Preventing falls in older adults: New interventions to promote more effective change-in-support balance reactions

Abstract

"Change-in-support"(CIS) balance-recovery reactions that involve rapid stepping or reaching movements play a critical role in
\npreventing falls; however, age-related deficits in the neuro-musculoskeletal systems may impede ability to execute these reactions effectively.
\nThis review describes four new interventions aimed at reducing fall risk in older adults by promoting more effective CIS reactions:
\n(1) balance training, (2) balance-enhancing footwear, (3) safer mobility aids, and (4) handrail cueing systems. The training program uses
\nunpredictable support-surface perturbations to counter specific CIS control problems associated with aging and fall risk. Pilot testing has
\ndemonstrated that the program is well-tolerated by balance-impaired older adults, and a randomized controlled trial is now in progress.
\nThe balance-enhancing footwear insole improves control of stepping reactions by compensating for age-related loss of plantar cutaneous
\nsensation. In a clinical trial, subjects wore the insole for 12 weeks with no serious problems and no habituation of the balance-enhancing
\nbenefits. The mobility-aid intervention involves changes to the design of pickup walkers so as to reduce impediments to lateral stepping.
\nFinally, work is underway to investigate the effectiveness of handrail cueing in attracting attention to the rail and ensuring that the brain
\nregisters its location, thereby facilitating more rapid and accurate grasping.