As we age, we are at an increased risk of falling and seriously injuring ourselves. In fact, 1 in 5 older adults living in the community fall every year. But the good news is that falls can be prevented.
“Being physically active is one of the best ways to keep our joints, heart and mind healthy. In many ways, exercise also helps to prevent falls,” said Dr. Linda Li, a senior scientist at Arthritis Research Canada and lead researcher on the Falls Prevention Study.
We’ve put together a list of frequently asked questions, videos and other resources about preventing falls that we hope you find useful.
Frequently Asked Questions
Who is considered an older adult?
Anyone over age 65.
Where do most falls happen?
Fifty per cent of falls happen at home.
Are people with arthritis more likely to experience falls?
In older adults, arthritis often coexists with frailty and that leads to a higher risk of falls. We know that about 40-50 per cent of older adults with osteoarthritis are physically frail and, in people who are frail, the risk of falls is higher.
What is frailty?
Physical frailty is a collection of symptoms that usually includes loss of muscle mass and weakness. People may unintentionally lose weight – for example, 10lbs in a year without trying. They may feel fatigued, move slower and be less active. An older adult is defined as having frailty when they have three or more of these symptoms happening at the same time. Frailty by itself is a condition. It can get better or worse. Physical activity is a promising strategy to help people move from being frail to more robust.
How likely is an older adult to experience more than one fall?
When someone has a fall, it’s important for them to have a strategy to prevent future falls. That’s why the Otago Exercise Program is such an effective intervention. It has been shown to reduce the risk of future falls in people who fell in the past.
What is the Otago Exercise Program?
The Otago Exercise Program was developed by a group of researchers at the University of Otago in the 1990s. It has been evaluated by researchers around the world showing that it helps to reduce the risk of falls in older populations. The program has two components: strength and balance exercises and walking. It’s a standardized set of exercises that is prescribed, tailored for older adults and is to be done three times per week. Short walks are to be done twice a week.
Physiotherapists deliver the Otago Exercise Program. It involves 4-5 home visits and, at the first visit, a therapist does the assessment and prescribes exercises. At a follow-up visit, exercises are tailored and changes may be made as the person is able to do more. Between those visits, participants receive phone calls to make sure they’re doing okay. This happens in the first six months. In the subsequent six months, older adults receive a monthly phone call to check on their exercise program.
Otago is a robust exercise program and it’s tailored for individuals to help them improve muscle strength and balance. The program has been shown, over the last 20 years, to help reduce the risk of falls. One of the studies done in British Columbia showed that exercise programs can reduce falls by over 50 per cent in older adults who are frail and have fallen in the past.
If the Otago Exercise Program is effective, why don’t fewer older adults fall each year?
Only 25 per cent of people who start the program, continue with it over time.
Why don’t people continue with the Otago Exercise Program over time?
People may not continue with the Otago Exercise Program for a variety of reasons. For example, they might not have time, they may forget, or they struggle to remember the specific exercises.
What is Arthritis Research Canada doing to help people continue with the Otago Exercise Program over time?
We’re testing a strategy to support physiotherapists who deliver the program to help older adults set goals and develop an exercise plan that’s realistic for them. We’re also testing the use of an app that will allow older adults to see their exercise program, follow it and record it as they finish. A therapist at the other end will then be able to see the progression of the exercise over time. The ultimate end goal is to prevent falls.
What role does physical activity play in preventing falls?
Physical activity is very important. It’s good for fall prevention and general health. For people with arthritis, in particular, exercise helps keep muscles and bones strong. It also lowers the risk of other conditions that are related to arthritis like heart and lung disease.
When should people start thinking about fall prevention?
We should always be thinking about fall prevention.
How can I go about finding a physiotherapist?
For residents of British Columbia, the Physiotherapy Association of BC can help.
Is it okay to watch TV while doing balance exercises?
It is a good idea to break up sitting time during the day. This is a good example how it can be done.
Why does the Fall Prevention Clinic not take people younger than 65?
It is best to check directly with the clinic. There may be other programs available to those younger than 65.
How can we enroll in the Otago trial?
We recruit from the Vancouver Falls Prevention Clinic. To access the service, you need a referral from a geriatrician.
Where can I register for the Otago program?
The Otago Exercise Program is usually delivered by a physiotherapist or a nurse at the person’s home. In British Columbia, it is mainly delivered by physiotherapists. You can get a referral from a geriatrician to a PT who does home visits and delivers the program in your area.
Is the Otago Exercise Program designed for a specific age group?
The Otago program is not designed for a specific age group, but for people who are at a high risk of falls, including those who had a recent fall. Many of these individuals are frail, older adults.
How can someone be trained to teach the Otago Exercise Program?
In the Falls Prevention Study, we collaborate with the Vancouver Falls Prevention Clinic to provide training for the Otago Exercise Program to physiotherapists who are interested in participating in the study.
What chances can I make in my home to reduce the risk of falls?
Make sure pathways, halls and stairways are well lit and free of clutter. Grab bars in the bathroom can be useful for getting off toilet seats or in/out of bath tubs. You may wish to consult with an occupational therapist for further advice.
I want to stay active but my arthritis doesn't allow some movements. Any advice?
Arthritis can sometimes get in the way of daily activities. If this is the case for you, it is a good idea to consult with a physiotherapist who has experience working with people with arthritis for your specific needs. To find a physiotherapists in British Columbia, go to https://bcphysio.org/find-a-physio.
What are a few simple exercises for improving balance?
It is best to have a health professional assess you first so that the exercises are safe for you.
Where can I learn more about Vancouver's Falls Prevention Clinic?
To participate in a study at the Falls Prevention Clinic, one needs to be referred for a fall risk assessment and/or a comprehensive geriatric assessment.
How does one juggle multi-tasking while walking curbs, stairs, etc.?
It is sometimes hard to multi-task. Slow down and avoid multi-tasking when walking up/down stairs/curbs. An assessment by your doctor or physiotherapist can be helpful if you are concerned about your risk of falling.
Will physiotherapists/other professionals be trained in the Otago Program in the Victoria area?
Some physiotherapists and other professionals are trained to delivered the Otago Exercise Program, many of them work in the community because the program includes several home visits. The best way to find out is to ask the health professional if they deliver this program.
Are there recommended tests that can be done to determine frailty levels or fall risk?
Yes, there are tests that your health professionals can do to assess your muscle strength, mobility and balance to determine fall risks. There are also established criteria to assess physical frailty. In addition to the items mentioned, health professionals will also assess things like weight loss, physical activity level, and energy level to determine where a person is at in the continuum from a robust health state to frailty.
Is there a way to counteract the constant dizziness of necessary medication?
It is important to have your medication reviewed by your doctor or pharmacist when you often experience dizziness.
Is it correct that the Canadian 24 Hour Movement Guidelines recommend no more than 8 hours of sedentary activity?
It is correct that the guidelines recommend no more than eight hours of sitting/rest time in the day. But it is certainly a good idea to keep the sedentary time low and break up sitting during the day.
What do you think of the GLAD program? How does it compare with the Otago program?
GLAD is excellent for people with hip/knee osteoarthritis to keep active.
Is aqua fit good for osteoarthritis in feet and hands?
Yes, pool exercise is good for people with arthritis.
Do you have to stand and exercise to increase bone strength?
Standing exercise is great for bone strength but there is also good evidence that lifting weights, even when seated, can help to strengthen bone.
What can I do to maintain my motivation to exercise?
The key is to find something that you like to do and do it with a friend/family member.
Do you think adopting a pet is a suitable way to improve physical activity levels in older adults?
Research has shown that pets, especially walking with dogs, is an effective way to increase your physical activity.
Falls Prevention Study
Falls are a major health care problem for older adults and healthcare systems as they account for 50 per cent of injury-related hospital admissions, 40 per cent of nursing home admissions, and a 10 per cent increase in home care services. This is why preventing falls is important.
Arthritis Research Education Series: Episode 7
More than 6 million people in Canada have arthritis and the number of older adults in the country is expected to grow to 10.4 million by 2037. Find out what we’re doing to prevent serious falls in these vulnerable, growing populations and hear about one woman’s lifelong journey to stay active and lower her risk of falling.
The Falls Prevention Study: Implementing an Evidence-Based Exercise Program to Reduce Falls in Community-Dwelling Older Adults
Mobilizing Falls Prevention Knowledge with Patients and Clinicians in British Columbia
Centre for Hip Health and Mobility: A Team Approach to Mobility in Vulnerable Seniors
Can the Otago Falls Prevention Program be Delivered by Video? A Feasibility Study
Public Opinion on Community-Based Education and Exercise Programs for Managing Hip and Knee Osteoarthritis-Like Symptoms: Results of a Survey
Understanding the Experiences of Rural Community-Dwelling Older Adults in Using a New DVD-Delivered Otago Exercise Program: A Qualitative Study
Understanding the Experiences of Rural Community-Dwelling Older Adults in Using a New DVD-Delivered Otago Exercise Programme
Mobility Predicts Change in Older Adults’ Health-Related Quality of Life: Evidence from a Vancouver Falls Prevention Prospective Cohort Study
Mobility and Cognition are Associated with Wellbeing and Health Related Quality of Life Among Older Adults: A Cross-Sectional Analysis of the Vancouver Falls Prevention Cohort
Mobility is a Key Predictor of Changes in Wellbeing Among Older Fallers: Evidence from the Vancouver Falls Prevention Cohort
Understanding the Experiences of Rural Community-Dwelling Older Adults in Using a New DVD-Delivered Otago Exercise Programme
Prioritizing Fall Prevention
Falls on ice are the top cause of sport and winter injury hospitalizations in Canada, according to the Canadian Institute for Health Information. The latest data shows that 8,532 people slipped on ice between 2017 and 2018. This is more than double that of cycling, the second most common cause of sport and winter injury hospitalizations. There is strong evidence that the Otago Exercise Program – involving strength and balance training delivered by a physical therapist – can reduce falls in adults over age 65.
Implementing an Evidence-Based Exercise Program To Reduce Falls In Seniors
Each year, 30 per cent of seniors have at least one fall — half of whom fall more than once. In fact, nine out of 10 hip fractures result from falls. These falls can have dire consequences, 20 per cent lead to death and a further 20 per cent are admitted to care homes for the balance of their life. Fortunately, falls are preventable.
Vancouver Falls Prevention Clinic
The Falls Prevention Clinic is a referral-based clinic that specializes in preventing falls and fractures among adults aged 65 years and older. Our mission is to identify the reasons why our patients fall, and to address these risk factors in collaboration with family physicians, specialists, and evidence-informed best-practice medicine.
Mary Pack Arthritis Program
The Mary Pack Arthritis Program has a wide variety of health care providers and services to help people with different types of arthritis manage and treat their physical and psychological symptoms. They give patients access to physiotherapists, occupational therapists, nurses, social workers and more.
24-Hour Movement Guidelines
Canada’s first ever 24-Hour Movement Guidelines for Adults offer clear direction on what a healthy 24 hours looks like for Canadian adults aged 18-64 years and 65 years or older. These guidelines are unique because they don’t just focus on a single movement behaviour, but instead look at how all these integrate together. This is the first time there are recommendations on various types of physical activity woven together with guidance on sedentary and sleep behaviours for these age groups.
Seniors and Aging - Preventing Falls in and around Your Home
Anyone can fall, but the risk of falling becomes greater with age. There are a number of simple steps you can take in and around your home to help prevent falls and the injuries caused by falling.
Government of British Columbia - Seniors' Fall Prevention
Falls are the leading cause of injury for seniors. One in three British Columbians over the age of 65 will fall once every year, and falls are the main reason why older adults lose their independence. Many falls can be prevented, and there are many resources available to help to keep seniors injury-free. In addition to providing information resources, the ministry supports the prevention of falls by working with health care professionals, injury prevention experts, and the public. Learn more about how you can prevent falls.
Vancouver Coastal Health - Fall Prevention Resources
Did you know that everyone is at risk for falls, no matter what your age? Falls can happen at home or in the community. We have a number of resources, including a brochure, a home activity program and clinic available to help you understand and avoid falls.
Fall Prevention Month
All Canadians play a role in preventing falls. The Fall Prevention Month website offers some great resources.
Arthritis Patient Advisory Board
Arthritis Research Canada works FOR and WITH patients.
Our Patient Advisory Board members and scientists collaborate to ensure research is relevant, meaningful and helpful.