Merriam-Webster dictionary defines balance as – the state of having your weight spread equally so that you do not fall OR the ability to move or to remain in a position without losing control or falling (http://www.merriam-webster.com/dictionary/balance)
Balance is all that, however, the meaning of ‘To be in Balance’ as applied to humans, is the ability of the body to recognize or be sensitive to the loss of its state of equal weight distribution or/& change in the center of gravity (COG).
It is necessary to lose balance, otherwise, we will not walk or run or jump or sit or stand, simply put we will not move!! It also necessary to lose balance at a particular point of movement or/& at a particular speed (the rate of loss of balance) to enable an effective movement. The untimely loss of balance (either the balance was lost quickly, before intended time or it was lost fast enough that there wasn’t enough warning of the loss) is what results in falls, fractures, and complications, especially in seniors.
Asian Journal of Gerontology (the scientific study of aging) & Geriatrics (related to the study of elders especially health) states that the fastest growing population segment by 2021 are the elders (above the age of 60), they will constitute 10% of the population. It goes on to say that between 2001 and 2051, the number of 70+ seniors is projected to increase 5-fold. The so called, oldest old (80 +) is expected to increase 4-fold.
The average remaining length of life is around 18 years (16.7 years for men, 18.9 years for women) at age 60 years and <12 years (10.9 years for men and 12.4 years for women) at age 70 years.(http://mospi.nic.in/mospi_new/upload/elderly_in_india.pdf)
As time duration for dependency increases, the old-age dependency ratio has increased over the past 2 decades, which increases the burden on the working population. (http://mospi.nic.in/rept%20_%20 pubn/507_ nal.pdf. Accessed 10 October 2011)
Asian Journal of Gerontology & Geriatrics in their June 2014 issue state that in India, the prevalence of falls among older adults aged 60 years and older was 14% to 53%.
Falls are highly under-reported, and the actual prevalence is likely to be higher.
In India, fall prevalence increases with age and is the highest in women and institutionalized older adults (seniors living in senior homes)
In U.S.A, the Center for Disease Control & Prevention (CDC) goes on to state that,
– One out of five falls causes a serious injury such as broken bones or a head injury
– Each year, 2.5 million older people are treated in emergency departments for fall injuries
– Over 700,000 patients a year is hospitalized because of a fall injury, most often because of a head injury or hip fracture
– Each year at least 250,000 older people are hospitalized for hip fractures
– More than 95% of hip fractures are caused by falling, usually by falling sideways
– Falls are the most common cause of traumatic brain injuries (TBI)
Though each of these studies shows that falls amongst seniors are a major concern for both the seniors & their caregivers, what it does not say is the complications it causes to their health, wellbeing, positive outlook & independence.
Many studies have shown that fractures & injuries amongst elders take longer to heal. The usual time for recovery, depending on the extent of injury or/& fracture to the musculoskeletal system lasts anytime between 3 weeks to 3 or 4 months.
During these extended periods of recovery, their mobility is restricted or they are in complete bed rest, their mental faculties are working but the body is not available to execute!
These are some of the human effects of injury & fracture (especially in seniors) –
1. Muscles deteriorate, causing loss of muscular strength, as a result, bones become weaker. This weakness of muscle & bone will lead to more limited mobility post recovery also. This causes lesser independence & greater loss of confidence.
2. Constipation &/or incomplete evacuation. It is of great concern amongst seniors. Poor digestion causes gas, acidity, bloating, belching, flatulence, diarrhea, constipation, nausea, parasites (enemy number one for seniors), candida, food allergies, gallbladder diseases, rectal itching, iron deficiency, psoriasis, B12 deficiency, arthritis.
3. Kidney related complications. AKI (acute kidney injury) is more prevalent in hip fractures. Again research has not categorically correlated hip fracture to AKI, however, prolonged stay, medications, immobility are all contributing factors of AKI.
4. Self-doubt, sorrow, gloom, despondency are real companions of our parents or grandparents if they are not involved in the daily act of life & living. Resting in bed, removed from all day to day activity is a real scary situation for the elders. The desire to participate in the exchanges of living is very abruptly removed by the well-meaning caregivers & medications during injury times. This should not be mistaken to Depression. This feeling of low is transient and effort should be made to involve them in a meaningful manner on a daily basis.
5. Lack of activity and prolonged rest reduces the neural feedback that the foot usually has in the day to day activities, hence when seniors return from injury or fracture, it takes a while before they can balance better, feel confident to bear weight on the injured hand or leg.
Loss of muscle strength, reduction in bone mass, lack of activity, prolonged rest, loss of confidence, coupled with the aging process (natural loss of vision & hearing) all contribute to loss of balance.
As we can see, a fall is not just a fall when you get older! The consequences of fall & loss of balance are far reaching and debilitating. Therefore it is important to improve balance, reduce the chances of falling by improving stability, posture & strength & most importantly learning to fall.
Balance training programs for seniors are primarily based on strength training, However, we at Activity Heals promote effective movement & posture. The focus on effective movement involves optimum balance & stability training, learning & relearning of force generation & most importantly sensitizing when to lose & regain balance!
ps – whilst I was writing this article, I came across a Harvard study, where they found that specific training on balance for seniors benefitted them more than just strength training programs.