Fall prevention

Fall prevention includes any action taken to help reduce the number of accidental falls suffered by susceptible individuals, such as the elderly (idiopathic) and people with neurological (Parkinson's, Multiple sclerosis, stroke survivors, Guillain-Barre, traumatic brain injury, incomplete spinal cord injury) or orthopedic (lower limb or spinal column fractures or arthritis, post-surgery, joint replacement, lower limb amputation, soft tissue injuries) indications.

Adults aged 65 years and older have a 30% chance of falling each year, making fall-related injuries the leading cause of accident-related death for this demographic.^[1] Current approaches to fall prevention are problematic because even though awareness is high among professionals that work with seniors and fall prevention activities are pervasive among community living establishments,^[2] fall death rates among older adults have more than doubled.^[3] The challenges are believed to be three-fold. First, insufficient evidence exists that any fall risk screening instrument is adequate for predicting falls.^[4] While the strongest predictors of fall risk tend to include a history of falls during the past year, gait, and balance abnormalities,^[5] existing models show a strong bias and therefore mostly fail to differentiate between adults that are at low risk and high risk of falling.^[6][7]

Second, current fall prevention interventions in the United States are limited between short-term individualized therapy provided by a high-cost physical therapist or longer-term wellness activity provided in a low-cost group setting. Neither arrangement is optimum in preventing falls over a large population,^[8] especially as these evidence-based physical exercise programs have limited effectiveness^[9] (approximately 25%). Even multifactorial interventions,^[10] which include extensive physical exercise, medication adjustment, and environmental modification only lower fall risk by 31% after 12 months,^[11] and by 21% after 24 months.^[1] Questions around effectiveness of current approaches (physical exercise and multifactorial interventions) have been found in multiple settings, including long-term care facilities and hospitals.^[12]

The final challenge is adherence. Average adherence in group-based fall prevention exercise programs is around 66%, mostly due to the highly repetitive nature of the programs and the extremely long duration required for noticeable benefits accrue.^[13] Adherence to physical therapy can be even lower.^[14] When adherence is below 70%, effectiveness of fall prevention physical exercise programs can drop to less than 10%.^[13]

Practitioners are aware that the most successful approach to fall prevention utilizes a multimodal, motor-cognitive training approach^[15] that could be introduced to all adults over 65. The scientific basis of this approach is an understanding of how the dual-task paradigm induces neuroplasticity in the brain, especially in aging populations.^[16] This is driving a growing body of research that specifically links the cognitive sub-domains of attention and executive function (EF) to gait alterations and fall risk.^{[17][18][19][20][21]}