mean that falls are inevitable. Training and exercises can definitely improve their outcome.

Bill: And there's more to it than just balance, right? Strength endurance, flexibility, all of those things play a role in balance?

Sandra: Absolutely. Strength and flexibility and lower extremities, and strengthen the core muscles, the stomach and back muscles, is key to being able to correct our position as we move and keep us stable. And then endurance, if we become fatigued as we're moving then our body can't respond as well, so then a small little waiver can turn into a fall with poor endurance. Our vision and inner ear systems are also important in sensation, so there's a lot more to it than just balance exercises.

Bill: So, how do you diagnose this then, and put a plan together for someone to improve their balance?

Sandra: So, when someone comes into physical therapy with either just concerns about balance or having had a fall, we go through an evaluation where we get a lot of information and medical history from the patient. We find out what situations they're experiencing the most difficulty with, and then we do an examination that includes a range of motion, flexibility, strength and a gait assessment, and then some standardized testing as well.

Bill: So, after you assess all of that, do you put a plan together then for each individual patient?

Sandra: Yes. So, then as a therapist develops that individualized plan of care for what exercises and activities are going to be best for that patient, and we work with the patient to set some very specific goals for what we want to accomplish with therapy. And then most importantly, we make sure that they are going to learn a home exercise program, so that they can continue after they're finished with therapy, continue to maintain the improvement that they've made.

Bill: So, tell us about typical exercises that you'll use to help someone improve their balance.

Sandra: Yes. So, we do a lot of exercises where we might stand on, what we call, a compliant surface, so a piece of foam or a board that's a little bit unstable, that makes you rock a little bit so that your bodies working much harder to try to stabilize. When we do that in therapy where we can safely guard someone as they're learning that, and we'll do a lot of exercises where maybe your eyes are closed, or you're moving your head, so that you don't have that visual input, so you have to work harder to maintain your stability. And then a lot of strengthening exercises for the legs, especially around the ankle. So, going up on our tiptoes and lifting toes up off the floor and standing up and sitting down from the chair without using hands to build some strength through the leg. Those are very common exercises you'll see in this type of program.

Bill: And how long does the program usually take? Is it a series of weeks or couple of months?

Sandra: So, it really depends on the individualized plan and what their starting point is, but generally, it takes at least, I would say, about four weeks to develop the type of strength that we're looking for. And then some people, it might take another month or two after that to really make sure that they're safe and stable. And that's our end goal, is to make sure that we're really reducing their fall risk before they finish therapy.

Bill: And that work that you give them to do at home has got to be critical because they really have to continue to work on that at home, isn't that right? That's really part of the plan is to get them to continue do these exercises when they're not with you doing the therapy.

Sandra: Right, we want it to be as much a part of their regular routine as brushing their teeth or choosing healthy foods to eat. It's something that is important to consider on a regular basis to maintain those improvements, and keep them safe.

Bill: Sandra, being ambulatory's a big part of having confidence, and feeling good about yourself, so when you help someone regain that sense of balance, you really are improving their quality of life.

Sandra: Yes. Yeah, we look at not just that you're not falling, but what are all the other things that you're able to do. And so, we have patients that are able to go see a baseball game that maybe they couldn't get out that easily or play with their grandchildren, and feel safe doing that. And so, those are the kind of improvements that we really enjoy seeing.

Bill: Yeah, that's got to be very gratifying when you see that. So, now when it comes to the home, are there certain tips you can share with us for people to help protect against falls?

Sandra: Yes. So, our first recommendation is always to make sure that pathways in the home are clear, and not having things out that can easily become a tripping hazard. And if people are going to use throw rugs, we recommend that they're tacked down with some sticky tape underneath, to make sure that you can't trip over them. We recommend that people use night lights because a lot of falls do occur in the darker environment, so having some night lights on in case you need to be moving at night time, and then making sure that you're wearing good footwear.

So, we're walking around in socks or in bare feet is not quite as safe as a nice sturdy shoe. So, that's something else that we consider as well. And then making sure that if it truly is a concern, and someone, especially if they live alone, we talk about getting one of those life alert or lifeline system, so that they can call for help if they do happen to have a fall, to make sure that they can get help quickly.

Bill: So, Sandra, for someone listening who feels they may need some balance technique, and some balance exercises, should they go see their primary care physician first, and then get referred to you, is that the normal process?

Sandra: Yes, that's the normal process. That way their physician can also review other risk factors for falls with them, like medications, and any other medical concerns that might be contributing. And then the doctor will make the referral to therapy where we can start a program.

Bill: That's wonderful and Sandra thank you for your time today. Can you tell us why should someone choose Tidelands for their health care needs?

Sandra: I think Tidelands has a very good comprehensive approach. We offer that the primary care physicians as well the therapy to really make sure that everyone is on the same page, and making sure that the patient gets the very best care that they can.

Bill: Sandra, thank you so much again for talking with us about balance and falls prevention. For more information about Tidelands Health Physicians Services and facilities visit, TidelandsHealth.org, that's, TidelandsHealth.org. This is Better Health Radio. I'm Bill Klaproth, thanks for listening.