Falls Risk Among Elderly: Berge Balance Scale

Introduction

Inpatient falls, especially among elderly patients have continued to be a problem in the healthcare system’s functionalities and challenges in providing quality care to elderly patients. According to Narayanan et al. (2016) studies report that falls occur frequently between 1.3- 8.9 falls per thousand bed days among hospitalized patients in the United Kingdom, the United States and the rest of the Western nations. From a global perspective, twenty-eight to thirty-five percent of older adults above the age of sixty-five years old experience a falls scenario as a result of age and loss of muscular functionalities. According to Hamm et al. (2016) falls among the elderly are highly linked to increased mental health challenges in anxiety and depression and higher chances of long-term hospitalization and hospital readmissions amongst the elderly.

As reports a study by Stanmore et al. (2019) the costs involved in caring for the elderly patients is immense both to the healthcare system and the individual patients’ families. It is, therefore, a priority in healthcare provision that the wellness of elderly adults is considered through proven assessment protocols over falls risks amongst this weak and vulnerable population group. The Berg balance scale has been approved by research to be an effective tool for use among elderly patients, as an assessment tool, based on 14 key assessment indicators (McGinley et al. 2020). The assessment is founded upon establishing patients’ postural balance through the assessment of the patient’s functional independence, motor performance, and balance.

Case Description

Ms. K is a 67-year-old, divorced African American female who has been residing in the UK for the last 30 years. Her children are all grown and away from the house where she currently lives with her two puppies. She was recently admitted to St.’s medical center by the area paramedics who acted in response to her distress call following a fall, which resulted in a hip fracture in her residential home. The patient lives a sedentary lifestyle with no physical activity and has been on antihypertensive medications for the last ten years, despite having no health insurance coverage and reports a reliance on social security support for her survival.

The Berg Balance scale as a falls risk assessment method is one such critical tool that has been used in the determination of fall occurrences amongst hospitalized elderly adults in the United Kingdom (Liang et al. 2020). With studies indicating increased risks of falls for the elderly being as a result of an increased state of imbalance, the Berg balance is an effective method of assessing elderly people’s fall risks by determining their propensity to falls (Liang et al. 2020). This is because the berg balance scale helps to determine the patient’s stability problems and rating findings in a way that easily helps in identifying those patients at high risk for falls. Further, Liang et al. (2020) notes that most of the fall risk assessment tools work to establish the patient’s stability mechanism which includes determining patients’ falls risks status, utilizing the risk factor checklist, and finally formulating an action plan.

Therefore, the use of the Berge balance scale will be beneficial for the patient in the study, give her increased risks of falls from the already identified risk indicators.

Literature Review

Evidence supporting Berge Balance Scale

Falls are inescapable occurrences amongst all population age groups as anyone can easily fall and break a bone or a body part. However, elderly adults are at higher risks of encountering the effects of falls owing to advanced age which causes a reduction in muscular functionalities. Aging has been associated with changes in elderly people’s physiological, mental and emotional change with the capacity to affect fall occurrences amongst the elderly (Liang et al. 2020). Some of these biopsychosocial changes occur as a result of altered functions of central nervous system, changes in muscles and skeletal functions as well as in neurons and digestive system malfunctions (Pauelsen et al. 2018). Further, Pauelsen et al. (2018) notes that the female gender is one critical risk factor for falls occurrences owing to increased prevalence of women fall as compared to men.

As the number of elderly adults continues surging, the effects of falls are becoming a major challenge in healthcare delivery, owing to the immense costs involved in the management of falls patients, especially the elderly (Zhang et al., 2020). In recent decades, falls have been reported to be amongst the main reasons for hospitalization, admissions to elderly persons’ care homes, and deaths among adults aged 65 years and above (Nicklett et al., 2017). Despite the availability of many fall risk assessment tools, studies have continued to report the inadequacies involved with the use of the available assessment tools.

As a recommended assessment tool, the Berge Balance Scale (BBS) tool has been used in several studies (Sherrington et al. 2020). The prevention of falls occurrences amongst the elderly faces impediments such as the falls risk identification amongst individuals, the interrelationship of the risk factors involved in falls occurrences as well as the implementation of treatment interventions (Shier et al, 2016). The BBS works in determining fourteen areas of concern among elderly patients in the development of falls. Sherrington et al, (2020), in a study determining the use and acuity of the Berg Balance Scale in determining falls, 21 studies validating the use of the BBS Assessment were reviewed. In this particular study, the researchers noticed sensitivity and a specificity margin of 0.01 with an accuracy curve of 0.84. The study findings also reported favorable indications for the use of the Berg Balance scale among adults below the age of 65, among patients with neurological conditions, and amongst those patients with over two falls’ cases (Ng et al., 2019). Ultimately, this study indicated that the BBS is a better fall assessment tool as compared to the STRATIFY assessment tool and other such tools, which have lower predictability as compared to the BBS.

In a separate study utilizing the BBS in a systematic review in predicting elderly falls risks among the non-pathology and pathology individuals, the nine studies from which data were retrieved revealed higher sensitivity and specificity rates of BBS in predicting falls. Finally, in a study aimed at determining patients’ muscular functionalities in relation to falls, the BBS score showed positive correlations between the elderly patients’ functionalities and the risks of falls for the hospitalized elderly adults (Dhargave and Sendhilkumar 2016). Thus, the BBS is an effective mechanism of fall risk assessment among elderly patients admitted to the hospitals.

Strengths and Weaknesses of the Berg Balance Scale

As a measure of strength, the Berg Balance test offers fourteen falls assessment criteria as opposed to the other assessment measures, therefore making it more reliable than the rest of the test mechanisms available. In this regard, the Berg balance Scale works best in identifying an elderly individual with the likelihood of experiencing falls-related problems while under inpatient care. According to Taheri-Kharameh et al. (2019), the Berg Balance Scale has the highest reliability and validity at predicting falls among older adults in inpatient care facilities. Therefore, the Berg Balance Scale is a practical assessment tool in inpatient falls risk assessment among the elderly and whose outcomes are deemed valid.

The BBS involves a weakness in the sense that the tool has to be used in combination with other assessment tools as a result of the variances in the cutoff scores and psychometric values (Sherrington et al. 2020). Therefore, healthcare providers intending to use the BBs would receive favorable results by combining BBS with other assessment tools. Besides, the Berge Balance Scale has been shown to underperform in assessing patient’s cognition effectively. This is a critical weakness given that most elderly patients present with confusion resulting from dementia and other related illnesses such as depression (de Matos et al., 2019). Therefore, alternative cognitive assessment methods should be used to reinforce the use of the Beige Balance Scale.

Exercise and the use of Berg Balance

In the management of falls among elderly adults, healthcare providers are required to assume a holistic approach to patient management, which includes identifying the patients’ biopsychosocial parameters. The early detection of elderly adults with higher risks of falls is important in the development of appropriate guiding interventions aimed at falls preventions. In this regard, using the Berg Balance score with therapeutic exercise interventions among elderly patients is one of the beneficial interventions in fall management. Stanmore et al. (2018) argue that exercise therapy can be the best intervention mechanism for use amongst the elderly.

Further, other study findings have continually indicated that using the Berg balance score in exercise is a timely intervention, with an effectivity that is estimated to be five times better amongst the elderly individuals (Park and Lee, 2017). Exercise interventions among the elderly have been linked with greater outcomes in reducing the chances of fractures, increased bone mass health, and increasing standing stamina (Park 2018). In a study to establish the benefits of physical activity and Berg Balance training over a year over risks of falls among aged women with weak bones, BBS activities proved beneficial in the treatment group of women as compared to the group that did not receive treatment (Viveiro et al., 2019). However, fewer evidence-based research studies have highlighted the use of the berg balance scale in addressing falls-related cases through exercise therapy.

Supportive Evidence for the Berg Balance Scale

Falls are increasingly becoming a matter of public healthcare interest in the UK, as is the case across most of the countries globally, especially with the bulging numbers of the aged population. Among the interventions indicated for use in clinical practice is a combination of both pharmacological and non-pharmacological options. In this regard, some studies have lauded a particular assessment mechanism for falls, besides the use of non-pharmacological options such as physical activity, as interventions in the limitation of falls among elderly adults in inpatient care facilities.

In a study to establish the effect of exercise and Berg Balance training over a year over risks of falls for elderly women with osteoporosis, BBS activities proved beneficial in the experimental group of women as compared to the control group (McGinley et al., 2020). However, fewer evidence-based research studies have highlighted the use of the berg balance scale in addressing falls-related cases through exercise therapy. As reports Koç and Sağlam (2020), in a comparative study design, several exercise programs with the inclusion of balance and resistance training exercises were administered amongst sarcopenia patients. Results from the study indicated that resistance exercise training alone did not yield many results in reducing the effects of sarcopenia, as did the mixed exercise program.

Key Biopsychosocial Implications of the Exercise in the Berg Balance Scale

The prevalence of falls amongst the elderly is contributed to by several compounding factors. Some of these challenges include biological factors related to an individual’s genealogical factors, some from behavioral sources and others from sociocultural factors (Woo et al., 2017). In general, these factors are categorized as intrinsic and extrinsic factors, out of the control of an individual. Most of the biopsychosocial factors are preventable, as in the case of behavioral factors that mostly act in aiding the development of falls amongst the elderly. Exercise therapy is one such intervention that seeks to modify and increase outcomes of patients managed for falls, especially within the healthcare setting. Berg Balance has been used together with multiple exercise options to address some changeable biopsychosocial aspects such as the behavioral factors (Sun et al., 2018). Therefore, the berg balance scale is useful in addressing several aspects of the fall’s occurrences among the elderly.

Biological aspects

The bodies’ posture is maintained by a group of conjoined body structures that work hand in hand to ensure that the body remains in a good state and avoids toppling over. In this regard, a good body posture will be achieved when one has a clear vision, as in the operations of the eyes, to avoid any obstacles on the way (Sherrington et al., 2020). As reports by Sherrington et al. (2020), to maintain a good physical balance, one must have an awareness of their body’s orientation in line with space. Besides, research studies have indicated that the ability to react to external stimuli promptly is also a factor of concern in preventing falls, together with the timely actions of the muscle in moving the body (Zhou et al., 2018). Old age has been reported to act in the reduction of these biological body mechanisms, thus derailing muscular activity, reducing bone strength, and increasing chances of falls.

Behavioral Aspects

In most cases, a majority of the elderly individuals in the United Kingdom experience falls owing to the increased psychological decline in their mental processes. Physical activity has been linked to increased psychological wellness amongst the elderly, working to correct mood changes (Bjerk et al., 2019). Bjerk et al. (2019) noted that engaging in light physical activity daily has been linked with physiological and psychological effects by enhanced cognitive abilities. Anxiety over falls has been reported as one of the main psychological challenges that immensely contribute to falls development among the elderly. As reports by Hallford et al, (2017) hospitalized, elderly adults have the possibility of developing falls-related anxiety, which could present in changes in bodily anxiety, behavioral and cognitive perceptions. In some studies, increased dizziness and the development of stiffness while moving the foot and increased muscle stiffness could easily lead to falls among the elderly (Elida and Triyana 2019). In this regard, interventions which seek to offer relief to the muscles, such as exercise therapy, could be beneficial in addressing the problems. Further, Payette et al. (2016) report that fear of falling, in addition to the already prevalent falls linked mental concerns, including the falls-efficacy and balance confidence, remains to be a common problem among elderly patients. Increased physical activity as guided by the Berg balance scale has been used promptly to help address anxiety challenges from elderly patients in inpatient care facilities.

Conclusion

The Berg balance scale has been proven to be the best assessment mechanism for falls among the elderly. Physical activity remains to be a key component of the berg balance scale as an intervention to falls prevention among hospitalized elderly adults. Physical activity practices that are individualized as per the elderly patients’ requirements have been shown to increase the elderly people’s functional abilities. Despite the presence of numerous falls risk assessment tools, none of them is as highly indicated for use among the elderly as the berg balance scale. In many of the studies, several assessment mechanisms were linked together to achieve the desired outcome in establishing fall risks among the hospitalized elderly adults. Falls are dangerous encounters for elderly adults, with increased chances of leading to broken bones and loss of muscular functionalities. Fear concerning falls among elderly adults should be treated with seriousness as a matter of concern over the lives of elderly individuals.

Therefore, it is recommended that all healthcare facilities and nursing homes admitting elderly patients should seek to address the biopsychosocial factors related to falls among elderly patients. Therefore, proper assessment mechanisms such as the use of the Berg Balance scale can aid in the prevention of such occurrences. Thus, assessment options addressing patients’ mental wellness would go a long way in determining intervention outcomes. Patients’ environment has been linked to various negative health outcomes, and as such, making use of the Berge Balance Scale in assessing patients living environments would be instrumental. Better falls risk assessment mechanisms such as the Berg balance scale could be timely in determining patients’ risks of falls prior to inpatient admission for better management.

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