Professor Dr Margie Sharpe says, “loss of confidence after a fall all too often translates into avoidance of physical movement/activity. Meaning, we sit for long periods of time in an attempt to avoid falling over. Unfortunately, the lack of physical activity actually causes more falls.”

You can think of it along these lines; sitting is the killer and movement is the healer. To activate our balance mechanisms we need to move (eg walking on uneven surfaces, shopping, gardening).

We are designed to live in a gravitational world (not in outer space); so gravity is our friend and not our foe.
If we look elsewhere, an article by Dr Colin Tidy titled “Prevention of Falls in the Elderly” it makes the observation, “Falls can be devastating to the affected individual but are also expensive to manage. In particular, when associated with fracture of the proximal femur, they carry a high morbidity and mortality. Even lesser falls lead to loss of self-confidence and reduced quality of life. This can also have significant economic consequences because of the cost of inpatient care and also loss of independence and the cost of residential care.” Ref#1
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This was an outcome of the assessment of the UK National Institute for Health and Care Excellence (NICE) Quality Standards update in January 2017.
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Margie says, “Maintaining our balance is a lifelong commitment, not just a short course in balance re-education. We must continue to use and challenge our balance mechanisms daily, as much as possible, and avoid sitting for lengthy periods of time. If you do not continue the balance exercises/moving and challenge your balance on a day-to-day basis after completing the course, you will revert very quickly to your former level of poor balance.”
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“The magic word is MOVE to HEAL because SITTING KILLS your balance.”
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When we delve deeper into the NICE Quality Standards, in particular, Statement 8 for Older people living in the community who have a known history of recurrent falls, it states; people at risk of falls should be referred for strength and balance training.
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This NICE standard has been a recommendation since 2015 and while some implementations have been evident across organisations, such as COTA’s “Strength for Life” program, Australia still has a long way to go to meet our international colleagues.
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For example, the NICE Quality Standards say, “Balance impairment and muscle weakness caused by ageing and lack of use are the most prevalent modifiable risk factors for falls. Strength and balance training have been identified as an effective single intervention and as a component in successful multi-factorial intervention programmes to reduce subsequent falls. It is important that strength and balance training is undertaken after a multi-factorial falls risk assessment has been completed.
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Typically in Australia, our falls prevention focuses on improving the external or environmental factors around a person. We encourage the use of handrails, non-slip surfaces, walking frames, non-slip shoes, and so on.
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But what if we showed you how to fall correctly?

Take one recent example from the Dutch, who like many elsewhere, are living longer than in previous generations, often alone. As they do, courses that teach them not only how to avoid falling, but how to fall correctly, are gaining popularity. Ref#3
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The Dutch have introduced a course called Vallen Verleden Tijd, which roughly translates as “Falling is in the past.”.
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Professor Dr Margie Sharpe says, “It is timely for Australian’s to create their own paradigm shift, regroup or recentre and focus on the person at risk of the fall, and not their environment. We need to accept people will potentially fall, own it, and then encourage people to know what to do about it for their minimal impact.
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So, what can a person do to accept a fall, fall correctly or fall with minimal impact?
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Examples such as the Dutch course are clinically devised to teach people how to navigate treacherous ground without having to worry about falling, and how to fall if they did. It’s using physiotherapy for the best purpose; that is, for prevention.
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The course is devised to practice the things you know you can do – to positively train and reinforce in other words – and not focus on the things you can’t.
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References
1) Prevention of Falls in the Elderly
Authored by Dr Colin Tidy, 03 Jul 2016
https://patient.info/doctor/prevention-of-falls-in-the-elderly-pro
2) Falls in older people: assessment after a fall and preventing further falls; NICE Quality Standards, March 2015 (updated Jan 2017)
3) Afraid of Falling? For Older Adults, the Dutch Have a Cure
Text by CHRISTOPHER F. SCHUETZEJAN. 2, 2018
https://www.nytimes.com/2018/01/02/world/europe/netherlands-falling-elderly.html
4) Implementation Guide for Preventing Falls and Harm From Falls in Older People: Best Practice Guidelines for Australian Hospitals and Residential Aged Care Facilities 2009 (PDF 1349 KB)