Health Service Focus

31.03.17

Strength and balance: the key to falls prevention

Source: NHE Mar/Apr 17

Maintaining and improving muscle strength and the ability to balance is crucial to reduce the risk of falling, but it is also critical in helping people live independently as they get older, writes Louise Ansari, director of communications and programme manager for physical activity at the Centre for Ageing Better.

People are living longer. By 2024 there will be 18 million people aged 60 and over, meaning that one in four of us will fall into this age bracket. While this shift in the profile of the population presents a huge opportunity for society, it also comes with its challenges. 

Our research at the Centre for Ageing Better has shown us that as people age, they identify being in good health as the most important factor to having a good later life. But when many people think about their health, their immediate concern is to avoid a serious illness that is potentially life-threatening, like cancer or a stroke. But what about other conditions that impact on our ability to get ourselves dressed, to use the stairs, to manage without help at home? Who worries about falling, and the possible consequences of a fractured bone? 

The reality is that falls – most of which are avoidable – are traumatic for individuals, and a shocking cost to the health system. One-third of people over 65, and half of the people over 80, fall at least once a year, leading to around 70,000 fractures. Once you’ve fractured a bone, only 24% of people return to their previous level of movement and independence. Nearly 4,000 people died from having a fall in 2014. And even if you’re not too badly affected physically, falls can destroy confidence, increase isolation and reduce independence, with around one in 10 older people who fall becoming afraid to leave their homes in case they fall again. 

Why are we falling? 

As we age we see a progressive loss in muscle mass, muscle strength, bone mass and flexibility. From the age of 40, adults lose 8% of muscle mass per decade, with this rising to 15% in over-70s. This decline puts people at a greater risk of falling, as well as a slower recovery, yet they are much less likely to understand how to prevent them from happening. 

A recent study carried out by Ipsos MORI for the Centre for Ageing Better shows that many people in all age groups aged 40 and over are confused about what activities help with improving their strength and balance – 95% of people said that walking was a helpful activity, but in fact moderate or slow walking does not improve muscle strength or balance despite it being good for general health. The research also shows that more than 40% of over-70s don’t realise how important good strength and balance is to reduce falls. 

The chief medical officer’s guidelines for older adults say we should do two sessions of strength and balance exercise a week. Evidence shows that exercises such as dance or tai chi, but also informal activities like carrying heavy loads, such as groceries or doing heavy gardening, can help improve strength and balance – yet only around 40% of people associate these sorts of activities with assisting in the prevention of suffering a fall. 

What can be done? 

Most people find it hard to change their habits even if they are at risk of falling, so although this guidance is available, acting on advice is less common. In January, the National Falls Prevention Coordination Group, which is convened by Public Health England, launched a Falls Consensus Statement. This statement gives clear guidelines for health and other professionals on what to do to commission and design services to make a difference for people who need to build up their muscle and bone strength and so avoid a fall. The NHS and local authorities can use information like this statement to help prevent falls by commissioning evidence-based services that improve strength and balance, and making them available to those most at risk. 

More needs to change, though. Our environment – from homes to public spaces in our towns and cities – needs to be age-friendly, including helping people be more active and less at risk of falling. We need to understand more about how to build strength and balance activity into our daily lives from middle age, not just when we’re older. The Centre for Ageing Better is working with partners on all these questions and areas of change. We’re focusing on helping more people improve their strength and balance as they age to prevent falls and be more independent – to help everyone enjoy a better later life.

For more information

The Falls Consensus Statement can be accessed at:

W: www.gov.uk/government/publications/falls-and-fractures-consensus-statement

To learn more about the Centre for Ageing Better’s work, visit:

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