How To Prevent Falls

Falls aren’t just “a part of aging.” Research shows there are 24 different risk factors, and the good news is that most of them can be improved or eliminated. In this video, we break down the myths about balance, strength, and aging, and show you what really works to prevent falls.

✅ Why age alone isn’t the cause of falls
✅ The 3 most common (but misleading) beliefs about balance problems
✅ What 10+ years of systematic reviews and meta-analyses reveal about fall risk
✅ The #1 scientifically proven intervention to reduce falls (hint: it’s NOT just core strength)
✅ The most effective types of exercise for balance and independence
✅ Why exercise outperforms medication, home modifications, and even combined interventions
✅ How the vestibular system (your body’s balance network) plays a key role in fall prevention

This isn’t about waiting, resting, or accepting decline; it’s about taking action with practical, research-backed strategies that truly work.

If you or a loved one want to stay independent, confident, and safe, this video will give you the tools to start making changes today.

Study References:
1. Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology. 2010;21(5):658-668

2. Lusardi MM, Fritz S, Middleton A, Allison L, Wingood M, Phillips E, Criss M, Verma S, Osborne J, Chui KK. Determining Risk of Falls in Community Dwelling Older Adults: A Systematic Review and Metaanalysis Using Posttest Probability. J Geriatr Phys Ther. 2017;40(1):1-36.

3. Muir SW, Berg K, Chesworth B, Klar N, Speechley M. Quantifying the magnitude of risk for balance impairment on falls in community-dwelling older adults: a systematic review and meta-analysis. J Clin Epidemiol.
2010;63(4):389-406.

4. Cheng MH, Chang SE. Frailty as a Risk Factor for Falls Among Community Dwelling People: Evidence From a Meta-Analysis. J Nurs Scholarsh.
2017;49(5):529-536.

5. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012.12;9.

6. Xu Q, Ou X, Li J. The risk of falls among the aging population: A systematic review and meta-analysis. Front. Public Health. 2022;
10:902599. doi: 10.3389/fpubh.2022.902599

Three common things we tend to hear from people about balance falls. We hear as as a balance specialist. So very, very common. You know, this just comes with age. And sometimes we hear this from the people themselves, and sometimes we hear this from healthcare providers. And we're going to see how even the science doesn't support that to be the case. Um, a another common one is, well, I just need to get stronger or even, you know, I'll ask I'll ask people oftentimes, you know, why do you think you have a balance problem? And some a lot of times very, very commonly they'll say something along the lines of, well, my core is weak. I think I need to strengthen my core. And we're going to see how that one piece is a very small component. And it's a much bigger component than just core strength. Um, and also a sense of kind of apathy. Um, that's another third very common response. Well, I fell because and then oftentimes elaborate stories will be kind of, uh, created, uh, even though there's been three or four falls. There's a story to go along with it. With each time I tripped over this or that, you know, this happened. And so really, it it becomes a pattern after a while. Um, and sometimes there's a sense of, you know, I just need to rest. It'll get better over time or even a sense of, well, you know what? What can be done? Nothing can be done about it anyway. And it couldn't. That could not be further from the truth. And we're going to talk about that today on what people can do, uh, to prevent these problems. And there's a lot that can be done about it. That's the exciting part. Let me introduce myself. My name is Doctor Jeffrey Guild, physical therapist, owner of Optimove. Uh, we are a mobile physical therapy practice that specializes in vestibular disorders, as well as all sorts of neurological disorders and balance and fall problems. And those things tend to go hand in hand well together. And so we work on those things such as balance and falls, decline and just complex movement problems in general. So it's not your typical outpatient orthopedic type of specialty. We work with cases that are more complex, neurological, and people who are, um, you know, eighty to ninety five is very normal, uh, for our clients. So my background is I was originally a strength conditioning, uh, professional and personal trainer. And I went to physical therapy school and became a vestibular specialist even before I got my physical therapy license. Uh, so I've been doing the vestibular specialty for quite a while. Um, and of course, I'm a business owner as well. Father and a husband and, um, and now a content creator. So that's a newer, uh, skill set that I'm working on, which is a whole nother journey in and of itself. So selling the right type of specialty you're looking for as we're working on how to prevent balance and fall problems. I'll tell you a little bit more about my story Here. And so here's the quick story. So it started off when I was actually a strength conditioning intern at the University of Iowa. So I was working with the elite Division one athletes in the weight room, basically as an intern during my undergrad. And there was this lady who came in, um, she was about in her sixties or seventies, uh, during lunch break, and she had her business casual clothes on and everything else. And she come in and she, you know, load up the bar and load up the weights and, you know, she'd be doing deadlifts and squats and, you know, push pull movements and also doing a lot of the things that the that the athletes were doing. And it was just fascinating to watch her work. And so, um, I spoke with her a couple of times. And so it turned out that her son was actually an assistant strength coach with the University of Iowa, and he taught her how to do all this stuff. And so she that was that became her form of exercise. She would come in during the lunch break and lift three or four days a week. And, you know, she would walk and swim and things like that. But, you know, the strength training was a big, uh, impact, uh, in her life. So that and that experience, along with additional studying that I did during my, um, during my internship and during my undergrad, I decided to do my undergraduate thesis on how to train for leg power to prevent falls in the aging population. And this was back in two thousand and five, two thousand and six. So this was very early days and all this information was very new, very fresh. And so it was very exciting to do an undergraduate thesis, uh, based on that. So sound like an inspiring story so far. And so basically, the passion was realizing that with the aging population, the baby boomers would be getting older over time. And so my undergraduate thesis was on preventing falls, because I saw that there would be an upcoming epidemic of fall problems and strength problems and decline as people got older. So I can't say I dedicated my career to the idea of preventing falls preventing decline in the older population. Of course, I love working with older people as well, so it was a natural population to work with. So the my career choice was dedicated towards preventing this problem that we're now facing very soon. Today, the older the oldest baby boomers, about seventy nine years old as of this recording. So we're going to be over the next few years. It's coming up where we're going to have a very large population of people that are going to be declining and getting more medically complex and falling more and declining more. So we as a healthcare system, as and as healthcare specialists, need to be ready for this. So I dedicated, um, uh, optimove, uh, to this problem of preventing falls in the older population and working with people with more medically complex, uh, situations. Although this journey started off as a strength conditioning professional, um, and I worked with people with physical limitations, and I knew that physical therapy would be the route to go to get on this path, to prevent these problems that that we saw coming up. And a lot of people have seen this coming up. And so we all need, as healthcare providers, need to take action very quickly to prevent this problem from, uh, as, as we're seeing it coming up. And of course, my background working, uh, as a physical therapist was mostly in skilled nursing facilities and hospitals and neurological rehab facilities. So it definitely had gotten that type of background. So now as a as a specialty practice, we're able to apply a lot of what we've learned, um, to, uh, to our clients so we can do the best we can at helping them. And we've got a great team, um, to be able to help them as well. So, Optimove, we work with people every single day to promote independence and, and mobility and reduce fall risk and reduce hospitalizations and of course, troubleshoot problems with our clients and their families along the way, and empower people eighty to ninety five years old to thrive as they get older and prevent decline. And we've got a great team of specialists that work with our clients every single day. So what are the risk factors for falls? And there is a list of twenty four risk factors. And this is from all major large studies, systematic reviews and meta analyses over the past ten to twelve years that have identified twenty four different risk factors for falls. So the main takeaway here is this is a very comprehensive list of very different things. And so this tells us that a lot can be done. We have a lot of things that we can tackle to help solve this problem. And so and notice of all these twenty four things, old age is only one risk factor from the list. And so and that was only a very recent, uh, meta analysis that showed that to be a risk factor. So that shows that a lot of different things can be done to help people. Since there are so many different risk factors, we have a lot of ways to address this problem. And here are the the studies which all of this comes from. So six major systematic reviews and meta analyses and what this what a systematic review and meta analysis is, is they take very large studies and through statistical analysis, they kind of pull all the studies together and use all that data, all those people, um, that have been studied to come up with additional insights because there is just so much data to pull from when they're when you pull from that many studies. And so that's the special thing about a meta analysis, is you can get a lot more insights from all these different studies instead of just one. So each of these six independent systematic reviews and meta analyses, and that's how we come up with these twenty four different risk factors, all published in peer reviewed medical journals. So. Our big takeaway again, there are so many risk factors to this problem. And that means that we have a lot of things that we can do to address this. And also this is not as simple as just age. It's not as simple as just a loss of strength and or just medication problems or dehydration. It's a lot of a big multifactorial problem that we need to address. Um, in fact, when we were going to look at medications here in a second, and I think some of the answers will surprise you. And again, this means that we have control over this because there are so many things that we can address here. So all sound good, sound exciting and refreshing news so far. So I marked on here basically in green all the risk factors that can be improved or eliminated. And I'm actually being conservative here because I'm not including the risk factors that might take a little more of a massive overhaul, such as smoking alcohol, moving people out of rural areas, or increasing socialisation. I'm being very conservative in this. So basically about seventy percent of these problems can easily be addressed through relatively simple interventions. And certainly the interventions that we use, and especially with collaboration from our healthcare providers and their families. Very simple things that can be done. And seventy percent of these things can easily be addressed. And I could make an argument for all these other things as well. So, you know, smoking cessation of course, can be addressed. Alcohol, you know, living alone and increasing socialisation. But I didn't throw that into, um, into that seventy percent because those things might take a little bit more of a massive overhaul. But again, those things can be done as well. And so I can say that even older age, of course, especially is something that can be improved upon. People can be made younger, and we do that all the time here, and we do that for ourselves as well. So how would you like to know how to get younger? Type in the chat. Let us know. And it's a lot of fun to be able to help people, to build to, to act younger and feel younger. And so that's something that's fun that we're able to work with every single day. Um, so you might be wondering, okay, with all these different risk factors, this is a lot. So where to start? How do we how do we go about addressing this with all these different risk factors. What do we do. So it turns out that the science actually consistently points to one direction for the best intervention to start first. So is it giving someone canes and walkers and optimizing that? Is it the medication list making their home safer. These are all the things that we tend to do, and we've been trained as healthcare providers to do. And so these are very, very, very common things that will be done first. Uh, you know, just making them stronger. Core strength is people tend to think the answer to the main and most effective intervention by itself to reduce fall risk, according to the science. And even I was surprised by the way, is exercise. And we're going to talk specifically about what types of exercise, because the research tells us that too. Here's the the bigger thing. Even exercise combined with other solutions is not as effective as exercise by itself. So how do we make sense of that? Because that kind of seems like a contradiction. Why would exercise plus other interventions that should be effective? Why is the two of those things or multiple of those things not as good as exercise by itself. And I'm going to talk about that a little bit further later on. And I'll, I'll bring it more real life to you. As to my theory why the science doesn't necessarily say, uh, say why, but I have my own thoughts. And so I'll share that with you. I'll make that very real, uh, for you, uh, and apply it to real life. So here is the evidence for, again, major systematic reviews and meta analyses that tell us consistently that exercise is the most effective intervention for reducing falls. Again, all of these are systematic reviews, meta analyses of randomised controlled trials. So it's not, you know, uh, you know, prospective studies or looking at, you know, populations of people and looking at patterns. It's having an intervention group and a control group and randomizing them and then seeing what the outcome is. And all of these studies are from randomized controlled trials, meta analyses of randomised controlled trials. So very high levels of evidence, very high quality studies. Uh, and so it comes from very reliable sources. Now some of the details with the statistics can get quite complicated. But the pattern is consistent across the board. That exercise is the number one solution according to all these studies. So what type of exercise consistently across all these studies is it the best exercise is a combination of leg strengthening and balance training. Preferably functional leg strengthening. Functional leg strengthening is thing uh, leg strengthening that has to deal with real life application. So standing up from a chair, squats, deadlifts, lunges, uh, climbing stairs, step ups, things like that. Things that are most applicable to daily life. So functional leg strengthening along with balanced balance training together. Not like strengthening by itself, but the combination of like strengthening and balance training. So when we look at like strengthened by itself, the evidence doesn't support it. Now what about powertrain? I mean, that's what I did. My undergraduate thesis on powertrain in and of itself does not reduce falls because there is not any evidence to support it. Core strengthening, Pilates training, things like that. And I'm a big fan of Pilates. I used to teach a Pilates water class, by the way, when I was working in the fitness world. But core strengthening in Pilates does not reduce fall risk in and of itself. And looking at yoga, there weren't any major studies to even look at, to know whether that would be effective at all. So there is not any evidence for yoga as well. What about other types of exercise intervention? So for healthy adults, for healthy older adults, dancing has been shown. According to a meta analysis published in twenty twenty, to reduce fall risk, and according to a couple major studies, tai chi and there are several different types of tai chi, and some are more effective than others. I'm not going to get into the weeds on that, but tai chi can be very effective, and that's effective for all populations of people who are more medically complex, higher risk, lower level people. Higher level tai chi is effective across the board. So there are a number of different types of interventions to choose from as far as exercise. So, you know, pick your poison. Uh, what do you, uh what do you like to do? What do you enjoy? Uh, there's there's a number of different options here. So the big takeaway, option one, strength training, uh, combined with balance training, tai chi and dancing if you're a healthy or older adult as well. So these are very effective interventions to reduce fall risk according to the science. So what about these other, uh, solutions? And these are very common, um, in the healthcare and medical world. Um, so risk assessment that was looked at medication management, walkers and canes, home modification. Those are very, very common solutions that especially healthcare providers will go to. Um, and oftentimes these things were combined with exercise. And of course, finding out the reason why someone is falling is a good idea. Of course, that can depend on the skill of the person doing the assessing and trying to figure out the why. Right. Um, and the big thing with this is why exercise along with these other things, why is that not as good as exercise in and of itself? And my explanation for that is because when you start including these other things and probably what this is what happened in in the research, when the exercise is the main thing, when you start incorporating these other things, you start taking away the time, the attention, the resources away from the main thing. And I think that's what's happening in the research. When we start in throwing in these other things, it starts diluting the main thing, which is the exercise. So medication and I'll give you an example here in a little bit medication management. Um this is oftentimes the first line solution according to the research does not support medication management as a primary intervention. Of course medication management is a good idea. And polypharmacy and the number of medications on the person's list, uh, are risk factors for falls. And of course, reviewing your medications with your doctor is always a good idea. The main thing is to make the exercise the main thing and don't view just. I checked the balance and faults list because I've reviewed my medications with my doctor. Absolutely do that, but don't stop there. Gotta throw in the exercise. And of course, if you have a specific medication that you're worried about, address that problem. If you think you're on too much blood pressure medication, you're getting lightheaded. Of course, address that. But the basic the main thing is make the main thing the main thing. Same with walkers and canes. What we're, you know, physical therapy school one hundred and one. If someone comes in, they're at risk for falls. Give them a cane or a walker, uh, to reduce their fall risk. The main takeaway here is don't stop there. Make sure that they get the intervention that they really need, which is the exercise. Yes. Make sure that they're optimized with their cane and walker. But don't stop there. Make sure that they're getting going with the type of exercise intervention that they need. Same with home modifications. Now of course people who are lower level have been shown to benefit the most from from home modifications. Um, and of course, if the home environment is the biggest problem, um, it's supported that of course, modifying that person's home is going to be more effective. But again, don't stop at home modification as an intervention. Make sure you get that person to the exercise intervention that they need as well. Does all this makes sense. Everybody type in the chat. Let me know. I get some head nods here. Is everybody understanding this? What questions do you have typing in the chat? Let me know. Is anything not making sense? I think anything specific, uh, Helen, that we can that can help you with. Let me know. Uh, I know this a lot of information. Type into the chat. Let me know if there's anything that is not clear. I want to make sure this is clear for everybody. We want to make this as clear and concise as possible from a lot of a lot of research that's been put together. All right. So I have a theory as to. I have a theory as to why exercise is so effective. If you look at this list of risk factors exercise. And again I'm going very conservative here. Exercise addresses at least sixty percent of these risk factors. So the one thing addresses sixty percent. And frailty I'll highlight very specifically is a big risk factor. And that's something that we can we're going to talk about in future presentations. Um and exercise of course dramatically helps with frailty. Frailty by definition in the research by the way has three main questions basically. Can you stand up and down from the chair five times without using your hands? Have you lost more than five percent of your weight in the past year. And do you have good energy or do you have bad energy? Those three things consistently and predictably determines whether someone over the age of seventy is frail. And then if they answered, uh, to the negative on two of those things, then they are frail and then that increases their risk for falls dramatically. And that's very well supported in the research. And of course exercise helps with that. And I'll say I could make an argument for one hundred percent of these risk factors. That exercise helps with all of these. So we know from uh, the smoking cessation, uh, research that exercise helps to reduce smoking. It helps to reduce alcohol and other bad habits that people have. Um, if the person's living alone, of course, if they go out and exercise amongst group and, uh, you know, group exercise classes and things like that, it's going to improve their socialization. So and of course older age we tend to actually act younger as we're exercising especially I'd say with strength training and balance training. And a lot of our clients will act and feel younger as they're getting going with that type of intervention. So even feeling older can make a big difference, or exercise can make a big difference with feeling older as well. So I could make a great argument for one hundred percent of the risk factors being solved by exercise as a solution. But I was conservative. I'll say sixty percent just to be very conservative here. The worst interventions that we find that people do, of course, is nothing worse than nothing. Bed rest and bed rest is a very, very common thing that people go to, and especially with the older generation right now, the silent generation, they were brought up in the era where bed rest and the doctor were the solution. And even if they logically know now and a lot of them do, um, they very logically know now that bed rest is not the solution, that rest is not the solution. But even then, it put in that stressful situation. We tend to find that people go to rest and bed rest a lot, or to do nothing, or to just wait or hoping it will get better. And we see that a lot as well. And another bad intervention is acceptance. Apathy. I had a mentor that told me one time in inpatient rehab, there are some things that are worse than death. And we want to make sure that we are empowering people to live the rest of their life on their terms. And the way we do that is by helping them be more active and independent and reducing their fall risk, reduce hospitalizations and reduce the risk of getting injured and physical and emotional trauma that go along with that. So this is very, very important. And to avoid some of these things. So big red flags that we tend to see are uh, we'll often hear from people, usually the person suffering themselves. Well, I don't plan on falling. And of course people can't plan on not falling other than what the person does months or years in advance. You can plan on not falling by taking action now so that you don't fall later. From healthcare providers, we'll we'll often, uh, tell people, don't fall, don't fall, don't fall. This is a big problem because it increases fall risk. And we hear this from our clients a lot as well, you know, why are you afraid of falling? Sometimes there's nothing wrong with them. Like. Well, because my doctors told me not to fall. My children told me not to fall. And I see my friends falling. And so the fear of falling starts to develop. Fear of falling alone is a risk factor for falls. And when people have a fear of falling, they start moving differently and they start living life differently. And then fear falling in and of itself increases fall risk. And so if we're if they're being told by people all the time to don't fall, don't fall, then that fear of falling increases and then their fall risk increases. So instead of telling them don't fall. Better to get them on the path towards an intervention. Find them, help them find a solution. And of course, now you're finding out today what the science says. Get them on an exercise program. Have the exercise be the main thing. Of course, review their medication list and, you know, do all those other things, but have the exercise intervention be the main solution. Because now that's what the evidence tells us. Uh, healthcare providers will often tell people, well, drink more water. And uh, which is great advice and absolutely do that. Uh, dehydration is a big problem with the older population. And malnutrition, of course, is one of the risk factors on that list. But basically don't stop there. Make sure that as well as promoting hydration, we're also promoting the exercise intervention that goes along with that as well. Got a question in the chat. Do do do we help people use walkers. Yeah. So what you'll often find that physical therapists do is they help people use canes and walkers and make sure that those devices are fitted to that person appropriately. And that's a big part of it. There's there's research as well that shows that a cane or a walker that is not used properly or does or is not fitted properly, actually puts the person at higher risk for falls. Um, if they're not used or fitted properly. And uh, there's, there's also research showing how very, very few percentage of people are actually provided, uh, an assistive device such as a cane or a walker, appropriately and fitted appropriately. So that's some that needs to be improved. Um, in the healthcare world. So any other questions? Type in the chat. Let me know. So back to these three common beliefs. Uh, from what the evidence tells us, of course balance and falls does not just come with age. This is a problem with many, uh, different risk factors. Uh, many problems. And at least one clear solution exists according to the science. Uh, according to very high quality evidence. So getting stronger core strength, all these other things not as effective for reducing fall risk as people may think. It's a combination of the leg strength thing along with the balance training. And that's what the science tells us. And so and the most common thing we tend to hear is the lack of action, the desire to just wait, to rest and assume it will all go away, or acceptance. And we find that this intervention is what kills people more than anything. It's the lack of action. And so we want to get people out of that situation and raise awareness as much as possible. Um, and what we've seen from the evidence is massive action is required, uh, in the form of exercise, because that's the greatest intervention. And we have all the evidence, uh, to, to back that up as well. So if you're an individual person, of course, finding the why you're falling is also very important. Um, and we want to get going on the, the exercise intervention as well. So we talked about how do we make sense of exercise plus multiple interventions and how the multiple interventions dilutes, um, the exercise and to make the main thing the main thing. And so the example I'll give on that is and we see this with our clients a lot. And you can think of we can think of ourselves as well. So if the person himself has a doctor's appointment, or you're looking after someone who has a doctor's appointment or or some other appointment that's come up oftentimes through group exercise class, the physical therapy session, the session with the personal trainer, those sorts of things tend to be rescheduled and moved to the side so that the doctor's appointment can be put in place. As an example, it could be anything really. It doesn't have to be a doctor's appointment. Now we can think of this as younger people as well. And when we're when our twenties, thirties and forties. What happens when something else comes up? The business meeting. Uh, the happy hour that whatever it is in our life, how often do we schedule the exercise away and put those other things in place? So it's a it's an example of how these other interventions and these other things that are done can very quickly dilute the, the exercise intervention. and we might think, oh, it's just one appointment. You know, it's not a big deal. And what we tend to find with a lot of our clients is it's a pattern of behavior that tends to develop. And when there's another appointment, the exercise is quickly rescheduled. It's like, okay, well, that's always there. We can always do that next week. And oh yeah, we'll return to that next week. And very quickly, a lot of these a lot of the exercise can be moved off the person's schedule and these other things put into place. So this is a very real life example of how multiple things done can dilute the main thing. And the main thing according to the research, is the exercise, the strength training along with the balance training. Does all that make sense to everybody? Type in the chat, let me know. So another quick story. So on my journey as a vestibular specialist. So the vestibular system that is our main balance system. So vestibular specialist is someone who basically treats dizziness and vertigo uh disorders. So I got started on that. My my mentor was doing a presentation, uh, to our physical therapy class. And of course, I'd done my undergraduate thesis on training for leg power to to reduce falls. And I dedicated my fitness career to reducing falls amongst, uh, the older population and people who are having physical limitations. And I saw within this vestibular specialty as this is the missing link to how to find out why people are falling. And I dedicated my physical therapy career to becoming a vestibular special, uh, vestibular specialist. And, uh, making, of course, the practice a vestibular specialty as well as a balance in neurological specialty as well. And the two together tend to go very well. Um, I cannot imagine addressing balance and falls without looking at the vestibular system as one of the main interventions. Um, so as vestibular specialist, that's one of the main things that we do. So I ended up working with my mentor for a year out of physical therapy school, um, as well as working with her through my, uh, my second clinical. So I've been, uh, working, building up as of the severe specialist and became of the severe specialist and started on that journey even before I got my physical therapy license. So because this is such an important specialty, uh, and a very important and great tool to help, uh, and address, balance and follow problems. So how do we balance? And let me know if you've heard this before or is this is new information, but I have to go over it. So of course we balance with our vestibular system. So our vestibular system is our main system basically from the brain on down. It's not an inner ear balance system like most people think. And this is one of the challenges in healthcare. Uh, oftentimes people are referred to the ear nose and throat doctor when they have a dizziness or vertigo or, um, balance problem. And the problem is that one part of the inner ear balance is just one part of a very large neurological system that goes all throughout the brain down the spinal cord. And it's a very large network all throughout our central nervous system. So it's not as simple as the inner ear system. In fact, this neurological system connects very directly with our eyes because as we're moving and walking and moving our head, we have to make sense of the world around us in order to balance. So our our vestibular system is very directly connected with our eyes. In fact, the eyes are pretty much a part of the vestibular system as well. And there is proprioception. So big fancy word for our joints telling our brain about where they are in space. So we have a little receptors in our joints, uh, and all of our joints that basically tell our brain, hey, this is where we are. And so these three things are very essential, uh, for balance. And these are the three ways in which we balance. And so you can imagine if you are crossing a busy street, looking for cars, moving your head side to side and stepping over a pothole and stepping up on the curb while having a conversation with someone else, while walking a straight line and making sense of all this stimulation coming around you. And to be able to make sense of the world around you, all while walking a straight line, not being dizzy and for your body to take in all this. So it's a very wonderful system until a wrench gets thrown into it, or if it becomes weak. And that's when things go awry. And that's what we work on as vestibular specialists. So again, our vestibular system connects with very directly with our eyes and the movement of our eyes and goes all throughout the brain. In fact, there is more and more research coming out, uh, ongoing, uh, how extensive the vestibular system connects into, um, all different parts of the brain. And we're, we're learning more and more and it becomes a much larger, intricate network. So if there's damage to any part of the brain, there's a potential that the vestibular system been affected. So the way that we develop our vestibular system, this is very important because we start as children and like many parts of development, we start in the form of play. We we roll down hills. We ask our parents to spin us. We go on amusement park rides that make us dizzy and we enjoy it. And so in the foreign play, we develop our vestibular system to become functioning adults. So as we become adults, of course, we're running around, we're raising children, we're working. And, you know, we have to be very active. We have to make sense of this world around us, and to be able to just go quickly and look for cars and, um, and to be able to go on uneven surfaces and to be able to play with children and do all this stuff as highly functioning adults. Now, as we get older, into our seventies and 80s, life tends to slow down for one reason or another. We're not rushing around as much as we used to. Um, and, you know, we may not have as much energy as we used to have. And so life tends to become a little bit slower. And so we tend to spend more of our time sitting, resting, maybe reading, enjoying, just having conversations with with friends and family, uh, sitting down. And so life slows down. So we move less. So the key to stimulating the vestibular system is head movement. And I'll tell you a quick story about this. When, uh, we had our, our first child, our daughter, she was a few months old, and I was, you know, in my early to mid thirties. And I was swinging with her on the swing very gently. And it was the first time I'd done this and I got very sick and nauseous. And here I am, only in my thirties. Already by that point, my vestibular system had declined because I had not been on a swing, probably in fifteen to twenty years. So by the time in my thirties, my vestibular system had already declined and gotten weaker. And you know this from, uh, growing up, when you wanted your parent to go on some of the spinning rides with you and they're thirty five, forty years old and they're saying, oh, no, that's just going to make me sick. I can't handle it. So we see a lot of these things in our daily life. So what happens if so, if that type of decline happens to someone by the time they're in their thirties, what happens to people by the time they're in their seventies and eighties? And the value of this is this means that there's a lot that can be done. And that's the exciting part about this. And so what can be done. And what's the intervention. It's amazing what happens when we get people moving their head again. And sometimes what we'll find is when we start working with older people, not only do they stop rushing around and life slows down, but they don't move their head as much anymore. And you'll see this if you look at some of your older friends or parents or whoever it might be when they walk, they turn to move their head along with their body, but they don't move their head by itself. They don't just kind of whip their head side to side like they used to when they were younger, say, when they're looking for cars or when they're changing direction, just kind of like scanning the world around them. So oftentimes people will move their head less, and that's the downward spiral that will tend to see all make sense. And you can start imagining these things. Think about your children. Think about yourself. Think about your own experiences in your daily life. So head movement. Head movement head movement. So what's balance training. We talked about balance training. So for us. What we. Our main intervention, of course, is finding out why the person has a balance problem and finding out specifically why is it a proprioception problem? Is it a vestibular weakness problem? Uh, are there some musculoskeletal things that are going on that causes the balance problem? And that's very, very important is to find out why for that individual person. And of course as vestibular specialists, the of course the vestibular system must be addressed. And even if there's not a problem with the vestibular system in and of itself, by making the vestibular system stronger, it's amazing the things that can be made a lot better by making that vestibular system stronger than it helps take away a lot of the other problems that the person has. By making that main central balance system strong and optimized and functioning a lot better. And that is very easily done with the right specialist, with the right intervention. And that's the exciting part about being a vestibular specialist and then taking that to people suffering with balance and falls. Here's a big thing. This is tactical balance. Don't view balance as how long it can stand on one leg. And I mentioned this because oftentimes that's the type of intervention that people get when they go to say generalized balance training. And so a lot of time and effort can be spent on having people who are, you know, seventy five to ninety five years old stand on one leg. And the problem with that is it's a very one dimensional way of looking at balance. And it's it's oftentimes very, very difficult for our older population to do so. A lot of time and energy and effort is put towards that when much more impactful things can be done to improve that person's balance in a very meaningful way. So, so working on head movement, working on is there some type of specific weakness with their musculoskeletal system that's causing an issue, or is it appropriate reception problem. So we need to make the vestibular system a lot stronger. Is it. They're not responding to a loss of balance the way that they should be. So there's all these other interventions, uh, that should be looked at instead of just looking at can they stand on one leg or not? And there's not a big reason for someone who's eighty years old to stand on one leg for ten to 20s. It's just not as important as it once was in their life. A couple seconds, yes. You know, stepping over objects. And there's a reason to definitely be able to lift up, uh, and stand on one leg for a second or two, but not for ten to 20s. So we're much better optimizing our time, focusing on other things. So does all that make sense? Type it in the chat. Let me know. Let me know if you have any questions so far. And we're getting into the weeds a little bit on the balance part of it. But you know, this is this is what we love to do. This is our specialty. So we want to give you guys a lot of valuable information. So what do vestibular specialists do? You may wonder? Basically we simply put we treat dizziness and vertigo problems. And so vertigo is when your crystals get loose in your inner ear balance system and give you a sense of rotational spinning. To put it very, very simply and quickly. And we're going to be doing another virtual event about business and vestibular disorders coming up. So, um, we can give you more information about that so that you can opt in to it as well. So you won't want to miss that. So an entire presentation on dizziness and vertigo disorders and, um, what we do as vestibular specialists to help people if they're suffering with those problems. And of course, we help to make the vestibular system more optimized so it connects better. So it just works better. Desensitise, uh, dizziness symptoms and strengthen the balance system as well. Strengthen the vestibular system so that people can be more safe in their homes and be more independent and not suffer with these types of problems. So I'm talking about furniture walking real quick, and I like to say that furniture walking is the new smoking. Now does everybody know what I'm talking about when I say furniture walking? Type in the chat. Let me know if you have any. If you're if you don't know what this is. So basically it's when older people, as they walk around they might be touching furniture, they might be touching walls. They basically use their hands all the time to get around, and it can get to the point when they don't have something to touch on to. They can become very anxious, very fearful. And you might be thinking, okay, yeah, it's like everything is the new smoking, right? So I like to say furniture walking is the new smoking. And and you might say everything has become the new smoking. Sitting has become the new smoking. So hear me out real quick. I want to tell you why I think furniture walking is the new smoking furniture. Walking is a terrible habit that is difficult to stop. Just like smoking furniture, walking creates a dependence and feeling of reassurance. Feeling of reassurance. Just like smoking and furniture, walking makes people feel good and helps calm them down. Just like smoking and furniture walking prevents people from addressing their real problems. Just like smoking and if not smoking, you can think of alcohol, drugs, throwing whatever habit you want. Furniture walking does very, very similar thing. So that's why I call furniture walking the new smoking. And it creates a fear of falling amongst people. It creates a dependence on people's hands to help them balance rather than using their legs for balance. It prevents people from relying on that sense that proprioception, the sense of the information going up to the brain for their legs to say, hey, here's where we are. People start shutting that down. The the brain starts, um, kind of ignoring those signals as they furniture walk more and more. It makes people move abnormally and to the point where people stop stepping when they lose their balance. So I lose my balance every single day. The difference is my body just takes a step or two and moves on with life, and I probably don't even recognize it. When people are furniture walking, they stop relying on that stepping response that's so essential to prevent them from falling. And that's how you get the older person falling backwards and just landing on their head. I call it timber, and so you don't want to be in that situation. So furniture walking promotes that type of a problem. And it increases the. Use of our vision to help us balance. So as we get older and as our balance system gets worse, we don't want to use our vision more and more. We want to use our vestibular system and our proprioception more. So we're feeding into the wrong, the wrong problem. We're going to a downward spiral where we're using compensations rather than things that we should be using. So it decreases the strength of the vestibular system, and it mutes the information from our legs coming up to our brain. That's so essential to help us balance. So that's why furniture walking is such a problem. So what do we do instead of furniture walking? Of course. Find out why the person's at risk for falls. Of course we can give them a cane or a walker. And oftentimes that's very important. But find out if the person needs a cane or a walker so you can get what can you do? Get evaluated by a physical therapist that's a specialist in this. And make sure that you need a walker a cane if you think you do. Do you need one? Make sure that it fits properly. And so that way you have a device. Get off the counter or the walker. Ideally by the by the exercise, by the intervention, by a specialized physical therapist or a specialist in balance disorders that can empower you to get off the cane or the walker. But in the meantime, use a cane or a walker if you need to, find out if you need to, and start from there. And then by the exercise, we can remove the dependence on the cane or the walker. And then you can physically and psychologically, emotionally get better and better and better. So the exercise intervention, balance training and leg strengthening or tai chi and for a healthier older adults dance. Another important thing here is after people go out to the hospital, one of the big problems in the health care system is there's oftentimes a delay in the intervention. Someone goes out to a hospital for a fall or a medical problem, and then they get back home. What needs to be happening is very, very quick intervention. And we see this with our clients and from people that we work with when we intervene very early, then we can prevent the decline. Once someone has gone up to the hospital. Because think about people. When they go into the hospital, they lie on their back. And so their balance system and their muscles get very, very weak and they can decline very, very fast. This can happen even with twenty year olds. You put them on bed rest and they will decline very, very fast. In older people that problem is amplified. So we want to intervene as quickly as possible. Now if we work on the exercise and balance training, we can build up resilience to the hospital. So if you become strong and your balance is very, very good, you basically climb a very high mountain. And so when you begin to fall down that mountain. You have a much farther mountain to fall down to. To fall down from. Whereas if you're on a very tiny hill as far as your physical abilities, there's not much more to fall down from. So by utilizing exercise and balance training and becoming as good as possible, we can make that mountain a bit very high. So we have something much farther to fall down from. So it builds resilience. In other words, when we're physically better than we would be otherwise. So training in advance for things like that happening to us, if we get the flu, if we get Covid, we end up in the hospital, something happens. Um, and then we have more resilience to be able to survive it and then build to thrive afterwards. And then a very fast intervention afterwards. Um, once you've gotten out of the hospital. These are very, very important things and not commonly done enough in our healthcare system falls very similar thing. Early intervention is best and we don't see this enough. Once someone falls, if they're not, even if they're not injured, of course, if they're injured, then a faster intervention is needed. Even if they're not injured. And I'll even say that even if they don't consciously have a fear of falling after a fall, their body will begin to move differently, and their body will will subconsciously have a fear of falling. And so early intervention is very, very important. Once someone has had a fall to prevent this downward spiral of continued falls. And we can train in advance in the event that someone does fall, if they have if they've been up to that very high mountain, they have much farther to drop down from. So all this is very, very important to act urgently. Now, if you've had a fall, uh, of course you should talk to your doctor. That's always good advice. Uh, if you've experienced a fall, talk to your doctor. You know, and absolutely do. Look at the medications. Make sure that that is optimized, especially if you're on pain medication or psychiatric medication. Make sure that those things are optimized, especially bone density. Um, it's not just, uh, fear, worry that the bone breaks. There is a direct connection physiologically between our vestibular system and our bone density system. And so optimizing the bone density system can actually help with our vestibular system as well. Uh, make sure that there's not a medical reason why you are falling as well. And that's another reason to see your doctor. Addressing frailty. Again, frailty is a big risk factor for falls. And the doctor has a lot of tools in their toolbox to be able to help with that, whether it's, you know, vitamin B12, vitamin B12 injections or checking you for anemia, um, or giving you the right resources so you can get on the exercise path, uh, to build, to address frailty, um, nutrition interventions, things like that. So you can start with your doctor as a solution for these types of problems. And of course, your doctor can give you resources that you need based on why you fell and whether you've had an injury or to be able to guide you from there. And so utilize your doctor on that. And my tip for you on this is when you before you go and see your doctor, of course, don't delay seeing your doctor, but the better the better that you can optimize your hydration, the better, because that's going to be one of the first things that they ask you is, are you drinking enough water? Are you hydrated? If you've optimized the hydration part, then your doctor can go into a deeper, more meaningful reasons why you fell or why you were lightheaded. They can look a little bit more deeply into, um, the cause. And if you've already optimized the hydration part. And because otherwise oftentimes the first thing that a health care provider will look at is the hydration. And so if you optimize that already, then you can, uh, solve that problem for them already and, um, help them help you if you will. So All this makes sense so far. Type in the chat. Any other questions? Anything that we've missed? All good. Okay. So basically what to do? Strengthen and strengthen your legs and balance. Training is the first line intervention. Absolutely. If you fall and talk to your doctor and see a physical therapist, preferably a vestibular specialist or a physical therapist that specializes in balance training or any other type of health care provider, that's a balanced specialist, occupational therapist or chiropractor, whoever it might be. There's all sorts of different, uh, different, um, licensed health care providers that work with balance problems that can be specialists in this area. So basically see the right specialist and take action. Now that's the number one thing, uh, is to take action. So balance training along with the strengthening that's the best intervention. And now we have all the science to back that up. So the big takeaway from all of this is movement is the medicine. And this is the right exercise done over time consistently is the best intervention for this. And individualized solutions based on your individual situation is the best way to go. So it's not what we thought the first line treatment of preventing falls. Not as much the medication intervention that we may have thought, or the hydration or just giving someone a cane or a walker. It's the exercise, the leg strengthening along with the balance training. I keep repeating that so it drills into into people's heads, the the leg strengthening along with the balance training. That's what the science says is the best intervention. And of course do all these other things as well. But don't let those other things dilute from the main thing, which is the exercise.