Balance is crucial for avoiding falls as we age

To evaluate your balance, try this pose: Put one foot in front of the other, heel to toe. How long can you stand without swaying?

If the answer is, “Not very long,” you aren’t alone. In fact, the author of this article didn’t fare nearly as well on the test as she expected, despite racking up many miles hiking trails in Western North Carolina every week as a hike leader and outdoor author (see sidebar, “Putting it to the test”).

Impaired balance brings with it a higher risk of falling and all that a fall can entail. According to the National Council on Aging, falls are the No. 1 cause of both injury and death in older adults. State data indicate that the rate of fall-related death and injury is increasing among both men and women and in all age groups 65 and older. But falling isn’t inevitable, and several programs in WNC are working to reduce the number of falls older adults experience, helping avoid injury and boosting quality of life.

Point of entry

Increasing older residents’ awareness of the importance of maintaining good balance can be the first step on the road to improvement, says Lori Schrodt, who led the team that developed the Building Better Balance screening program in collaboration with the WNC Fall Prevention Coalition in 2010.

As a professor of physical therapy at Western Carolina University, Schrodt’s research focuses on community-based models and expanding the reach of balance- and fall-prevention programs for older adults. She’s been a physical therapist for over 25 years in various settings, but she says she has a special affinity for working to provide independence to older adults.

“We need to capture people before their first fall,” Schrodt says.

The Building Better Balance screening consists of questions such as, “Have you had any falls?” and “Do you have problems with balance while walking?” Participants also respond to questions about their fear of falling and demonstrate their walking ability by rising from a chair and walking a short distance.

Though the screening program targets those who are at least 50, all ages can take part. Sometimes adult children bring mom and dad, Schrodt says, and everyone ends up being screened. These days, agencies try to engage people at younger ages before their balance and mobility become impaired to reduce fall risk even further.

When performing the screenings, Schrodt says, trained volunteers encourage participants to talk to their doctors about their individual risk, since a heightened risk of falling can stem from a variety of factors.

Balance exercises need to be part of all prevention programs, Schrodt says. Based on research findings, Schrodt recommends three or more hours a week of balance training, which will prevent 39 percent of falls. To be effective, the movements must be challenging and tailored to the individual. A physical therapist can provide guidance about exercises that can be performed at home and to review progress.

Get a move on

One targeted program that’s widely available in WNC is the YMCA’s Moving for Better Balance, a tai chi-based exercise program that improves balance to help prevent falls in older adults. A study of three balance-building programs published in the Journal of Safety Research in 2015 showed that the twice-weekly, 12-week MBB series provided the largest net benefit among the studied programs and delivered a return of over 500 percent on health care dollars invested.

To participate in the Y’s MBB program, adults must be 65 or older (or over 45 with certain health conditions); the average age of program attendees is 71. A Y membership isn’t required to take part, though many folks do join the Y when they sign up for the class, and some repeat the series multiple times. Nearly 500 have gone through the program at local branches of the YMCA since its inception here in 2012.

Developed by the Oregon Research Institute, the program uses eight forms derived from the traditional 24-form Yang-style tai chi, progressing from easy to difficult. The moves have colorful names like “grasping the peacock tail” and “repulse monkey.” The institute’s research shows that people who complete the program are half as likely to fall and are less fearful about falling.

MBB instructor JacKaline Stallings says it’s fun to watch people progress. People who couldn’t get up from a chair without using their hands now can. They report more confidence at the end of the program. If people are more confident about not falling, they’ll go out more, she says.

“I love tai chi,” Stallings says. “It has a different effect than yoga. I can feel the chi. I can see the red in my palm, the energy flow. We move in all directions. This program works on both sides of your body and helps you understand how you move your body in time and space.”

Diane Saccone, director of healthy aging initiatives at the YMCA of WNC, says many factors contribute to older adults’ propensity for falling. “Eighty percent of older adults are sedentary, which increases the chance of chronic disease and obesity. Vision and hearing may decline. Taking four or more drugs — prescription or over-the-counter — decreases balance and so does alcohol.”

As we age, we tend to make excuses, promising ourselves, “I’ll exercise tomorrow,” Saccone says. That behavior isn’t limited to the senior crowd, however. Folks in younger age cohorts such as Generation X and millennials, she notes, “are right behind them.”

 Fear of falling

Stephanie Stewart, aging program specialist at the Land of Sky Regional Council, has always been interested in community wellness and health promotion. “I felt strongly about prevention. You can always do something to get healthy,” she says. It’s easy to get enthusiastic about fall prevention when talking to Stewart, a millennial.

Stewart administers A Matter of Balance, a federally funded program run by community members. The money for this program originated with the Older American Act of 1965; the funding must be reauthorized regularly and matched by state and county funds.

First developed by Boston University, A Matter of Balance was later redesigned to make it possible for volunteer leaders, most of whom are not health professionals, to teach the classes. The series includes eight two-hour sessions, which means that participants must “buy into prevention,” Stewart says.

Participants discuss their fear of falling. “Fear of falling is an indicator for actually falling. The program attracts men because they fear losing their independence,” Stewart says. At the third session, the program adds a regular 45-minute exercise component, consisting of balance, endurance, strength and flexibility. “Walking alone won’t be enough,” she says.

A Matter of Balance classes, which are held in community or senior centers, have been taking place in WNC in the program’s present form since 2015.

Participants like the exercises but also the conversations. At the end of the series, many participants report that they feel more confident about their ability to avoid falls.

Stewart advises younger folks to get moving to prevent problems as they age. She favors an exercise program that incorporates weight training and that becomes a regular habit. She also urges people of all ages to ditch the flip-flops and wear comfortable shoes.

Healthy Aging Day

On Thursday, Sept. 13, the annual Healthy Aging Day will kick off Healthy Aging Week. The event runs 9 a.m.-noon at the Reuter Family YMCA at 3 Town Square Blvd., Asheville, and features vendors, lectures, group exercise classes, pickleball, flu vaccines and free health screenings. More information is available at www.ymcawnc.org/healthyagingday.