ELDERLY FITNESS for LIFE

1. ELDERLY FITNESS for LIFE Texas Department of Aging and Disability Services Quality Assurance & Improvement Symposium: Standing Strong: Falls Prevention & Management FRANKLIN MILLER, CHAPLAIN

2. VULNERABILITY A Growing Public Health Crisis 1/3 to 1/2 of older adults acknowledge fear of falls Fear of falling is associated with: depression decreased mobility and decreased social activity increased frailty increased risk for falls as a result of deconditioning

3. VULNERABILITY Falling is the leading cause of injury and the 6th leading cause of death in individuals 65+ Falls are responsible for 70 percent of accidental deaths in persons 75+ The elderly, who represent 12 percent of the population, account for 75 percent of deaths from falls www.cdc.gov/ncipc/factsheets/fallcost.htm

4. VULNERABILITY In the US in 2004: • 15,000 seniors died from falls.  “Every 35 minutes, an older adult dies from a fall”. • 1.85 million treated in Emergency Departments • 1.3 million treated & released • 473,000 hospitalized • Admission rates increase with age (39% of fall related admissions are 85+) www.cdc.gov/ncipc/factsheets/fallcost.htm

5. VULNERABILITY In 2005, 1,211 Texas residents died as the result of falls; 9.4 percent of all 2005 injury deaths in Texas Fall Injuries in Texas (2009). Texas Department of State Health Services. Environmental & Injury Epidemiology & Toxicology Branch

6. VULNERABILITY *Death rate is number of deaths per 100,000 population Fall Injuries in Texas (2009). Texas Department of State Health Services. Environmental & Injury Epidemiology & Toxicology Branch

7. VULNERABILITY Texas Death Rates from Fall Injury, by Race/Ethnicity, 2004 and 2005 deaths per 100,000 population Fall Injuries in Texas (2009). Texas Department of State Health Services. Environmental & Injury Epidemiology & Toxicology Branch

8. FALLS PREVENTION 1/2 to 2/3 of falls occur around the home A majority of falls occur during routine activities Falls usually aren’t caused by just one issue. It’s a combination of things coming together. A large portion of falls are preventable!

9. FALLS PREVENTION Common misconceptions about aging Physical detriment is inevitable Changes are irreversible and beyond one’s control Motivation for change is low Assumed that exercise will do no good and may even be harmful We now know that even a little bit of exercise is beneficial (BA Harris, 2008)

10. FALLS PREVENTION Cognitive Restructuring(Bandura and Lachman, 1997) Method of turning negative thoughts into positive thoughts Need to define barriers, obstacles when engaging in a new behavior Identify strategies for overcoming the barriers Plan realistic/feasible experiences so you can experience success www.doh.state.fl.us/demo/.../AMatterofBalance-AProgramReview.pdf

11. FALLS PREVENTION Focus Interventions on: Changing misconceptions Teaching skills that promote self-confidence in one’s abilities (self-efficacy) Instill the belief that one’s efforts will make a difference (outcome expectations) Encourage positive adaptive responses in the face of difficulties (attributions) (BA Harris 2008)

12. FALLS PREVENTION Designed to benefit community-dwelling older adults who: Are concerned about falls Have sustained a fall in the past Restrict activities because of concerns about falling Are interested in improving flexibility, balance and strength Are age 60 or older, ambulatory and able to problem-solve

13. A Matter of BalanceVolunteer Lay Leader Model Model Program Adaptations: • Classes taught by volunteer lay leaders, called coaches, instead of healthcare professionals.

14. WARM-UP EXERCISES Deep Breathing Place your hands on stomach and take a deep breath in, filling your diaphragm. Feel your hands move out as you fully breath. Exhale and feel your hands return.

15. WARM-UP EXERCISES Good Morning Stretch Stretch your arms wide. Take a deep breath and exhale, stretch some more, add a gentle turn to the left and then to the right. Move slowly and breathe deeply.

16. WARM-UP EXERCISES Shoulder Rolls Roll your shoulders forward, making small circles for a count of 5. Then roll your shoulders to the back for a count of 5.

17. WARM-UP EXERCISES Foot Circles Sit with both feet on floor. Raise one foot and gently circle (rotate) your foot in a clockwise direction 5 times. Change direction and repeat.

18. WARM-UP EXERCISES Seated Knee Raises (Seated Marching) Lift your left knee and then lower it. Lift your right knee and lower it, as if you were marching.

19. STRENGTH AND BALANCE EXERCISES Diagonal Arm Press Across the Body and Toward the Floor Starting with your left arm, press to the right, toward the floor and across your body. Alternate your right and left arm.

20. STRENGTH AND BALANCE EXERCISES Diagonal Arm Press Across the Body and Slightly Overhead Starting with your left arm, press to the right, toward the ceiling and across your body. Alternate your right and left arm.

21. STRENGTH AND BALANCE EXERCISES Rowing Exercise With both arms straight out in front of your body, pull arms in, as if you are rowing a boat. Try to pinch your shoulder blades together as you row.

22. STRENGTH AND BALANCE EXERCISES Seated Knee Raises (Not Alternating) First, lift your left knee and then lower it. Repeat 5 to 10 times.

23. STRENGTH AND BALANCE EXERCISES Toe Stands (Heel Raises) Stand behind your chair. Use the chair for support. Place your feet about shoulder width apart and lift up your heels, rising up on to your toes. Pause, then return your heels to the floor.

24. STRENGTH AND BALANCE EXERCISES Alternating Steps (Marching In Place) Start marching, alternating steps at a slow to moderate pace. Continue for 15 to 30 seconds

25. STRENGTH AND BALANCE EXERCISES Side Stepping Step your left foot to the left, then step your right foot to match your left foot. Step your right foot back to the right, then step your left foot to match your right foot. Continue for 15 to 30 seconds

26. STRENGTH AND BALANCE EXERCISES Seated Leg Extensions Slowly straighten your left leg and then return your left leg to the floor. Slowly straighten your right leg and then return your right leg to the floor. Alternate and repeat 5 to 10 times

27. STRENGTH AND BALANCE EXERCISES The Box Step (Waltz) Right foot forward, then feet together. Left foot to side, then feet together. Left foot back, then feet together. Right foot right, then feet together Repeat cycle 3 to 5 times

28. STRENGTH AND BALANCE EXERCISES Standing Hip Extension Stand behind a chair or sturdy table, slide your foot back, sliding from heel to toe, finishing with leg back and toe pointed, touching the ground. Repeat 5 to 10 times with each leg

29. STRENGTH AND BALANCE EXERCISES Leg Lift to the Side Lift left leg out to the side, pause, bring it back to mid-line. Touch your left heel to your right toe. Repeat 5 to 10 times. Lift right leg out to the side, pause, bring it back to mid-line. Touch your right heel to your left toe. Repeat 5 to 10 times

30. STRENGTH AND BALANCE EXERCISES Wrist Rise & Fall Place your arms on the armrest of the chair. Gently let your hand hang off the edge of the armrest. (Use tabletop if armrests are not available). Slowly bend the back of your hand, lift your fingers up toward the ceiling. Then gently lower your hand. Repeat 5 times, increase as appropriate

31. STRENGTH AND BALANCE EXERCISES Finger Spread Spread fingers of both hands far apart, keeping fingers straight. Then relax hands and fingers into a gentle fist. Repeat 5 times, increase as appropriate

32. STRENGTH AND BALANCE EXERCISES Wrist Rotation Spread fingers of both hands far apart (like the finger spread.) Then, rotate your hand, palm up, palm down. Repeat 5 times, increase as appropriate

33. STRENGTH AND BALANCE EXERCISES Touch Elbows Stretch (front and back) Stretch Front: Place your fingertips on your shoulder. Raise elbows to shoulder level. Gently move your elbows together (toward your body’s mid-line). Try to get them as close as possible, while still remaining comfortable. Hold for 3-5 seconds

34. STRENGTH AND BALANCE EXERCISES Arm Chair Push Put hands on arms of chair and push body up out of chair, partially standing. Repeat 3-5 times.

35. STRENGTH AND BALANCE EXERCISES Hip Circles With your hands on hips, make circles with hips without moving shoulders. Pretend that you are doing the hula dance or playing with a hula-hoop toy. Do this each direction for 10-15 seconds. Repeat the cycle 2 times

36. STRENGTH AND BALANCE EXERCISES Standing Foot Circles Using the chair for support, stand with both feet on the floor, gently raise one heel slightly off the floor, maintaining contact with the floor and your toe. Circle your heel clockwise. Repeat 5 times. Circle foot counter clockwise. Repeat 5 times.

37. STRENGTH AND BALANCE EXERCISES Heel Cord Stretch Stand about an arm’s length away from the chair. With right foot in front of left, lean forward keeping left heel flat on the floor. Hold 10 to 15 seconds. Counting out loud. Repeat with opposite foot in front. Repeat cycle 2 times Before returning to your seat, take two or three deep breaths.

38. COOL-DOWN Ear to Shoulder Bring left ear to left shoulder and hold for 10 seconds. Repeat to the right. Repeat cycle 3 times.

39. COOL-DOWN Look Left, Look Right Look to the left, look to the right. Move slowly. Repeat 5 times.

40. COOL-DOWN Good Morning Stretch Stretch arms open wide and yawn, if you like. Take a deep breath, stretch some more, add a gentle turn to the left and then to the right. Move slowly and breathe deeply. Repeat cycle 2 to 3 times.

41. COOL-DOWN Giant Bear Hug Stretch Wrap your arms around your body. Try to reach your hand behind your back (like a big bear hug) Squeeze and stretch and relax

42. References • Barrett-Connor, E. (1995). The economic and human cost of osteoporotic fracture. American Journal of Medicine, 98((suppl 2A), 2A?S-2A?S. • Beasley, C. (2009). Fall Injuries in Texas. Texas Department of State Health Services Environmental & Injury Epidemiology & Toxicology Branch • Centers for Disease Control. (2007). Costs of Falls Among Older Americans: How big is the problem? In Cost of Falls. Retrieved Nov 5, 2007 from http://www.cdc.gov/ncipc/factsheets/fallcost.htm • Cummings RG, Salkeld G, Thomas M, and Szonyl G. Prospective study of the impact of fear of falling on activities of daily living, SF-36 Scores, and nursing home admission. J Gerontol 55A: M299–305, 2000

43. Englander, F., Hodson, T.J., Terregrossa, R.A. (1996). The economic and human costs of osteoporotic fracture. Journal of Forensic Science, 41(5), 733-6. • Fear of Falling Among Seniors: Needs Assessment and Intervention Strategies (2003) Accessed Nov 4, 2007 from http://www.pitt.edu/~super1/lecture/lec12801/index.htm Friedman, SM, et al, 2002, Falls and fear of falling: which comes first:”, Journal of the American Geriatric Society, 50 (8): 1329-35. Greenhouse, A.H. (1994). Falls Among the Elderly. In Albert, M.L., Knoefel, J.E. (Ed.), Clinical neurology of aging (2nd ed., pp. 611-26). New York: Oxford University Press.

44. Health in Aging Advocacy Center- American Geriatrics Society. Help keep Seniors Safe From Falls. Retrieved Nov 13, 2007 from ttp://ga1.org/healthyagingadvocacy/alert-description.html?alert_id=5801319 NCHS Press Room. Falling Accidents in Older Adults.(2008) Retrieved on April 16, 2008 from http://images.google.com/imgres?imgurl=http://nchspressroom.files.wordpress.com/2007/09/fall.jp g&imgrefurl=http://nchspressroom.wordpress.com/2007/09/&h=441&w=524&sz=28&hl=en&start= 20&um=1&tbnid=q8hbqS70ODtM:&tbnh=111&tbnw=132&prev=/images%3Fq%3Dfalls%2Binjury %26um%3D1%26hl%3Den%26client%3Dfirefox-a%26rls%3Dorg.mozilla:en-US:official%26sa%3DN Healy, T. C., Peng, C., Haynes, P., McMahon, E., Botler, J. & Gross, L. (2008). The Feasibility and Effectiveness of Translating A Matter of Balance into a Volunteer Lay Leader Model. Journal of Applied Gerontology, 27 (1), 34-51. .

45. Lach, H., 2003, Fear of falling: An emerging public health problem”, Generations, VXXVI, 4, pp. 33-38. Perterson, E. et al, 2003, Resources for fall prevention and management of fear of falling:, Generations, VXXVI, 4, pp 89-92 Reyes-Ortiz CA, Al Snih S, Markides KS. Falls among elderly persons in Latin America and the Caribbean and among elderly Mexican-Americans . Rev Panam Salud Publica. 2005;17(5-6):362-369 Rubenstein, L. Z. (2006). Falls in older people: Epidemiology, risk factors and strategies for prevention. Age and Ageing, 35(Suppl. 2), 37-41.

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47. Tinetti, M.E., Baker, D.I., McAvay, G., Claus, E.B., Garrett, P., et al. (1994). A multifactorialintervention to reduce the risk of falling amoung elderly people living in the community. N Engl J Med, 331, 821-7. Weigelt, J.A. (1997). Trauma. In Advanced trauma life support for doctors (6th ed., Vol. 26). Chicago: American College of Surgeons.

48. THANK YOU !!