Nutrition & exercise: preventing falls in aged care

April 3, 2018
/ Aged Care, Bones, Muscle, Protein, Sarcopenia

One of our staff recently spoke with someone whose father is in an aged care facility. They discovered he had a hairline fracture in his hip – about a week after it happened. The nurse accidentally dropped him when she was helping him out of bed, and it wasn’t reported.

Around one in three older adults suffer from falls, and up to 60 percent will suffer an injury. Three times more people tumble in long-term aged care.

Most injuries are superficial cuts, grazes, bruises and sprains. Some are more serious. Falls cause 40 percent of injury-related deaths in older adults. Hip fractures are the most serious and costly fall-related injuries, resulting in 19,000 hospital admissions for older Australians from 2011 to 2012.

More broadly, falls – and fear of falling – can impact independence and quality of life. But it’s not a cross lotto. Older people can reduce their risk of falls with nutrition and exercise.

Nutrition and falls prevention

Assessment tools can predict risk of falls, to help tailor prevention strategies. These tend to assess physical capacity like mobility, balance, strength and gait. But nutrition status is also a key predictor for likelihood of falling and the gravity of injuries.

Malnutrition and low body weight result from depleted protein and energy stores. This carries multiple adverse outcomes including bone loss and fragility, poorer movement coordination, slower reaction time and diminished muscle strength – all of which increase risk of falling.

Low calcium and vitamin D impact bone health and risk of falls. Low vitamin K also increases bone fragility. Poor eyesight can compound propensity to fall, also impacted by nutrition status. Low levels of vitamins A, C and E contribute to weak vision.

Insufficient vitamin B12 and folic acid can reduce nerve function in extremities, and in the brain lead to confusion. Dehydration, a common problem in older adults, can also cause delirium, as well as constipation and low blood pressure; all increasing fall risk.

Providing a healthy, tasty diet high in protein from eggs, dairy, fish, chicken, nuts and legumes and a variety of foods from the core food groups is an important step towards preventing nutrient depletion and associated risk of falling.

Exercise and falls prevention

Regular physical activity is important to reduce age-related loss in muscle mass and bone density. Recently, the SUNBEAM trial (Strength and Balance Exercise in Aged Care), tested a program of individually tailored physical activity in aged care.

The program reduced falls by 55 percent, larger than any other study to date according to lead investigator Jennie Hewitt, physiotherapist from Feros Care and PhD candidate at the University of Sydney.

Over 200 aged care residents from 16 facilities in New South Wales and Queensland took part – half of them were randomised to do the program and the other half continued normal activities.

Participants in the program engaged in 50 hours of group-based resistance (strength) training and balance activities over 25 weeks, then a six-month maintenance period.

Not only did falls decrease dramatically in the exercise program group, but participants had considerably better balance and mobility. Some found the enhanced independence life-changing, and rejoiced at being able to go out with their families.

It’s not just about falls; healthier lifestyles and greater mobility have positive ripple effects for happy aging.