PREVENT THE ELDERLY PERSON FROM FALLING IN PSYCHOMOTRICITY Leslie Cohen-Dadoun, psychomotrician (full national certificate), Head of the Alzheimer's Special Team. (Juliette Maceda translater)

PREVENT THE ELDERLY PERSON FROM FALLING IN PSYCHOMOTRICITY

Leslie Cohen-Dadoun, psychomotrician (full national certificate), Head of the Alzheimer's Special Team. (Juliette Maceda translater)

The elderly person is submitted to an aging musculoskeletal system: the fiber of the skeletal muscle decreases in density, implying a decrease in muscle mass and thus, functionally, muscular strength, which will influence the tone of the subject. A bone mineral loss occurs, as well as a reduction in the mechanical strength of the bone. Finally, the cartilage becomes thinner and the overall water loss induces a reduction in the elasticity and mobility of the joints, resulting in an alteration of its mechanical properties, which is source of fragility. Balance and temporo-spatial orientation problems are often associated, therefore; amplifying the phenomenon. This ageing process leads to unsafe and unstable moves, with an increase in falls.
The fall often generates a real trauma, also called in specialized literature "post-fall trauma". This trauma can be physical (e.g.: fracture of the neck of the femur) or psychological and trigger a real questioning about the diminution of the person’s abilities: "fall" will then take the meaning of "degradation" or " loss ".

- Information: many falls are due to causes external to the motor abilities of the individual, especially unsuitable shoes (open behind), or a lack of vigilance regarding the environment, such as differences in soil heights (e.g.: steps, carpet, etc.). It is also necessary to reassert, in collaboration with the occupational therapist, the importance of using technical equipment (cane or walker) and to review the conditions of usage if inappropriate, which could become a cause of fall. 

- Fall prevention workshops: they allow concrete body work in order to prevent falls. The sessions are organized in several ways to reinforce the muscles and the muscular tone, to consolidate the balance, to enhance the capacities and to reinvest positively one’s body.

Fall prevention passes through different stages:
 

1.      Strengthening the muscle structure: this involves articular and muscular warm-ups followed by various exercises such as using balls of different sizes (passing the ball with hands, feet, standing, sitting, with one hand ...), or the use of rhythmic gymnastic sticks allowing an aesthetic expression of the tonic variations of the arm, or by using one's own body through body expression exercises to work the muscles and joints (mime, dance ...). This list is not exhaustive, and will not be, because it depends on the creativity of each individual (the patient and the therapist) in the setting into motion of one's body and the encountering and adaptation to others.

2.      Consolidating balance: in the fall prevention workshops, some mediations are much appreciated by the elderly, such as ballroom dance, which allows a playful work of balance much appreciated. Tai Chi exercises are also often used and proposed to strengthen balance, etc.

3.       Emphasizing one's capacities: an elderly person who has already fallen or who is apprehensive about the fall will immediately adopt a protective positioning by limiting his moves and movements as much as possible. This attitude, understandable, is deleterious, as muscles submitted to inactivity tend to atrophy and lose their tone. Standing becomes increasingly difficult. Eventually, all this can lead to a psychomotor regression syndrome. During the fall prevention workshops, being present and accompanying the person in the rediscovery of his forgotten / lost capacities enables him to feel the body with more confidence and security, therefore realizing that he is still "capable of". The relationship established by the therapist and the exercise framework are at the center of this physical care. Thereafter, the elderly person could regain more autonomy and enough confidence to move alone, outside the framework.

4. Positively reinvesting the body: finally, let us arouse the central issue of the body and its investment by the elderly. A person who moves a little (by apathy, or because of pain) reduces his sensory-motor experiences, which modifies his physical perception: the less one feels his body the less one invests it. It is common to see older people no longer able to locate parts of their anatomy accurately. Soft gymnastics thus allow to get back to body movements. The patient gradually re-appropriates the body over the course of the sessions, according to a generally positive experience.

Falling without falling-over and getting back on the feet
Reassuring the elderly person is the last point we will discuss. The person who has not yet fallen can demonize the fall whereas the one who has already fallen, depending on the trauma, will apprehend it more or less. In any case, the therapist must be able to contain this fear and de-dramatize the situation. It is necessary to explain to seniors that all falls do not have a tragic outcome. Proposing a training adapted to fall and getting up is a concrete learning process by reducing risks and apprehensions. During these workshops known as the " workshop floor rising", the methodical succession of gestures is thus "re-learned" to the elderly so that they can regain the way to stand up from the ground after a fall when it remains unpainful.

Clinical vignette:
Mrs. B, 87, made many falls before arriving at the EHPAD. She uses her cane inappropriately: she does not lean on it and holds it in her hand by dragging it behind her. Mrs. B. has a post-fall syndrome: she has an avoidance attitude while seated (she is slumped in her chair) and refuses to get up from her seat without absolute necessity.
We started to work the fall prevention by teaching her to use her cane, then headed towards the soft gymnastics workshops. At first, she was not involved, and when asked about the different parts of the body that were warmed up at the beginning of the activity, she usually did not respond.
Gradually, she got involved in the group dynamic and answered to our questions and participants’ solicitations. We were able to notice a change in her seated position, as well as greater confidence regarding her abilities. After several months of participation, Mrs. B. stood up to meet other residents of the EHPAD, and no longer by necessity.
The team also highlighted several changes:
- her mood improved. Breaking with isolation enabled her to engage in conversations and seemed more fulfilled in her drop-in center.
- Mrs. B. performs more actively her morning toilette. The other result reported by the nursing auxiliaries also corroborate the reinvestment of her body.
The integration of Mrs. B. in a fall prevention care has contributed to an overall enhancement of her mood and physical condition, revitalizing her ability to communicate socially and improving her personal hygiene care.