Keeping Steady

Each year, one in every three adults age 65 and older falls, with the leading causes being an accident or a gait or balance disorder. Shockingly, less than half of these adults talk to their health care provider about it. If you are an older adult, it may be time to take action. Understanding the origins of balance difficulties, talking to your doctor, and taking simple steps to maintain and improve balance can help you keep steady for a lifetime.

Understanding Balance in Older Adults

By Grace Mullaney

Normal Balance

The Vestibular Disorders Association (VEDA) defines proper balance as the body’s ability to maintain its center of gravity over its base support. While seemingly simple, balance is maintained through a complex set of sensorimotor control systems that require sensory input from sight, touch (proprioceptors), leg and foot muscles, and the vestibular system (center of balance in the inner ear). The brain receives information from the eyes, muscles, proprioceptors and vestibular system and uses the information to send signals to the controlling muscles in the body in order to maintain a dependable equilibrium. Each information input and output is crucial to maintaining the body’s balance.

Causes of Imbalance in Older Adults

Deterioration of any essential functions in the system of balance can lead to some form of imbalance. For a variety of reasons, older adults are often the worst sufferers of balance disorders. It is often difficult to determine a singular origin for balance difficulties because there are a number of factors involved. Consider the following:

Faulty Motor Output

One cause of imbalance is inadequate movement of muscles or joints. “Balance is dependent on good muscle strength and joint mobility. A sedentary lifestyle and arthritis or diseases of bones and muscles can compromise these,” says Dr. Amjad M. Munir, medical director of HealthSouth Chattanooga. The National Institutes of Health (NIH) report that arthritis and muscular degeneration can weaken muscles and joints, throwing off a person’s center of gravity.

Inaccurate Sensory Input

Imbalance in older adults frequently results from inaccurate information transmitted to the brain about a person’s center of gravity. If one of the essential functions of balance is disrupted, the brain will become confused. Older adults are more prone to a number of diseases that disrupt the systems essential to balance. According to VEDA, diseases like cataracts, glaucoma, and macular degeneration affect a person’s vision, confusing the brain and disturbing the body’s balance. Persons suffering from diabetic peripheral neuropathy may experience an altered position sense in their feet and legs, which can disrupt the body’s equilibrium. Finally, degeneration of the vestibular system is a major cause of inaccurate input and imbalance in older adults, and this is discussed at length in the following section.

The Aging Vestibular System

Utilizing data from the NIH, the Archives of Internal Medicine determined that an estimated 35 percent of Americans over the age of 40 suffer from vestibular dysfunction, or what is more commonly known as an inner-ear balance disorder. The vestibular system is made up of the parts of the inner ear and brain that process the sensory information involved with controlling balance. The inner ear has a complex system of fluid-filled tubes and chambers, and nerve endings inside these structures determine a person’s head positioning and center of gravity. The brain depends on signals from these nerve endings to control the body’s equilibrium while standing and walking.

As a person gets older, the vestibular system begins to deteriorate. VEDA reports that by the age of 55, nerve endings in the inner ear begin to shrink and blood flow to the inner ear decreases. Because this degeneration is gradual, a person may easily disregard the occasional difficulty in standing up or walking. As much as possible, adults should be alert to these changes—the effects of vestibular degeneration can develop into dangerous balance disorders.

The most common vestibular disorder among older adults is Benign Paroxysmal Positional Vertigo (BPPV). BPPV occurs when the fluid-filled tubes in the vestibular system are disrupted by small pieces of floating calcium carbonate or “ear rocks” called otoconia. This disturbance confuses the vestibular system, sending incorrect messages to the brain and knocking the body off-balance. The Mayo Clinic cites a loss of balance, lightheadedness, nausea, and dizziness as common symptoms of BPPV that may last for less than a minute.

Treatment for BPPV begins with canalith repositioning—a physical treatment that can be performed in a doctor’s office. The doctor will slowly move a patient’s head into various positions for approximately 30 seconds at a time. These movements help clear the area of the inner ear affected by the calcium disturbance. “Over time, your brain may react less and less to the confusing signals triggered by the particles in the inner ear,” Dr. Munir says. “This is called compensation. Compensation occurs most quickly if you continue normal head movements, even though doing so causes the whirling sensation of vertigo. Certain exercises may be done to speed the compensation process.”

If canalith repositioning fails to restore balance, surgery may be required to block up the portion of the inner ear causing the imbalance. While this procedure is less common, the Mayo Clinic reports that it has over a 90 percent success rate.

Improving Balance & Preventing Falls

A loss of balance isn’t something to resign to as a result of growing older. There are simple, easy steps older adults can take to maintain and improve their balance in standing and walking.

Exercising regularly is one way to prevent falls and other balance difficulties. Tai Chi and yoga are frequently recommended as balance improving exercise programs, as they require both strength and flexibility. However, Dr. Munir says nearly any activity that keeps you on your feet and moving—even walking—can help you maintain good balance. “You can even include specific balance exercises in your daily routine, such as balancing on one foot while waiting in line, or standing up and sitting down without using your hands,” he says.

For many older adults, making simple dietary changes can also prevent balance difficulties. The NIH recommends eating low sodium foods and staying away from caffeine and alcohol. Particularly if imbalance is caused by high blood pressure or diabetes, a healthy diet can dramatically improve balance in a person’s body.

Lastly, taking precautions in the home will help reduce the risk of serious fall-related injuries. VEDA suggests taking hazardous things like loose furniture, wires, or rugs out of the home and installing handrails in places where a fall or loss of balance is likely.

As people grow and age, their balance systems often face new challenges. Understanding and treating the causes of imbalance and practicing healthy habits will go a long way in preserving and maintaining strong balance for a lifetime.

Grace Mullaney is a student at Covenant College, majoring in both philosophy and English. She is currently the managing editor of Covenant’s newspaper, The Bagpipe.