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Balancing Act For Seniors

Published: July 18, 2016

Balance Act


Olfat Mohamed is an expert on balance among the senior population who knows that falls among Americans 65 and above are prevalent, dangerous and expensive.

“Each year, one out of three Americans 65 and over experiences falls; falling once doubles the chance of repeated falls,” said Mohamed, a member of the university since 1994. “Falls are the leading cause of accidental death over 65 and the leading cause of injury overall in older adults. The financial costs of fall injuries exceed $30 billion annually in the U.S.”

Mohamed, a teacher of geriatrics in CSULB’s Department of Physical Therapy, has had a passion for studying falls since her father had one. “He was an active man in his 80s but one fall drastically changed that,” she recalled. “My commitment is personal as well as professional.”

Our senses of balance do not exist in one system but are part of a complex network, Mohamed explained.

“Balance attaches to several systems,” she said. “People fall for many different reasons. You could have strong muscles yet still fall because the brain is inaccurately processing sensory information. The reasons can range from general health to muscles and bones, from the medications people take to the clutter they may live in at home. When we think of preventing falls and improving balance, we have to target all of these factors.”

Education plays a role in preventing falls but it is only one piece of a formula. “By itself, education is not enough to prevent falls but it serves as a motivation to address things that are risk factors,” she said. “For instance, in the Osher Lifelong Learning Institute (OLLI) sponsored by the College of Health and Human Services, we teach seniors about the importance of footwear and wearing the correct prescription glasses. We stress the importance of training when using assistive devices like canes. It took me a while to get used to mine after an injury. Education addresses the things we need to think about and the areas in which we need help.”

The balance program is multidisciplinary and was conducted along with Mohamed’s co-researchers—nursing’s Barbara White, psychology’s Young-Hee Cho and physical therapy’s Vennila Krishnan. The program is partly funded by a grant from SCAN.

Feet can fail any senior.

“Many of us wear socks around the house but they can be a risk for falls on smooth floors,” she said. “Flip-flops and high heels are not ideal for senior citizens. They need shoes that grip. Things like flip-flops and socks that seem safe can be dangerous.”

Exercise also plays a part in preventing falls. “Exercise for balance is a complex issue,” she said. “Aerobics are good but not enough for balance. Strength training is good but it is not enough for balance by itself. Any exercise program for balance must tackle all the systems that contribute to balance.”

Those systems include not only muscles and joints but the vestibular system that coordinates movement with balance. “Part of what we do in the OLLI program is to prepare participants to do two things at once in dual-task training,” she said. “They are taught how to perform a motor task like walking in tandem while, at the same time, making calculations or spelling words backwards. They do physical tasks at the same time they do mental tasks. This is how we function all day.”

Participant feedback has been positive, said Mohamed, who remembers one woman who suffered a fall at the beach in the dark and, since the accident, stopped going to the beach through fear of another fall.

“But after the class, that woman said she wasn’t scared anymore,” she said. “She returned to the beach and started going out at night again.

Olfat Mohamed
Olfat Mohamed

“Fear of falling is real,” she added. “When people fall, they are scared of falling again. People try to cut down on the level of their activity to avoid another fall. But that, in itself, makes them more prone to falling. When they don’t move, it actually makes them more vulnerable. They regain their confidence by participating in our project. It is so rewarding when you see someone who may be scared to stand on a piece of foam until they find out they can.”

Falling seniors is a global problem and is especially true for cultures used to working late in life and continuing to be active.

“If people sit in a chair all the time and do not move, it is true they may not fall as frequently. But they remain prone to falling,” said Mohamed. “We live in a time of unprecedented aging in the world population. Longevity is a wonderful thing but it comes with issues we need to address.”

Mohamed earned her bachelor’s and master’s degrees in physical therapy from Cairo University before acquiring her Ph.D. in physical therapy from USC in 1989.

Her interest in senior falls will continue, with the hope of preventing them.

“We are trying to find the secret recipe,” she said. “What is the best recipe for addressing falls? To this day, we are tweaking our program according to new scientific evidence so we can be more efficient and more successful in preventing falls. We know from our data that we are successful in preventing some falls because the number of falls experienced before the program decreased in some participants one year later. However, we still didn’t prevent all falls. We need to continue until we can.”