Exercise for Neurological and Neuromuscular Conditions: Ageing and Falls Risk

Comprehensive vocabulary flashcards covering fall definitions, epidemiology, personal and economic outcomes, risk factors, and sensorimotor, neural, and muscular changes associated with ageing and gait.

Fall (WHO Definition)

An event which results in a person coming to rest inadvertently on the ground or floor or other lower level.

Fall (Prevention of Falls Network Europe Definition)

An event in which the participant comes to rest on the ground, floor, or lower level.

Fall (Canadian Institute for Health Information Definition)

An unintentional change in position where the older adult ends up on the floor or ground.

Incidence of Falls (NSW Community Data)

The epidemiological rate showing that $25.6\%$ of community-dwelling people aged $> 65$ years ($775{,}000$ individuals) fell at least once in the preceding $12$ months, comprising $55\%$ females and $45\%$ males, with $65\%$ of incidents occurring in or around the home.

Incidence of Falls in Residential Care Facilities

The proportion of older adults living in residential care facilities who experience falls, documented at an incidence of $50\%$.

Personal Costs of Falls

Individual consequences of falling, including: two-thirds of falls resulting in injury ($10\text{--}15\%$ causing fractures), one-fifth requiring hospitalisation, $10\%$ requiring ongoing assistance from community care services, and secondary activity restriction with loss of confidence.

Economic Costs of Falls (NSW Data)

Healthcare expenditures related to fall injuries in NSW totaling $558.5\text{ million}$, with an average cost of $3{,}906$ per fall injury treated ($4{,}211$ for females vs. $3{,}366$ for males).

Demographic and Psychosocial Fall Risk Factors

Non-medical predictors that increase fall risk, including advanced age, previous history of falls, limitations in activities of daily living (ADLs), female gender, living alone, physical inactivity, fear of falling, and alcohol consumption.

Medical Fall Risk Factors

Clinical pathologies and conditions contributing to falls, including impaired cognition, stroke, Parkinson's disease, depression, acute illness, arthritis, foot problems, vertigo, orthostatic hypotension, and vestibular disorders.

Pharmacological Fall Risk Factors

Medication-related contributors to fall risk, particularly psychoactive medications (benzodiazepines, antidepressants, and antipsychotics), polypharmacy ($\ge 4$ multiple medications), cardiovascular medications, analgesics, and anti-inflammatories.

Postural Stability (Balance)

The physiological ability to maintain the position of the body's centre of mass (COM) within the base of support (stability limits).

Postural Sway

Constant fluctuations of the centre of mass (COM) from vertical alignment, which increase in magnitude and velocity with age and become more discriminating under conditions of sensory deprivation.

Categories of Postural Control Tasks

The four functional balance classifications: maintaining stability during sitting or standing (postural sway), anticipatory adjustments to voluntary movement (reaching, stepping, gait initiation), reactions to expected perturbations (catching a ball), and reactions to unexpected external perturbations (trips, slips, or bumps).

Vestibular System Sensation (Ageing)

An inner ear sensory system that detects the position and motion of the head for posture and head-eye-body coordination; undergoes functional decline with age due to the loss of stereocilia.

Peripheral Sensation (Balance and Gait)

Somatosensory inputs including tactile cues from the skin of the hands and feet that describe environmental interaction, and proprioception from muscles and joints that signals body and limb position.

Age-Associated Visual Declines

Visual changes that impair environmental navigation and body movement feedback, including decreased visual acuity, contrast sensitivity, depth perception, visual field (peripheral vision), and reliance on corrective glasses.

Age-Associated Neuroanatomical Changes

Central nervous system declines including a $10\%$ loss of brain weight by $90$ years due to neuronal loss, loss of myelin that slows nerve conduction velocity, basal ganglia deficits impairing movement initiation and speed, and cerebellar deficits impairing equilibrium and interlimb coordination.

Age-Associated Muscular System Changes

Progressive deterioration of the musculoskeletal system characterised by a $35\text{--}40\%$ loss of muscle quality by $80$ years (with further acceleration past $80$ years), preferential atrophy and loss of Type II muscle fibres, and substantial reductions in muscular strength, power, and endurance.

Simple vs Choice Reaction Time (Ageing)

The capacity to detect and respond to stimuli; simple reaction time slows gradually from $20\text{--}60$ years before accelerating, whereas choice reaction time and complex tasks demonstrate far larger age-related deficits due to compounding sensory, processing, and motor declines.

Mechanical Energy Absorption (Gait)

The deceleration and shock absorption phase of walking executed by the ankle dorsiflexors, ankle plantar flexors, and hip extensors.

Mechanical Energy Generation (Gait)

The generation of propulsive force driving forward gait progression, primarily powered by the ankle plantar flexors and hip extensors.

Swing Phase Control (Gait)

Muscular coordination that controls the trajectory and clearance of the non-weight-bearing limb during walking, executed by the hip flexors, ankle dorsiflexors, and knee flexors.

Age-Associated Changes in Gait

Characteristic kinematic and kinetic modifications in older adults, including decreased walking speed, reduced stride length, reduced stride rate, increased stance time, increased stance width, reduced joint range of motion (ROM), reduced push-off power, and increased gait variability.