By Dr Amy Sedgwick MD, FACEP, E-RYT.
“Patient to trauma room one, patient to trauma room one, stat!”…an overhead page that is all too common in my line of work. Among the many types of patients I take care of as an emergency physician, I see a large proportion of elderly patients who come to me in the wake of a fall. More than one-third of people aged 65 and older fall one or more times per year.1
Falls occur due to multiple risk factors, including decreased muscle strength and postural awareness, medication side effects, cognitive impairment, and depression.2 These patients come to me with hip and long-bone fractures, acute mental status changes due to brain injury, skin tears and lacerations, and many other life-threatening injuries.
In many of these cases, the falls could have been prevented with some basic interventions. Especially those to help patients maintain the strength, stability, and mobility in their bodies, as well as a sense of overall wellness.3 Sadly, broken bones and head bleeds are just the start of the problems that often follow a fall. Oftentimes the immobility and stress on the body that results from a fall, as well as the psychological impact of falling, sets elderly people up for a host of problems. Secondary infections such as pneumonias and wound infections can impede recovery. Brain injury and physical disability often lead individuals to lose much of their autonomy. This overall decrease in function often results in repeat falls, subsequent injury, a reduction in quality of life, and sometimes even death.4
Treating the Underlying Cause of Falls
As yoga professionals, we are in a unique position to address some of the underlying causes of falls. The benefits of strength and balance training are, of course, cited frequently in the medical literature. These, combined with the breathwork and relaxation specific to a yoga practice, can provide a regimen that offers an individual physical strength and stability as well as a sense of well-being and enhanced quality of life.
When I am treating a patient for a particular problem, I often find it helpful to check in with the latest medical literature so that I know what kinds of things my colleagues have found effective in treating similar patients. While I believe it is good to review the literature, however, studies vary widely in their strength and validity, and if one is not used to reading medical literature critically, it is easy to be led astray by apparent “good” results that are based on poor research methods. My hope, as both a practicing physician and yoga teacher, is to empower you with the same kind of evidence that medical providers rely on before prescribing a treatment plan for patients.
There has been a fair amount of research conducted on how to prevent falls in the elderly. Studies looking specifically at yoga regimens occupy a smaller subset of this literature, and the biggest criticism I found in my quick review was that the size of the study populations have, to date, been quite small. Still, I think the papers I review below may be helpful as you think about promoting yoga for seniors. At the very least, realize that what you are offering is more than just a simple yoga class. In fact, you may be the link in the chain that prevents the next fall!
In 2013, a paper in the Journal of Gerontology by Tiedemann et al. detailed a randomized, controlled trial of 54 “community dwellers” (read: people who do not live in institutional settings such as nursing homes) with a mean age of 68 who were not practicing yoga or tai chi prior to participation. The study divided the two groups into an intervention group who received an educational booklet with poses, and another group that participated in twice-weekly yoga classes for 12 weeks. The control group only received the education booklet but did not participate in classes.
At the end of the 12 weeks, the intervention group had better agility when moving from sitting to standing, better balance in a one-legged stand, and a faster and more confident gait. The yoga poses emphasized were tadasana (mountain pose), virabhadrasana I (warrior I), virabhadrasana II (warrior II), virabhadrasana III (warrior III), ardha chandrasana (half moon), vrksasana (tree pose), adho mukha svanasana (downward facing dog), and savasana (corpse pose).5
Less robust in its design but with similar results was a study from 2014 by Kelley et al. in the Journal of Alternative and Complementary Medicine. This study looked at a similar cohort of participants and analyzed the effects of a 12-week, twice-per-week hatha yoga practice in community-dwelling adults with the average age of 72. This study was not randomized (so a little less robust than the one described above) and was a pretest/post-test style study looking at the “before and after” effects of a group of participants.
The yoga poses were similar to those in the Tiedemann study, with the addition of centering breath work, warm-up shoulder rolls, heel raises, and baddha konasana (bound angle pose). The outcomes were similar, noting improvements in mobility, postural control, and gait speed.6
Other meta-analyses (studies that evaluate a group of similar studies looking for common outcomes) show more modest evidence that yoga, in particular, is superior to other forms of physical-activity-related interventions in elderly people.7Patel et al. did a meta-analysis looking at studies from 1950 to 2010 and found 18 relevant studies looking at older adults across a range of settings. This meta-analysis suggested yoga improved the participants’ sense of good health, aerobic fitness, and strength.
Realizing that there are no perfect studies proving that what we do as yoga teachers help these folks avoid falls, I do think there is a legitimate growing body of evidence suggesting that yoga can help our elders achieve increased strength, stability, coordination, and well-being. In my mind, that is better than any drug I have ever heard of—and certainly better than the injury, disability, and death that can result from preventable falls.
I encourage you to continue to target this age group. I hope you realize what an important contribution you can make toward improving the health and well-being of older people! Rather than a new drug or quick fix, it is the small, daily, purposeful things we do with integrity that often bring about the most meaningful change. This is yoga.
Good luck and namaste, beautiful yogis!
View the original article on Yoga International.
About the Author:
Dr Amy Sedgwick MD, FACEP, E-RYT lives in Portland, Maine where she practices emergency medicine. She is an active contributor to Yoga Medicine, so keep an eye out for more articles from Amy. Click here to learn more about our contributors and teaching faculty.
1. Lord SR, Ward JA, Williams P, Anstey K. Physiological factors associated with falls in older community-dwelling women. J Am Geriatr Soc. 1994; 42:1110–1117.
2. Rossat A, Fantino B, Nitenberg C, Annweiler C, Poujol L, Herrmann FR, Beauchet O. Risk factors for falling in community-dwelling older adults: which of them are associated with the recurrence of falls?, J Nutr Health Aging. 2010 Nov; 14(9):787–91.
3. Tiedemann A, Shimada H, Sherrington C, Murray S, Lord SR. The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people. Age Ageing. 2008; 37:1–6.
4. Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall-related injuries in older adults, Am J Public Health. 1992 Jul; 82(7):1020–3.
5. A Tiedemann, S O’Rourke, R Sesto, C Sherrington, A. 12-Week Iyengar Yoga Program Improved Balance and Mobility in Older Community-Dwelling People: A Pilot Randomized Controlled Trial, J Gerontol A Biol Sci Med Sci. 2013 September; 68(9):1068–1075.
6. K Kelley, EdD, PT, NCS, D Aaron, BS, SPT, K Hynds, BS, SPT, E Machado, BS, SPT, and M Wolff, BS, SP. The Effects of a Therapeutic Yoga Program on Postural Control, Mobility, and Gait Speed in Community-Dwelling Older Adults, J Altern Complement Med. 2014 Dec 1; 20(12):949–954.
7. Patel NK, Newstead AH, Ferrer RL. The effects of yoga on physical functioning and health related quality of life in older adults: a systematic review and meta-analysis, J Altern Complement Med. 2012 Oct; 18(10):902-17.