The Science and Hope of Fall Prevention

STANDING STRONG
By: Lennard M. Goetze, Ed.D

Under the Integrative Pain Healers Alliance (IPHA) and the AngioInstitute’s SMARTER AGING program, the issue of fall prevention is emerging as a public-health priority. For many seniors—and for those with chronic neurological, orthopedic, or systemic disorders—a single fall can mark the difference between independence and decline. Beyond the immediate trauma, falls often lead to fear, reduced mobility, and cascading health complications. Our mission is to confront this challenge through education, innovation, and evidence-based prevention. Here are a few quick facts on Falling:

• 1 in 4 seniors experiences a fall each year.

• Over 90% of hip fractures are due to falls.

• Falls are the leading cause of injury-related death among adults over 65.

• Prevention programs can reduce fall risk by up to 40%.

Why We Fall: Understanding the Root Causes

Falls are rarely caused by a single factor. They are usually the outcome of multiple physiological, environmental, and behavioral vulnerabilities that intersect with age or chronic illness. Common contributors include:

• Loss of balance and proprioception: Aging weakens sensory integration—especially from the feet, inner ear, and visual systems—reducing stability and spatial awareness.

• Muscle weakness and frailty: Sarcopenia (age-related muscle loss) reduces the body’s ability to react quickly to imbalance.

• Medication side effects: Sedatives, antihypertensives, and polypharmacy can cause dizziness, confusion, or blood-pressure drops.

• Vision or vestibular disorders: Cataracts, glaucoma, and vertigo all distort orientation and coordination.

• Neurological conditions: Parkinson’s disease, stroke, multiple sclerosis, or traumatic brain injury interfere with motor control and reflexes.

• Orthopedic limitations: Joint degeneration, arthritis, or post-surgical stiffness affect gait mechanics and stride confidence.

• Peripheral neuropathy: Diabetes, chemotherapy, or toxic exposures can dull foot sensation, disrupting balance.

• Environmental hazards: Poor lighting, uneven floors, slippery surfaces, clutter, or poorly fitted footwear remain among the most preventable triggers.

Each of these factors magnifies risk, but together they create a perfect storm—especially in elderly individuals, spinal cord–injured (SCI) patients, or those with prior falls. The outcome can be devastating: hip fractures, head trauma, or a spiral of immobility that accelerates aging itself.

The Hidden Costs of Falling: Beyond physical injury, the emotional and financial toll of falling is enormous. Fear of falling often leads to self-imposed isolation, loss of confidence, and depression. Clinically, the “post-fall syndrome” often includes reduced activity levels, muscle atrophy, and even cognitive decline due to reduced social and physical engagement. From a public-health perspective, falls are one of the most expensive age-related events—responsible for billions in hospitalizations and long-term care costs annually.

A New Vision for Prevention:  The SMARTER AGING approach integrates multiple disciplines—rehabilitation science, neurology, biomechanics, and advanced imaging—to identify risks before they manifest as accidents. Our collaborative research seeks to map out early warning signs, measurable biomarkers, and responsive solutions through technology and holistic interventions.

1. Diagnostic Technologies

• Balance and Gait Analysis Systems: Pressure-sensitive walkways, motion sensors, and AI-driven video assessments can detect subtle asymmetries or instability before a fall occurs.

• Ultrasound and Thermography: At the AngioInstitute, advanced imaging helps identify muscular asymmetry, neuropathic deficits, and vascular insufficiencies that correlate with weakness or poor lower-limb circulation.

• Wearable Devices: Smart insoles, accelerometers, and posture-tracking bands provide real-time feedback to both patient and clinician, allowing individualized corrections and safety alerts.

• Brain and Nerve Scanning: Non-invasive imaging and neurofunctional testing can reveal sensory-motor integration issues linked to traumatic brain injury (TBI) or neurodegenerative disorders.

2. Rehabilitation and Physical Reconditioning: Restoring mobility requires more than physical therapy—it demands neuromuscular re-education. Programs combining kinesiologic integration, core strengthening, and functional movement retraining rebuild the neural pathways of balance. Techniques include:

• Proprioceptive re-training: Exercises on unstable surfaces to enhance joint awareness.

• Cross-patterning and neuromuscular stimulation: Techniques from applied kinesiology and physical therapy to synchronize right-left brain–body communication.

• Low-impact resistance and vibration platforms: Promote bone density and reflexive balance responses.

• Aquatic therapy: Safe, supportive movement environments for those with frailty or chronic pain.

3. Integrative Healing and Regenerative Modalities: The IPHA network emphasizes non-pharmacological approaches to strengthen the body’s natural resilience:

• Photobiomodulation and PEMF (pulsed electromagnetic field) therapy to enhance muscle recovery and nerve regeneration.

• Nutritional optimization with vitamin D, magnesium, and amino acids to support bone and muscle health.

• Manual therapies such as osteopathic manipulation and myofascial release to restore structural alignment.

• Acupuncture and neurostimulation to regulate proprioceptive and balance centers.

4. Environmental and Lifestyle Modifications: Simple changes can drastically reduce risk

• Home safety assessments: Removing loose rugs, improving lighting, and installing handrails or grab bars.

• Footwear and orthotic optimization: Proper arch and ankle support can restore balance confidence.

• Community fitness programs: Tai chi, yoga, and dance-based exercises enhance coordination and mental focus.

• Medication review: Collaboration with prescribing physicians to minimize sedative or hypotensive drug loads.

Beyond Age: Who Else Needs Fall Prevention: While the elderly are the most visible at-risk population, fall prevention is also critical for:

• Post-TBI and stroke survivors, who often struggle with equilibrium deficits.

• Polio and SCI patients, whose compensatory movement patterns require ongoing retraining.

• Chronic pain patients, whose reflexes and posture are distorted by pain avoidance behaviors.

• Those recovering from orthopedic surgery or immobilization, whose proprioceptive awareness declines rapidly.

Research Toward Personalized Fall Prevention Under the IPHA and AngioInstitute umbrella, our upcoming Fall Prevention Research Initiative aims to evaluate what truly works for those who fall repeatedly. The study will integrate clinical imaging, wearable technology data, and functional assessments to correlate specific interventions with measurable outcomes.

The research objectives include:

1. Identifying modifiable risk factors in recurrent fallers.

2. Testing the efficacy of integrative therapeutic modalities (physical, neurological, and metabolic).

3. Developing individualized “Fall Recovery Roadmaps” combining diagnostics, therapy, and patient education.

4. Creating community-based awareness programs to empower seniors and caregivers with actionable strategies.

Our interdisciplinary approach—bridging medicine, rehabilitation, and technology—seeks not only to reduce injuries but to restore confidence and mobility. Fall prevention is not just about avoiding trauma; it’s about reclaiming independence, dignity, and quality of life.

A Message of Hope For the millions living with the fear of falling, there is hope. The convergence of technology, integrative medicine, and compassionate care is reshaping how we age. The SMARTER AGING initiative is building pathways toward safety, strength, and stability, offering tools that empower patients to stand taller—physically and emotionally.

As Dr. Robert Bard, Director of the AngioInstitute and co-founder of IPHA, states:

“Every fall we prevent is a life we keep moving forward. Through our research, we are not just studying balance—we are restoring it, in every sense of the word.”

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SMARTER AGING PART 2:

KINESIOLOGY 101 — The Science of Balance and the Art of Longevity

Dr. Lisa M. Avila, a seasoned kinesiologist, chiropractor, and herbalist with more than 25 years in private practice, brings a distinctive and deeply integrative perspective to patient care. Her approach combines advanced kinesiology techniques with a holistic understanding of the body’s reflexes, musculature, and neurochemical balance. As she explained in a recent professional exchange, her work thrives where conventional medicine and physical therapy often fall short—especially in complex cases where balance, neurology, and systemic resilience intersect.

Complex Cases as a Calling: For Dr. Avila, difficult cases are not obstacles but opportunities. She embraces the challenge of patients whose conditions require thinking beyond standardized protocols. “The hardest person possible to walk through my door is the one I’m the most excited over,” she reflected. These are the patients who make her think, research, and innovate—pushing her to apply kinesiology on both a micro and macro scale to restore function and well-being.

Her clinical method begins by analyzing the larger reflexes of the body—such as visual alignment and pelvic stability—and then moving into smaller, intricate reflex connections. This layered process helps reveal where trauma, disease, or biochemistry have disrupted balance and communication within the nervous system. By restoring these connections, she enables patients to regain mobility, reduce symptoms, and improve their overall quality of life.

The Science Behind the Practice:  Although kinesiology can appear unconventional, Dr. Avila grounds her work in science. She explains her methods in terms of neurological reflexes, re-patterning, and the restoration of reflexes that often go offline due to trauma or illness. For example, she likens balance correction to gazing at the horizon while seasick—an external reference point that re-orients the brain. Similarly, kinesiology provides the nervous system with inputs that recalibrate function and stability.

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SMARTER AGING 3: ALZHEIMER’S DISEASE- A GLOBAL EPIDEMIC 

 Written By: Roberta Kline, MD  (Originally published in Journal of Diagnostic Science,©2024)

Age-related dysfunction of the brain can escalate in aggressiveness and complexity over time as the victim progresses toward the end of life.  ALZHEIMER’S DISEASE (AD) is currently viewed as a progressive neurodegenerative disease that is uniformly fatal. The most common form is termed Late-Onset Alzheimer’s Disease (LOAD), which primarily impacts people over the age of 65 and is the focus of this article. In addition to its devasting impact on individuals with AD, it has a wide-reaching impact that touches every aspect of our society.  But there is hope. In the following pages, we’ll review the current state of the science and clinical approaches to AD, and introduce promising new ways to approach prevention and treatment. Making these changes will require a fundamental shift in how we approach not only AD but our health and healthcare as a whole. 

All stakeholders must work together to change the tide in this global epidemic. From individuals, families, and communities to healthcare, research, and private and government institutions, we all have the opportunity to be part of the solution. It won’t be easy, but to keep going in the same direction is unthinkable.

ALZHEIMER’S DISEASE WILL BANKRUPT HEALTHCARE
Without a drastic – and rapid- change in our approach, caring for people with dementia, particularly Alzheimer’s disease, is predicted to bankrupt this country’s healthcare systems by the year 2050.  Currently, we spend more than $321 billion in direct healthcare costs caring for the more than 6 million Americans living with Alzheimer’s. In large part due to the increase in our aging population, that number is expected to increase to 13.8 million, with costs projected to be over $1 trillion by 2050. [1] Evidence shows that taking a more holistic approach can improve quality of life [2 but this requires a different mindset and strategy. In addition to the staggering cost of healthcare, there is a hidden cost that often fails to receive attention: unpaid caregiving. 

More than 11 million unpaid caregivers spend an estimated 18.4 billion hours a year caring for family members with Alzheimer's or other dementias. The value of these unpaid services is estimated at $350 billion [2], exceeding the direct healthcare costs. However, this number is even greater in terms of total impact, as it does not account for the emotional, physical, and social toll, nor does it include lost wages and related benefits due to caregiving responsibilities. 

 AGING DISEASE
Alzheimer's disease is fatal and is the fifth‐leading cause of death among Americans aged 65 and older. [3] This number does not include those with Alzheimer’s who die of other diseases first, but where Alzheimer’s was likely a contributing factor. While people aged 65 and older only survive an average of four to eight years after diagnosis, some can live as long as 20 years. [3] 

Twice as many women as men are diagnosed with Alzheimer’s disease, and women account for almost 2/3 of the approximately 7 million Americans currently living with Alzheimer’s. [3e] Ethnicity also plays a role. Black/African American individuals have twice the risk of Alzheimer’s disease compared to Non-Hispanic white individuals, and Hispanic/Latino individuals are just slightly lower at 1.5x. [4] 

When looking at people 65 and older, the highest prevalence of AD is among Black/African American individuals at 13.8%, with Hispanic/Latino individuals at 12.2%, non-Hispanic white individuals at 10.3%, American Indian and Alaska Native individuals at 9.1%, and the lowest group being Asian American and Pacific Islander individuals at 8.4%. [4] The U.S. Census Bureau has predicted that the U.S. minority population will increase from 20% to almost half by 2060. Despite these statistics, most research has been conducted with non-Hispanic white populations, hampering both understanding of underlying causes as well as treatments for an increasing demographic. There are currently no good treatments in the conventional medical model, and thus people with Alzheimer’s are often led to believe that there is nothing they can do. Ending up in a nursing home often seems inevitable.

NURSING HOME VS HOME CARE
According to the CDC, as of 2020 there were more than 15,000 nursing homes serving more than 1 million residents, and for-profit companies owned 70%. [6] One of the top three reasons older people are placed in assisted living facilities and nursing homes is dementia, with Alzheimer’s being the most common type and accounting for almost half of all nursing home residents; this rate is even higher for Medicare beneficiaries. As people with Alzheimer’s disease age, they are often found to have other forms of dementia as well. [3]

Research shows that those who are in nursing homes do better when provided with more specialized services. However, less than 5% of nursing home “beds” are in facilities that provide these. [6] But nursing home care is not inevitable. More than 60% of people with Alzheimer’s disease and related dementias live at home, half of them living alone.  [6] This concept of “aging in place” may help alleviate the burden of nursing home care. It also can help slow the progression of the disease, as people are kept in familiar environments that provide a sense of belonging and purpose. This continued connection to their community also provides better opportunities for social and cognitive engagement.

Living at home requires aids and adaptations, as well as caregiver support. This brings up another challenge: “Who provides the support?” How we treat the elderly reflects our societal values. With an overemphasis on achievement and productivity, those unable to meet this standard are seen as “less important” and thus less valuable. Often, this intersects with traditionally female roles, including caretaking for the elderly, children, and those who are sick, infirm, or disabled. 

As women are often the primary caregivers, they are much more likely to disproportionately suffer additional consequences. Women from historically minority and marginalized groups with fewer resources and access to services are even more impacted. [3]

Age distribution of AD in 2023. [3]

LEADING CAUSES OF ALZHEIMER’S DISEASE
Alzheimer’s disease is a complex interplay of genetic and environmental factors. 

1. AGE: Age is the single largest risk factor for AD. The vast majority (90-95%) of people with AD are over age 65, with risk increasing with age. 

2. GENETICS: Specific forms of the APOE gene are associated with late onset Alzheimer’s disease (LOAD), the most common type that typically affects individuals after age 60. People carrying the E4 variant of the APOE gene have the largest genetic risk, based on research involving individuals primarily of European descent. Those with two copies of the APOE4 gene are estimated to have about a 60% risk of developing AD by age 85, and recent research suggests that the form of disease may be different than AD in those with normal APOE genes. [7] 

Interestingly, this study also found that almost everyone with two copies of APOE4 developed brain changes in beta-amyloid and tau consistent with Alzheimer’s Disease by age 55. But previous studies have estimated that almost half—40%—of people with two copies of APOE4 don’t develop Alzheimer’s disease, so it’s not necessarily inevitable. [8]

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DR. ROBERTA KLINE is an ObGyn physician, an award-winning author, an educational advocate, and an inspirational speaker for the professional and women’s communities. She holds a combined mission to upgrade how we approach health and deliver healthcare for women through education, globalized communication, research, and advocacy.  Dr. Kline develops and teaches CME programs, consults on gene expression project designs, and leads collaborative projects designed to advance the direction of women’s health. She is also a clinical advisor in integrative medicine and functional genomics to many health organizations including the Integrative Health Research Center. Dr. Kline is Director of Educational Programs for the Women's Health Collaborative, Editor of the Women’s Health Digest, and on faculty at the University of Western States.

FUNCTIONAL ANALYSIS OF AGING There are a variety of influences that determine healthy aging.  According to Dr. Joshua Berka, enacting an early lifestyle that includes regular motion and exercise regimen, an intelligent diet and proper sleep.  Other elements contribute to a positive life-design include stress management (and a positive outlook), exercising brain use (to instill good health habits) against cognitive decline, having leisurely activities, having regular social interactions and eliminate alcohol, drugs and other toxins. These and other factors represent quality of life and drive our pursuits to a preventive life plan leading to longevity and resilience. Re - NIH on Aging 2024) AGING & MICROCIRCULATION EXPLAINED By Dr. Joshua Berka (Published for Functional Diagnostics / Smarter Aging 101 program) When we think about aging, one common angle of this study is directed at LONGEVITY.  We can also think about LIFESTYLE CHOICES, and the many decisions that steer health. There’s also the study of GENETICS (both heredity and environmental effects or one’s epigenetics).  But as of lately, an area that's growing in attention is MICROCIRCULATION.  Since 2019, there's been a publication by Dr. Kunlin Jin called "The Microcirculatory Theory of Aging". All the story that we previously received was about OXIDATIVE REDOX saying "you're burning, you're rusting and you're not recovering". And then the next story in medicine that we were taught is MITOCHONDRIAL BIOENERGETICS- saying that you're not transforming enough energy to be utilized.  This aligns with the belief that diseases (like cancer) are ubiquitous, making disease the leading cause of death here in the United States.  "Metarteriole" - Source: Wikipedia Moreover, HEART DISEASE (another common killer) doesn't start in the large vessels of the heart. It actually starts in the MICROVESSELS, what we call the resistance vessels. The precapillary arterials, these microvascular networks, and they're very sensitive. The slightest change in pressure results in a cascade of effects so much in our body.  Enough evidence shows that the reason why we live, age, and die is the ability or inability to maintain functional tone of thousands of miles of microvessels. This means thousands of miles of vessels that have little tiny muscles inside of them- which are designed to hold a tone (not to open, not to close, but) to hold a functional tone. Just like your vessel or the pupil in your eye. That's just one sphincter. If you can visualize thousands of miles of these opening, closing, maintaining tone in relationship to the pumping of the heart.  It's not just the heart that's pumping all the blood through the body (and the heart's only responding many times based on how we're perceiving our environment). It makes perfect sense how this all affects anxiety and stress. It's not just the diet of food we put in our mouth and we process, transform and clear out. It is how we're integrating into our surroundings, how we feel about people, places and things.  Studying AGING and LONGEVITY also comports with how we support daily performance and resiliency to bounce back from any disease- but the recovery aspect; most people aren't even recovering and sleeping. And it's now shown that individuals who have some level of insomnia, may also have a moderately increased risk of an acute myocardial infarction. That's a heart attack just from not sleeping! So little simple lifestyle hacks of gaining deeper sleep. I believe that we'll be really gaining in age, in health span and lifespan if we don't just try to buy tools or use medical devices to biohack, but actually take the beauty within our own DNA and to use that in an efficient manner to express itself in a way that we're designed to not just survive but also thrive.  Ref: https://pubmed.ncbi.nlm.nih.gov/31165010/

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 CLINICIAN'S REVIEW - By: Dr. Robert L. Bard

Integrative Balance: A Holistic Framework for Functional Health

As the years pass, the aging body inevitably accrues wear and tear—microtraumas, cumulative stress, loss of tissue resilience, and neurological decline. To many, that seems an unavoidable decline. Yet Dr. Robert Bard believes we can challenge that narrative. In his view, the aging community must become seekers of answers, not passive accepters of loss. The key lies not only in repairing damage, but in retraining the body—restoring systems, reactivating reflexes, and reinforcing strength to reclaim performance and dignity.

Wear, Tear, and the Loss of “Automatic” Function
Over decades, joints degrade, fascia stiffens, neural pathways become less responsive, and postural reflexes dull. What once was effortless—rising from a chair, stepping off a curb, maintaining balance while distracted—can become precarious. The body’s intrinsic safety nets erode. That is when “accidents” cascade in: minor missteps, loss of balance, even small slips can spiral into injury.

Dr. Bard underscores that many modern regenerative and restorative techniques—for example, what he calls laser-guided Very Small Embryonic Like Stem Cells (VSELs)—aim to revitalize fascia, tendons, and neural connectivity. In his blog, he describes injecting laser-activated VSELs targeted to balance centers and musculoskeletal anchor points, with the goal of reawakening dormant tissues and restoring structural integrities. Bard News Today But such biological tools, while promising, are only part of the solution. Without functional retraining, gains may plateau or regress.

Retraining the Body: Not a Luxury, but a Necessity
Retraining the body is a proactive, continuous process: movement, reflex restoration, neuromuscular re-education, proprioceptive training, and strength work. For older adults, this means re-establishing systems that operate subconsciously—reflex arcs, balance responses, intermuscular coordination. In effect, you teach the aging body to remember how to “do what it once did” safely and reliably.

By retraining, the aging person restores a foundation for performance: better gait, smoother transitions (sit-to-stand, stair navigation), agility in unpredictable settings, and resilience against perturbations. It’s about reengaging the body’s intelligence.

Fall Prevention: A Central Concern
One of the gravest risks for older adults is falling. Falls can shatter confidence, independence, and physiologic reserve. Dr. Bard emphasizes that preventing falls must become a pillar of aging-well strategy. Retraining balance systems, stimulating vestibular and proprioceptive feedback, and integrating perturbation-based challenges in supervised settings are crucial.

Programs may include controlled destabilizations (balance boards, foam surfaces, dynamic stepping), vision–vestibular integration drills, and reflex “resetting” sequences. The goal is to enable the body to react smoothly and timely when pushed off balance.

Muscle Strength, Screening, and Physiology Checkups
No discussion of aging strength is complete without addressing muscle mass. Sarcopenia—the age-related fading of muscle—robs many of stamina and safety. Dr. Bard urges a regimen of resistance training tailored to the individual’s capacity, emphasizing slow, controlled loading, and periodic progression. Even modest gains in key muscle groups (glutes, quads, core, dorsals) translate into improved posture, joint protection, and balance.

Moreover, regular physiological screening is nonnegotiable. That includes metabolic tests, hormonal panels, vascular health, inflammatory markers, bone density, and neuromuscular conduction studies. These screenings catch underlying contributors to decline: nutritional deficiencies, hormonal shifts, or vascular insufficiencies.

Dr. Bard’s focus on regenerative modalities like VSELs complements—but does not replace—these foundational approaches. His procedure descriptions show how restoring fascia or tendon integrity can support muscular and functional retraining. Bard News Today But he would caution: without the ongoing discipline of movement, balance training, and physiological care, even cutting-edge interventions may not translate into durable life improvements.

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In sum, Dr. Bard’s message to the aging community is clear: the quest for quality of life demands active engagement. Wear and tear are real, but not irredeemable. Retraining the body—to rebuild reflexes, fortify strength, sharpen balance systems—is a core piece of the strategy. Fall prevention must be central, muscle strength must be defended, and regular checkups must guide adaptive interventions. With consistency, wisdom, and integrative tools, aging can be a phase of resilience, not decline.