Balance exercises for elderly

Predicting Fall Risk in Older Adults

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As we age, maintaining balance becomes increasingly crucial for preventing falls, which are a leading cause of injuries in older populations. In fact, falls are among the leading causes of burden of disease and injury in Australia, ranking 17th for fatal burden, 24th for disability, and 18th for overall burden (4). Alarmingly, 2 out of 3 falls occur in older women.

Falls risk is influenced by external factors (i.e. poor lighting, obstacles) and internal factors (i.e. reduced physical capacity, vision and vestibular changes). Older people are at a higher risk for hospitalisations as a result of falls due to lower bone density, reduced muscle mass and conditions affecting balance and eyesight (4). Due to lower bone density, falls can often be more significant for older populations who are more likely to suffer fractures as a result.

Accurately identifying individuals at greater fall risk and routinely assessing those who are already established fallers is an important way of reducing the burden of disease and informing healthcare interventions including strength and balance exercises.

Recent research has aimed to study balance in older individuals and tried to identify which balance characteristics best predict the risk of falling in older adults. Their findings shed light on key parameters that differentiate fallers from non-fallers.

To understand balance, we first need to explore how balance is accurately measured using cutting-edge technology.

Understanding Center of Pressure

Centre of Pressure (CoP) is a single point representing the average location of force being applied to the ground by an individual (2). A person can control where their CoP is by shifting their weight forwards and backwards, or side to side. This is one of the body’s main ways of maintaining the centre of mass (CoM) between the base of support (BoS), thus maintaining balance. In this way, CoM is a key point in the middle of your body, whereas CoP is a point on the floor.

CoM is a point representing the average location of all mass in the body. If an individual’s CoM is located above their base of support (i.e. their feet), they will remain upright. If their CoM deviates outside the bounds of their base of support, they will begin to fall.

Centre of Pressure (CoP) is often measured using force plate technology, which measures the force exerted on the plate by a human standing or moving on top. Very sensitive receptors inside the force plates work out where the changes in force are happening, and map out how this CoP moves. More movement indicates poor balance, as you are unable to control your centre of mass relative to your contact on the ground. Very small movements indicate good balance, where your body can adjust dynamically with small changes.

Balance and falls risk

Figure 1: The location of Centre of Mass (CoM) and Centre of Pressure (CoP) on the human body when stepping on a force plate (3).

Controlling posture and balance depends on the complex interaction between systems, including the vestibular (inner ear), visual (eyes), and proprioceptive (sensory) systems. Information from these systems merge to provide an internal, sensory understanding of the bodies’ position in space. As we age, our ability to effectively maintain our posture and balance declines, and our risk of falls increases.

Research Findings

Recently, researchers conducted a systematic literature review – which is a type of research that groups the results of other studies together to assess how important and consistent any reported findings might be.

This systematic review set out to identify CoP characteristics that best-distinguished fallers from non-fallers in an elderly population. Over 4000 articles were screened, and a total of 44 articles with a combined 7176 participants met the inclusion criteria to be analysed in this study. From these thousands of participants, several CoP parameters were identified as good indicators to differentiate fallers from non-fallers.

The three best parameters were:

  1. Sway area per unit time (the area enclosing the CoP trajectory, per second)
  2. Anteroposterior (AP) mean velocity (forward back sway velocity)
  3. Radial mean velocity (combination of both forward/back and side-to-side directions)
Balance and centre of pressure

Figure 2: Visual representation of postural sway (5)

Sway velocity refers to how fast the CoP moves. Large, jerky reactions where you move your entire trunk around to regain balance have a high sway velocity. Small, subtle corrections result in smaller sway velocity and reflect better balance.

Take home message

Assessing balance is an important way that we can identify people who are at risk of falling.

Using technology such as force plates to conduct quiet-standing balance assessments can provide data including characteristics of CoP.

Taking such measurements over time can also provide insight into balance changes over time.

SportsPlus are proud owners of VALD ForceDecks, which can be used to assess balance and determine fall risk. Our skilled exercise team is trained to prescribe exercise programs targeted to improve balance and strength to reduce fall risk. Get in touch today to find out more!

References

(1) Quijoux, F., Vienne-Jumeau, A.,, Bertin-Hugault, F., Zawieja, P.,  Vidal, P., & Ricard, D. (2020). Center of pressure displacement characteristics differentiate fall risk in older people: A systematic review with meta-analysis. Ageing Research Reviews, 62, pp.101117. DOI: 10.1016/j.arr.2020.101117.

(2) Ruhe, A., Fejer, R., & Walker, B. (2011). Center of pressure excursion as a measure of balance performance in patients with non-specific low back pain compared to healthy controls: a systematic review of the literature. European Spine Journal, 20(3), 358–368. DOI: 10.1007/s00586-010-1543-2

(3) VALD Health. (2021). The location of Centre of Mass (CoM) and Centre of Pressure (CoP) on the human body when stepping on a force plate. Accessed 15 March 2024. https://valdhealth.com/news/centre-of-pressure-centre-of-mass.

(4) Australian Insititute of Health and Welfare. (2022). Falls in older Australians 2019–20: hospitalisations and deaths among people aged 65 and over

(5) Corrà, M.F., Vila-Chã, N., Sardoeira, A., Hansen, C., Sousa, A.P., Reis, I., Sambayeta, F., Damásio, J., Calejo, M., Schicketmueller, A., Laranjinha, I., Salgado, P., Taipa, R., Magalhães, R., Correia, M., Maetzler, W., & Maia, L.F. (2023). Peripheral neuropathy in Parkinson’s disease: prevalence and functional impact on gait and balance. Brain, 146, 225-236. DOI: 10.1093/brain/awac026.

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