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Physiotherapy - Fall Prevention in Geriatric Population

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Physiotherapy - Fall Prevention in Geriatric Population

4 min read


Fall among older adults is very common and can lead to various complications. Know how physiotherapy plays a significant role in fall prevention in older adults.

Written by

Ranjeet Singha

Medically reviewed by

Dr. Sneha Kannan

Published At June 18, 2020
Reviewed AtAugust 8, 2023


Fall is widespread in the elderly population. Because of a fall, the person might suffer associated injuries such as a fracture of the femur or other musculoskeletal injuries, which may lead to impairment and disability, decrease mobility, and thus reduced community-level participation. If the fall is severe, it will put additional strain on the family members, caregivers, and the patient might be hospitalized, which will put an extra burden on the healthcare system. So, it is important to address this issue for improving the quality of life of this population. Physiotherapy plays a significant role in fall prevention in older adults.

A fall puts a lot of strain on the family, caregivers, and the healthcare system. There are a lot of factors that are considered a risk and may lead to a fall. Proper assessment through subjective examination followed by physical examination is important to identify old-age people at risk of a fall. It has been found in various studies that exercise therapy of multiple types is useful in fall prevention among the community-dwelling geriatric population. Along with exercise behavior modification and environmental modifications also play a vital role in fall prevention in this population. Physiotherapists can teach exercise, educate the old peoples, and make them aware of the importance of fall prevention. They can involve themselves in conducting awareness camps or seminars in the community regarding this issue.

What Causes Falls?

Falls occur due to the discrepancy between an individual's physiological function, environmental requirements, and behavior.

1) Physiological Function - This will include any impairment in vision, proprioception, and vestibular system. Along with it, there are other factors within an individual, which will play a crucial role in maintaining balance and preventing falls. This will include an intact musculoskeletal system, muscle strength, joint integrity, flexibility, proper biomechanics parameters, such as a line of gravity, posture, joint alignment, and the position of the center of gravity. Also, there is the role of higher centers of the brain along with cerebellum and basal ganglia, which plays a crucial role in maintaining one's balance and thus preventing falls. Any disease such as osteoporosis, osteoarthritis, stroke, or Parkinsonism, along with medication effects such as hypotension, alertness, and coordination, may impair one's balance and cause a fall.

2) Environmental Factors - The environment where the person performs any task may be a risk factor that may cause falls, especially in older people. This may include poor lighting, slippery floors, obstacles, such as a rug, wire of extension cords, and stairs without rails.

3) Behavioral Factors - This will include any behavior adopted by an individual that leads to falls—wearing slippery footwear, taking something from a high shelf, walking in a dark room, or room with dim light. Also, performing any high-risk behavior like climbing stairs without holding rails is an example that might put an individual at risk of falling.

What Is Fall Risk Assessment?

The strongest predictor of future falls is the history of a previous fall in the geriatric population. A history of prior falls increases the risk of a fall by five times in this group of people.

Assessment of Physical Function:

It is the next important predictor of falls, which includes the assessment of strength, balance, coordination, sensation, and vision. Also, medication use is a significant risk factor that may cause falls (hypotension due to side effects of medication).

What Are The Prevention Strategies For Falls?

Various studies have been carried out to identify different interventions by which falls in old peoples can be prevented, and those were found to be effective.

Exercise Therapy:

There is strong evidence suggesting that exercise is effective in preventing falls in community-dwelling older adults. Also, they found out that the 'multicomponent exercise' program seems to be the most effective. It includes gait training, balance training, strength training, yoga, tai chi, flexibility, endurance, and functional task type of training as compared to any single component exercise only. Exercise can be executed in a group or home setting or through online consultation.

Balance Exercises -

  • Stand up while holding a chair. Stride standing progress to narrower foot placement, progress to reaching in different directions, standing in hard surface progress to standing on foam. Stepping in different directions with an eye open, then progress to eye closed. More prolonged or faster steps, step over an obstacle.
  • Walking practice with eye open and then closed. Decrease base of support (tandem gait), increase step length and speed as improvement in performance occurs, walking in different directions, walking on different surfaces, walking around and over obstacles, heel, and toe walking.
  • Stand with an eye open and then closed. Do not use hands to push off, lower chair height as more control comes, softer chair, add weight (vest or belt).
  • Heel raises with an arm holding chair. Decrease hand support gradually, hold raise for longer, one leg at a time, add weight (vest or belt).
  • Step-ups over stepper or stairs. Forward and lateral. Decrease hand support gradually, increase step height, add weight (vest or belt).
  • Half squats sliding down a wall in stride standing. Decrease hand support gradually, hold the squat for more prolonged, move a short distance away from the wall, add weight (vest or belt), one leg at a time.

Multifactorial Interventions:

As there might be multiple causes for falls, it has been found that it is better to identify those factors to prevent falls. Interventions targeting medication dosage, behavior, and type of exercise were found to be very effective in preventing falls. But some studies found out that even single intervention is as effective and cheaper as multiple approaches.

The best strategy by a physiotherapist would be to start with a single exercise prescription for all older adults initially and then add on additional interventions if they find any patients who are at risk of a fall.

The risk-taking behavior of older adults should be addressed. For example, vision and strength, awareness of the environment, and adopting protective behavior, such as using handrails, and walking in a properly lit area to prevent falls. Risk behavior may include climbing, reaching, or bending while performing activities of daily living. In various studies, it has been found that the fall of older adults happened while climbing stairs, standing on unsteady or unstable surfaces, or participating in any vigorous sports activities such as tennis. It was reported that the task was done in a hurry, and concentration and attention were lacking, which resulted in a fall.

The other points which need to be considered are to give education on fall prevention, advice on environmental modification, and the gradual progression of various types of exercise programs. For patients who are hospitalized, physiotherapy sessions should include anticoagulant exercises, breathing exercises, active and passive exercises, that aim at keeping the correct mobility in the joints, the flexibility of the soft tissue, and strengthening the muscles. The aim is to improve strength and balance gradually.

What Are The Implications for Physiotherapy Practice?

As research supports that a well-designed exercise program effectively prevents falls in geriatric populations, the physiotherapist should use it to the maximum level. This may be done via-individualized home exercise program, referral to community level or hospital-based group exercise program, or via teleconsultation for people who are present in remote locations. Also, raise awareness regarding the importance of exercise among the old age people in the community by conducting camps, doing a presentation, and writing articles for local newspapers or websites.


Serious injuries, a loss of independence, and a drop in quality of life can all result from falls. Interventions in physical therapy are intended to evaluate individual risks, address underlying problems, and use techniques to improve balance, strength, and mobility. A proactive strategy that can considerably raise the quality of life for older persons is fall prevention through physical therapy. Seniors who receive physiotherapy are able to keep their independence and lower their risk of falls and associated injuries by addressing underlying physical difficulties, improving mobility, and improving balance.

Frequently Asked Questions


What Are the Different P's of Fall Prevention?

There are 4 P's of fall prevention, and caregivers and concerned staff use them to prevent falls and accidents. The different P's of fall prevention is as follows: 
- Pain - This helps assess pain and discomfort. 
Position - This allows better placement of the injured individual
- Placement - This focuses on placing things within reach. 
- Personal Needs - This centers on the primary and emotional needs of the person, such as hunger, thirst, etc.


What Measures Can Geriatric Patients Take To Prevent Falls?

Geriatric patients can take several measures to prevent falls and accidents, such as: 
- They should remain physically active and perform exercises that their body allows them to do. Mild forms of weight training help build muscle strength and decline the rate of osteoporosis, thereby ensuring bone strength. 
- They can also incorporate exercises such as yoga and pilates for improved core strength and flexibility. 
- They should also make sure that their surroundings and home are fall-proof. Several approaches to achieving this include installing anti-slip flooring to enhance safety and reduce the risk of slipping accidents. 
- They should get their eyesight and hearing tested frequently. 
- They should remain healthy by having good, nutritious, and healthy meals. 
- They should also ensure that they are well-rested.


What Are the Various Simple Measures People Can Take To Prevent Falls at Home?

People can take several measures to prevent falls. A few of them include the following: 
- People should watch their steps while walking. 
- People should opt for comfortable, ergonomic, and sensible footwear. 
- Have anti-slip flooring at home. 
- Ensure proper lighting at home. 
- Remain healthy with a nutritious diet and regular exercise. 
- People should get their eyesight checked, 
- People should get optimal hours of sleep and avoid alcohol abuse. 


Are There Any Standard Fall Prevention Interventions?

Fall prevention interventions vary based on the fall's risk, severity, and location. However, in general, the following measures can be considered to prevent falls in all environments - 
- Removing excess furniture, supplies, and equipment from the flooring and rooms. 
- All spills should be cleaned immediately. 
- Electrical wiring, coils, ropes, etc., should be well secured. Unnecessary ones should be removed. 


Is Physiotherapy a Painful Therapy?

Physiotherapy, when done at the right time, under proper guidance for the required time, should not hurt. Therefore, selecting a skilled and well-trained professional is of utmost importance. However, it is crucial to recognize that initiating rehabilitation and physiotherapy at the right time during the recovery phase is essential. Otherwise, it is common for patients to encounter discomfort during therapy due to muscle and tendon stiffness.


How Long Does It Take To Rehabilitate Following Physiotherapy?

Recovery following physiotherapy varies from one patient to another. It is also based on other variables, such as:
 - Age of the patient. 
 - Type of injury. 
 - Nutrition of the patient. 
 - The general well-being of the patient. 
Some injuries recover within a few weeks, while others may require several months to years.


What Is Physiotherapy?

Physiotherapy is a form of rehabilitative and treatment modality. In essence, it is that domain of health care that focuses on restoring function and movement while maximizing the physical potential of an individual. It is a holistic approach that is major in individual pain management.


What Type of Treatment Is Given in Physiotherapy?

Several kinds of treatments can be employed under physiotherapy. A few of them include the following: 
- Manual manipulation over soft tissues and joints of the body. 
- Electrical stimulation. 
- Joint mobilization.
- Muscle stretching.


Are There Any Side Effects of Physiotherapy?

When done under appropriate guidance, physiotherapy does not have any side effects. However, some patients may complain of muscle soreness, fatigue, and pain post-therapy, which often subsides quickly. If patients experience unbearable pain that does not subside, they should inform their therapist to identify the primary cause of discomfort.


When Do Patients Require Physiotherapy?

People can seek physiotherapy for several reasons, such as to recover from a serious injury or surgery. In addition, people frequently attend physiotherapy sessions to eliminate the discomfort that limits their strength and mobility. Physiotherapy may also be used when prescribed medications fail to provide results.


Can a Physiotherapist Perform Surgery?

No, physiotherapists do not perform surgeries. They primarily play a significant role in rehabilitating patients following surgery or injury. The injured area's strength and functionality can be regained by employing various exercises involving mechanical forces and gradual repetitive motions.


Can a Physiotherapist Give Injections?

No, physiotherapists are not licensed to give injections to patients. However, there is one exception. An invasive technique called the dry needling method is used to relieve muscle pain and spasms. In this method, the physiotherapist uses a needle resembling one used in acupuncture. If the physiotherapist is competent, rarely hurts, and is safe.


Is Physiotherapy a Good Choice of Profession?

In complete honesty, as with any profession, physiotherapy is a good choice. Ultimately, the decision and enthusiasm of the individual pursuing it are paramount. It is an excellent professional choice for individuals wanting to serve in the healthcare industry.


Is There a High Demand for Physiotherapists?

Physiotherapy is a skilled profession with increasing demand in today's world. Physiotherapists are healthcare professionals that specialize in treating injuries and restoring function, strength, and mobility. They use various techniques that help patients rehabilitate and improve the quality of their lives.
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Ranjeet Singha
Ranjeet Singha



physiotherapyosteoarthritisfall preventionolder adults
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