Leaves, pumpkin spice, and Halloween candy: Fall is in the air! And this year, that means something special to the American Physical Therapy Association (APTA).
Every October, the APTA celebrates Physical Therapy Awareness month, dedicating the first full month of fall to an awareness campaign on physical therapy treatment for chronic conditions, injuries, and overall health. APTA stresses the benefits of physical therapy over more costly and invasive alternative treatments, as well as its economic value for both treatment and preventive care. This year, the APTA is bringing in autumn by focusing on falls and fall prevention specifically as the theme of 2024 (“National Physical Therapy Month”).
APTA’s recent report from September 2023, “The Economic Value of Physical Therapy in the United States: A Report From the American Physical Therapy Association,” stresses the economic benefits of physical therapy treatment across a range of conditions. In addition to falls, these conditions include; acute low back pain, vascular claudication (also known as peripheral vascular disease), stress urinary incontinence, carpal tunnel syndrome, cancer rehabilitation, epicondylitis (tennis elbow), and osteoarthritis of the knee. When it comes to falls and fall-related injuries, the Foundational Paper reports 3 million emergency department visits and over 30,000 deaths of individuals aged 65 or over in the United States. These data, published in 2018, showed a 31% increase from 2007 to 2016 (American Physical Therapy Association; Kakara 513).
Fall Prevention and Elderly Care
The risk of falling is especially prevalent in the elderly population over 65 years of age. This risk is not only increased by the balance and walking issues that often accompany aging, but also by factors like commonplace hazards in the home (ie: tripping hazards, dim lighting) and even the use of medications. Studies have shown the risk of falling is exacerbated in individuals using multiple medications at once (Stutzman) and that regular use of several medications concurrently (ie: polypharmacy) further increases this risk (Xu 3-4).
A fall in an elderly patient may cause only superficial harm with no immediate serious consequences, but even in these cases, patients have reported decreased quality of life for as long as 9 months after a falling incident (de Jong 148). This decreased quality of life is related to difficulties with mobility, self-care, and enjoying activities as usual (Hartholt). Additionally, any fall should be taken seriously because experiencing even one, however minor, can double the chances of falling again (“Assess your Falls Risk”).
Considering the impacts on quality of life and the financial costs associated with treatment, the APTA Foundational Report concluded that choosing care with physical therapy can save over $2,000 per person per year. The National Council on Aging (NCOA) agrees, reporting that physical therapy can save over $80 billion worldwide when it comes to elderly care (“Get the Facts on Falls Prevention”).
In addition to annual primary care visits and “fall-proofing” the home, maintaining strength and balance is the most important factor in preventing a serious fall—and that’s why physical therapy is such an effective treatment.
Physical Therapy for Strength and Balance
Because physical therapists are specialized in examining, diagnosing, and treating movement dysfunction, their instruction offers a more targeted and effective intervention than home exercises alone, especially when it comes to preventing falls in the first place (“PT Moves Me”). Physical therapists may also be considered movement experts, as they are uniquely suited to assess movement and balance and to determine what activities or home exercises would be most beneficial.
In contrast to the belief that muscle function cannot be improved past a certain age, studies have shown that improving strength in your 60s, 70s, and 80s is absolutely possible (“Debunking the Myths of Older Adult Falls”; Liu 14) In fact, a systematic review of randomized controlled trials in adults aged 65 or over showed that progressive resistance strength training (PRT) resulted in significant improvement in muscle strength with regular training. Most of these exercises were undertaken in gym or clinic settings, while some were home-based or a combination of the two. Almost all trials enforced a consistent regimen, with exercises being performed two to three times a week.
Here, physical therapy has an additional benefit over home exercise alone. Physical therapists can use functional screening tools to evaluate things like balance and flexibility and to identify potential deficits or asymmetries so they can, in turn, identify future risks (Whittington). A physical therapist can make a personalized plan, ensure the exercises being performed and their intensity are strength-appropriate, work with other care providers to address any underlying conditions that might increase fall risk, and help make the home as safe and fall-proof as possible (“Guide to Falls”). They can even teach patients safe ways to get on or off the floor in case of a fall (“How a Physical Therapist Can Help You Reduce Your Risk of Falling”). While one fall may increase the chance of falling again, regular exercise can reduce this risk by 13% to 40% (Li 425; “Debunking the Myths of Older Adult Falls”).
Regular visits with a professional can also help with noncompliance. Evidence has suggested that noncompliance with home treatment in the context of musculoskeletal exercises can be as high as 50%, which adds to treatment and economic burden (Argent e47). If attending physical therapy regularly isn’t realistic, an annual visit as recommended by the APTA can still be an excellent preventive tool (Schrodt).
Because physical therapy is often associated with healing or restoring function following injury or surgery, spreading awareness of the role it can play in preventive care is important, especially when it comes to preventing elderly individuals from experiencing a fall that could have a huge negative impact, whether mental, physical, or both.
APTA Resources
Practitioners can raise awareness about the importance of physical therapy and its application for fall prevention in elderly populations with the APTA’s public awareness resources. Their toolkit includes social media graphics and themed handouts for fall prevention, including a home safety checklist and fact sheet (APTA Public Relations and Marketing Center). The toolkit also features materials related to direct access advocacy, which is a huge win for the APTA—this past May, Alabama was the last state to move to a provisional direct access model, cutting out the need for referral from a physician entirely (“Historic Wins: Last Severe Restrictions on Direct Access Eliminated”). There is now no need for a physician’s referral in any state. Nearby practitioners can be found by going to choosept.com/ with the abbreviation for your state (ie: choosept.com/al, choosept.com/ca, choosept.com/il, etc) (“Direct Access Advocacy”; choosept.com).
Why Physical Therapy Matters
With treatment access the easiest it’s ever been and evidence of its effectiveness growing stronger by the year, physical therapy awareness is more important than ever. Whether you’re a practitioner, a prospective patient, or know a prospective patient, this fall is the perfect season to learn and spread awareness about what physical therapy can do.
References
American Physical Therapy Association. Foundational Paper on The Economic Value of Physical Therapy in the United States—A Report From the American Physical Therapy Association. APTA, September 2023.
APTA Public Relations and Marketing Center. ChoosePT. American Physical Therapy Association, 2024. https://brandcenter.apta.org/portals/4q9nj2v8/ChoosePTPublicRelationsandMarketingPortal?_gl=1*1n9hfsa*_gcl_au*Njg4OTUyNTMwLjE3Mjg0MTkxODE.*_ga*MTI3MTE1ODA5OC4xNzI4NDE5MTgx*_ga_ZZJK74HXNR*MTcyODY2NzEzNC4yLjEuMTcyODY2Nzk2My42MC4wLjA
Argent, Rob, Ailish Daly, and Brian Caulfield. Patient Involvement with Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence? JMIR Mhealth Uhealth, vol. 6, no. 3, 2018, pp e47.
“Assess Your Falls Risk.” ChoosePT, American Physical Therapy Association, revised September 11, 2024. https://www.choosept.com/health-tips/assess-falls-risk
Burns, Elizabeth, and Ramakrishna Kakara. Deaths from Falls Among Persons Aged >65 Years—United States, 2007–2016. Morbidity and Mortality Weekly Report (MMWR), vol. 67, no. 18, 2018, pp. 509–514.
“Debunking the Myths of Older Adult Falls.” Falls Prevention, National Council on Aging, 2024. https://www.ncoa.org/article/debunking-the-myths-of-older-adult-falls/
“Direct Access Advocacy.” American Physical Therapy Association, 2024. https://www.apta.org/advocacy/issues/direct-access-advocacy
“Get the Facts on Falls Prevention.” Aging in America, National Council on Aging, 2024. https://www.ncoa.org/article/get-the-facts-on-falls-prevention/
“Guide to Falls.” ChoosePT, American Physical Therapy Association, 2024. https://www.choosept.com/guide/physical-therapy-guide-falls
Hartholt, Klaas A, Ed van Beeck, Suzanne Polinder, Nathalie van der Velde, Esther van Lieshout, Martien Panneman, Tischa van der Cammen, and Peter Patka. Societal Consequences of Falls in the Older Population: Injuries, Healthcare Costs, and Long-Term Reduced Quality of Life. The Journal of Trauma: Injury, Infection, and Critical Care, vol. 71, no. 3, 2011.
“Historic Wins: Last Severe Restrictions on Direct Access Eliminated.” American Physical Therapy Association, 2024. https://www.apta.org/news/2024/05/24/limited-direct-access-end
de Jong, Marlies R, Maarten Van der Elst, Hartholt Klaas A. Drug-Related Falls in Older Patients: Implicated Drugs, Consequences, and Possible Prevention Strategies. Therapeutic Advances in Drug Safety, vol. 4, no. 4, 2013, pp. 147–154.
Li, Fuzhong, Elizabeth Eckstrom, Peter Harmer, Kathleen Fitzgerald, Jan Voit, and Kathleen A. Cameron. Exercise and Fall Prevention: Narrowing the Research-to-Practice Gap and Enhancing Integration of Clinical and Community Practice. Journal of the American Geriatrics Society, vol. 64, no. 2, 2016, pp. 425–431.
Liu, Chiung-ju, Nancy K. Latham. Progressive Resistance Strength Training for Improving Physical Function in Older Adults. Cochrane Database of Systematic Reviews, vol. 2009, no. 3, 2009, CD002759.
“National Physical Therapy Month.” ChoosePT. American Physical Therapy Association, 2024, https://www.choosept.com/nptm#:~:text=October%20is%20National%20Physical%20Therapy,therapy%20and%20celebrate%20the%20profession
“PT Moves Me.” American Physical Therapy Association, 2020, https://www.apta.org/contentassets/5a330c03bbe24a999608030270ced59c/physical-therapy-overview-high-early-college.pdf
Schrodt, Lori, and Jennifer Vincenzo. “How a Physical Therapist Can Help You Reduce Your Risk of Falling.” Falls Prevention, National Council on Aging, 2023. https://www.ncoa.org/article/how-a-physical-therapist-can-help-you-reduce-your-risk-of-falling/
Stutzman, Lora. Fall Prevention: Balance and Strength Exercises for Older Adults. Health, Johns Hopkins Medicine.
Whittington, Brian. “What Does Preventative Physical Therapy Look Like?” Athletico Physical Therapy, 2022. https://www.athletico.com/2022/02/23/what-does-preventative-physical-therapy-look-like/
Xu, Qingmei, Ou Xuemei, and Jinfeng Li. The Risk of Falls Among the Aging Population: A Systematic Review and Meta-Analysis. Frontiers in Public Health, vol. 10, no. 902599, pp. 1–8.
Hi, I'm Hallie Koontz, a writer and editor based in Chicagoland who specializes in medical research and healthcare communications. My experience is primarily in dentistry and oral medicine, but I love reading and writing about a variety of research and awareness topics.
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