All in the balance


AVOIDING PIT FALLS The risk of falling rises as we age, but we can take effective preventative measures.

Andrew O'Brien

‘Get down from there or I’ll kill you’. ‘If you fall off there, I’ll kill you’.
Sounds like a couple of quotes from a Quentin Tarantino film doesn’t it? Actually, it’s more like the sound track to an afternoon at my mate’s house when we were kids. This friend was always climbing something, the higher the better, and seemed to have no fear.
His mum, on the other hand, wasn’t so keen on him climbing onto the roof to then jump onto the trampoline, or climbing over the 12-foot-high fence of the tennis court when there was a perfectly good gate directly below him, but he did it anyway. Oh, and he fell off things – a lot – and broke more bones than everyone else at school combined. Thankfully though, neither the falls nor his mum killed him.
Childhood is an interesting time, we learn about danger, fear – especially fear of falling – and risk assessment. Part of the job or parents is to facilitate this and let kids take some risks while at the same time stopping them from doing anything too dangerous. You can understand why my friend’s mother was a bit anxious at times.
What about grown-ups though? Who helps us? I do quite a bit of work in nursing homes, where one of the key jobs of a physiotherapist is to keep residents as mobile and active as possible while at the same time minimising their risk of falls and injury. It can be just as hard to get the balance right for someone who is 88 as for a child of eight.
As we age, factors like weakness, stiffness, cognitive decline, medications and long-term health conditions can all combine to affect our balance and therefore our mobility and falls risk. Extrinsic factors like floors, pets and weather can all have an effect as well. There seems to me to be two types of older people who are likely to fall: those whose balance isn’t as good as it used to be, but who don’t realise, and those whose balance isn’t good and are terrified by the prospect of falling.
The first group above are a bit like my mate, in that they try to do things that are just a bit much for them. That could be as risky as climbing a ladder or as simple as picking something up off the floor, depending on the individual and the circumstances.
The second group have likely graduated from the first; they’ve had a fall or two and are now scared that it could happen at any moment. These people tend to ‘cruise’ around furniture, holding onto the back of a chair, then the kitchen worktop and so on. They often use a walking aid and tend to walk with that almost caricature ‘old-person’ gait – bent in the middle and taking shuffling steps.
Is there hope for people who are at risk of falling? Of course there is; all risks can be mitigated against. Obviously, prevention is better than cure, so maintaining a healthy level of physical fitness regardless of age is important.
By doing regular exercise you can improve balance, strength and bone density, which combine to reduce the risk of falling, and the risk of injury if you do happen to fall. Exercise regimes like tai-chi and yoga are great in this regard, and can be modified to suit all levels of ability, but so too are sports like golf and tennis with their variety of movements.
A guided exercise programme, either at home or in the clinic is crucial; there is strong evidence to show that three hours of exercise that challenges balance can reduce falls risk by almost 40 percent. Considering the HSE estimates the monetary cost of falls and fractures in over 65s to be about €380 million a year, three hours of falls-prevention exercises seems like a pretty good investment.
For those with impaired mobility, the right walking aid is key, and getting advice from a chartered physiotherapist is a good idea when choosing an aid and getting the size right. The wrong-sized walking stick can do more harm than good, and a Zimmer frame may hinder the mobility of someone who could use a four-wheeled walker instead.
The take away? If you’re worried about balance, do something about it – if you’re not, try not to be overconfident!

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at