Balancing Act: Fall Prevention for
Older Adults with Vision Impairments
Seminars@Hadley
Balancing Act:
Fall Prevention for Older Adults
With Vision Impairments
Presented by
Ann Cowles
Moderated by
Ed Haines
March 14, 2016
Ed
Let me officially welcome you all to Seminars@Hadley. My name is Ed Haines and I’m an Instructor at the Hadley Institute for theBlind and Visually Impaired. Today’s seminar is titled Balancing Act: Fall Prevention for Older Adults with Vision Impairments. Fall prevention is a critical concern for older adults and their families and caregivers and when vision loss occurs falling risks often increase,unless individuals adopt specific strategies to maintain safety and independence.
Please join me in welcoming today’s presenter, Ann Cowles. Ms. Cowles is the Fitness Director with the New England College of Osteopathic Medicine’sU-ExCEL. That stands for Exercise and Conditioning for Easier Living Program and has worked to develop a comprehensive fall prevention training that’s not only directed at the general population, but is designed to be accessible to those with low vision so without further ado, I’m going to turn the microphone over to Ann.
Ann
Thank you, Ed. First of all, I hope everybody can hear me and welcome to this webinar. I’m really excited to be here. I have to tell you though. This is the first time I’ve done a webinar on this topic. Usually I have a crowd and I make you get up and exercise and do our program, so I think this might be your lucky day. Like Ed mentioned, I am the Fitness Director for a program called U-ExCEL and again, he mentioned U-ExCEL stands for Exercise and Conditioning for Easier Living, and I’m very fortunate to be able to work for the University of New England.
Being a part of a university, especially one that’s interested in research, we’re really given a lot of opportunities to utilize our program in ways that if we were just on our own, we wouldn’t have accessibility to them so I’m very grateful for UNE for having this program be under their umbrella. U-ExCEL itself and our program is considered an auxiliary program, in that all of the funding and the resources and all of our staff, we’re all under the same hood, where we don’t actually get funding from the university specifically.
We make it all on our own so I go out to a variety of different communities, typically centered around older adults, whether it’s a life care retirement community offering a variety of services through independent living, assisted living and nursing home level care or maybe just a strict assisted living home. I even go to a church once a week and do an exercise class with those community members. Our program mission is simple and our mission is simply to improve the health and well-being of older adults through fitness and wellness programming.
To take it further, we also adopt a philosophy that anyone willing to exercise can. We always use the examples of we have people that are wheelchair dependent or even sometimes dependent in their beds and they can’t get up, but as long as you’re willing to put in some effort, exercise is something that we can offer you and in a goal to improve the quality of your life, so I think it’s always easier when talking with new people to understand a little bit about what we’re doing so you know where I’m coming from when I’m discussing where I cameup with different conclusions, so I just wanted to give you a little bit of background on what I’m doing specifically which is really just to open it up a little bit more from there.
I go to these different communities and provide a bunch of different services. Some communities we focus strictly on exercise, providing group programs, individual programs, doing consultations on what different health modifications individuals can make to improve their quality of life. We go to different assisted living homes and give presentations on health-related topics. We do presentations, both statewide and in Maine, so Maine tends to be where a lot of our presentations and trainings are held, but I have started reaching out to different communities and different states as we’ve progressed in the field over the past few years.
Our programs are always either exercise-based or education-centered. We tend to now focus on balance and falls because as you well know, falls are one of the biggest threats to an older adult’s quality of life, so naturally we focus on balance improvement, trying to use it as a falls prevention strategy. Our definition of fall, I think that’s always a nice thing to talk about in the beginning because for a lot of people it can mean different things. I know when I’m working with older adults, they don’t classify a fall, unless they get hurt so they might not feel the need to tell their physician that they fell, unless it was obvious that they fell.
The definition that we use is coming to rest inadvertently on the ground or at a lower level. The reason that we had to add the word inadvertently in there is because my boss works a lot with a nursing home here that is all run by nuns, and naturally there’s a very spiritual-centered community there and they had to change the way that they were reporting falls because people would go down to pray at the end of – before they were going to bed, and they couldn’t get back up off of the side of the bed so the nurse would go in to help them, and they would be on the ground and because they didn’t see them willingly go to the ground, they had to classify it as a fall so we added the word inadvertently there because clearly, these individuals were purposely going to kneel on the side of their bed, so we found it really important to make sure that everyone understood that it’s an inadvertent act that gets you landed at a lower level.
Falls can be associated with a lot of different things, decline in your ability to move around, needing to be placed in a nursing home or a hospital stay, increased use of medical services and the fear of falling. I’d like to talk about the fear of falling with individuals one on one to talk about if that is something that is limiting their mobility, limiting their trust in themselves, and a lot of times fear falling increases your risk of falling because you change the way that you’re living your life which is putting you more at risk.
Balance training specifically, there’s a lot of different benefits to it. Thinking muscular and physical health-wise, balance training can increase your joint stability, increase your muscle strength and increase your flexibility. It increases your functional fitness performance, and I’ll talk about functional fitness in a second. Doing balance training also stimulates your brain so you’re really thinking more specific for your balance which stimulates your brain to function a little bit more appropriately than it was before.
It also helps reduce the seriousness of your injuries if a fall were to occur, so we found that those that were practicing balance-specific exercises did reduce the seriousness of an injury if they did have a fall so balance exercises to reduce your risks for falling can really be strength-based, coordination-based, dynamic-based and static-based, and what I mean by strength-based, that’s really what most people think about when they exercise or when they’re thinking about exercise, counting to repetitions, focusing on a muscle group, squeezing, contracting.
That’s what people are thinking about with strength-based. Maybe it’s bringing your leg out to the side. Maybe it’s doing a squat. Any of those exercises are considered strength-based exercises, and they do have an improvement with your balance because the muscles that you’re targeting are stronger and able to hold you upright for a longer, safer amount of time.
Coordination-based exercises, our definition of that is any exercise that’s involving some type of coordination andmovement so it might be walking slowly, lifting your knees high up, doing a march, moving location, walking heel to toe down a hallway. Any of those movement-based changing location exercises would be considered coordination.
Dynamic-based, our definition there is that it’s movement-based, standing in the same location but there’s some movement component. It may be movement with your upper extremity or your lower extremity but anytime there’s movement-based, we’re considering a dynamic-based exercise, and in the final exercise group for balance exercises is static-based exercises. Static is when you’re holding a position. No movement is associated with it, and you’re holding it for time more than anything else. In our program we use all static-based exercises.
Before I jump right into Balancing Act and what the program is and the exercises, I think it’s important to see where we came from, and why we developed Balancing Act the way that we did. When I first came to the University of New England back in 2010, there were ten pieces of paper put together that had some exercises on them, but there wasn’t really a lot of structure to it but there was a really great foundation for what our program became and what it is now.
In 2010 when I came to UNE, they had tested the exercises with a group of older adults in one of our retirement communities that we go to. That pilot study is what turned into our Balancing Act program now. From that study I was able to put together the exercises in a way that really gave them more flow and creativity, and it allowed for those initial participants to really have a hands-on say in what the best way and methodology to continue our program was.
In 2012 we were awarded the Maine Governor’s Council on Physical Activity Special Populations Award, and that was a really big deal for us because at that time, we had nothing besides that original pilot study that wasn’t anything – it was eleven participants and they’d had the program for eight weeks and that was all we had, but we had put so much time andeffort in the program that by 2012 when we received this award, we were already on our second addition of our published manual.
In 2013 we were finally awarded our first grant. We were awarded a grant from the National Institute of Health and this grant was really the kick start to what our program is today. I’ll talk more about that in a second. In 2015, this past summer, we actually for the first time tested our Balancing Act program in a small group class setting with a lay leader model. What we mean by a lay leader model is that we had a nonprofessional lead the group class to a group of her peers, so actually, what it looked like was we went to a community. It wasn’t an assisted living. It was an all independent living community, and this one woman took control and she took her group of her peers. There were eight participants and they went through the exercises together so that’s what we mean by lay leader model, so back to my National Institute of Health, that research grant.
We tested Balancing Act on older adults with vision impairment, and this is the first time that vision impairment really came in the forefront of where we were taking Balancing Act itself so our program, U-ExCEL, partnered with the University of Maine Orono Center on Aging and the Iris Network in Portland, Maine. The Iris Network is a group that works with visual impairment and blindness through a wide spectrum of ages and abilities, so they were the ones that approached us looking for an opportunity to do research on a fall prevention program specific for vision impairment, so it was really because of them that the grant was even put together.
The Iris Network was responsible for providing the participants in the study. They were all past clients of them. The University of Maine Orono was really responsible for the behind the scenes on the data analysis, making sure all of our T’s were crossed and I’s were dotted for the grant aspect and my program, U-ExCEL, we were responsible for, a) providing the program, providing the training and expertise on working with older adults and then being a resource for the Iris Network staff that were going out in the field and testing the Balancing Act study itself.
The criteria for the participants were that their vision had to be 20/70 or worse in their best corrected eye. They had to be older than 62. They had to be able to follow directions which this is my favorite test ever. We asked them to fold a piece of paper in half and if they could, they could follow directions, and they had to be able to walk the aisle of a grocery store. We picked that as our limit for distance because really you don’t need to walk in our program, but we needed to make sure that there was some ambulation possible. It didn’t matter if they were using a cane, a walker or the grocery cart. As long as you could move that far, you were eligible for the study.
What was really nice with this research is that we were able to involve over 100 people in the State of Maine with our Balancing Act program, whether it was just a small initial meeting or it was long-term, they made it through the six month study or they were part of our initial pilot feedback, where we went out into the field and we tested our manual to make sure that the wording was appropriate, that our instructions were clear, that the format of the manual was appropriate for working with vision impairment and things like that, so even just before we started the program, we made huge changes to the manual’s formatting.
We took out a lot of wording, unnecessary words and we also decided, based on the Iris Network’s recommendation, to take out the pictures that we had describing each exercise. Now since then, we have added the pictures back in and in my own opinion, the pictures add a huge sense of clarity to the instructions. We also as a result of this research study, developed a large print, a bridged version of our manual. We now have an audio version so those with vision impairment that no longer can read have a way of listening to the exercises. We even made a braille copy so this research grant was really great for us and just branching out the options that we have on working with adults with vision impairment.
We focus our program, Balancing Act, on older adults simply because that’s where our focus is but like I mentioned, Balancing Act can be adapted to any population and any group. Anybody that wants to improve their balance, this program is right for them. We put it together – the reason that Balancing Act is designed the way that it is is because we see a need in our world and in the exercise world for a program to be accessible for everyone. You don’t need to travel someplace once a week to do your exercise class, or maybe it’s you needing a personal trainer or a physical therapist to lead the sessions. We really wanted it to be accessible for all ages, for all abilities and for all groups.
We wanted it to be able to be something that you can do at home, throughout your day, not all continuous at one time and try not to discriminate against anyone who was interested in trying the program. In our full version of our manual, we have information for healthcare providers, for different agencies and organizations and then for groups or individuals looking to participate in the program itself. We worked very hard at making this an accessible program, so I’m going to move into talking about Balancing Act itself. I want to, before I move on though, give anybody the opportunity to ask a question before I move on so I’m going to log out.
There, that was my obligated five seconds to give you a chance, so we can always come back to this if you have questions afterwards so like I mentioned, Balancing Act is all standing, stability, static exercises so if we break down those words, the standing. They’re all standing exercises. Stability, focusing on that standing stable. There’s no movement component to it and then that static. That’s that there’s no movement component to the exercise itself.
We decided to do static stability versus a movement-based dynamic exercise because in the exercise science world, it is harder to do a static exercise than it is to do a dynamic exercise. However improving your static stability improves your dynamic abilities, so we focused on the static option so we could try to improve balance in both areas. Balancing Act is designed to be very progressive, meaning that you start off as easy as possible, and if you got all the way to the end, it’s very, very challenging so the ways that we did that were that we made different levels of exercises.
In our manual we have beginner, intermediate, advanced and action exercises and those are all the levels. Within each level, you can see the progression of making them easier to harder. I want to go through some key terms with our Balancing Act program before I go any further because I think I’ve already caught myself using a few of them already, so what I’m going to do is just go through a word and what our definition of that word is when thinking about Balancing Act, so the first word is balance and our definition of balance is even distribution of weight, enabling someone to remain upright and steady, so simply standing without needing to fall over, remaining upright.