Preventing falls in older adults: Understanding postural instability to improve fall assessment and prevention

Falls in older adults are a serious and increasing problem for the NHS. Due to their multifactorial causes falls are difficult to prevent but research suggests that assessment and early interventions of those at risk of falling can help reduce fall frequency and consequently alleviate the health service burden and improve quality of life for older adults. The overall objective of this work was to investigate postural stability in persons over the age of 65 years to understand why this age group are susceptible to falls. Three main research aims were pursued (i) establish the scale of the issue of falls in older adults; (ii) develop an assessment system to measure postural stability; (iii) determine the conditions that compromise postural stability and assess awareness of this compromised stability. Firstly the existing literature was reviewed and a large scale analysis of accident reports from a sample of UK care homes was carried out. The results showed that falls are a serious issue for older adults residing in care homes, but also that accident reports are not necessarily reliable and some institutions may underreport falls. Pilot work in the early stages of the research process developed an accurate and reliable system to measure levels of postural stability. A Wii balance board was interfaced with a computer based kinematic assessment tool to measure postural stability whilst carrying out a variety of computerised secondary tasks. This assessment system was then used to fulfil the final research aim of investigating postural stability in older adults when loaded with various secondary tasks. Older adults’ postural stability was found to be compromised when undertaking a concurrent visuomotor task, but critically the results showed that this group were unaware of this compromise. The implications of these findings are discussed and further research directions are suggested.