Poor balance in seniors and the elderly is associated with an increased risk of debilitating falls. As we age, due to weakening of our muscles and reduced bone density, we lose physical strength and may experience various forms of deterioration in our sense of balance.
These changes increase our risks of falling. What causes loss of balance? Is poor balance in seniors and the elderly inevitable with aging? If you are reading this article, chances are that you may already be having loss of balance issues and are looking for answers. I know I did. I often wondered about my occasional disposition to poor balance and almost tripping for no apparent reason.
By understanding why balance deteriorates, we can find ways to mitigate the effects of old age and maintain a good quality lifestyle beyond retirement.
What is Balance?
Balance plays a key role in our daily activities without us really being aware of it, whether it is standing, sitting or all other types of movement. It provides stability to the body. In your 50s, subtle changes begin to occur (Harvard Health Publications 2020). With aging, a decrease in ability to balance results in diminished confidence to be upwardly mobile. This causes many seniors to become “couch potatoes” which is counter-productive because it accelerates a further decline in muscle strength and balance and then affect the quality of life.
Did you know that as balance declines in seniors and the elderly it causes them to begin to take shorter walking steps, and over time, this can deteriorate into a shuffle type of walk. Sound familiar? You have probably seen this slow calculated walk in some senior citizens. Taking these shorter steps mean that more energy will need to be expended to even travel short distances. No wonder the general complaint of being tired by many seniors!
Is There A Simple Way to Check My Balance?
Yes, there is. There are two simple exercises I learned could give you insight into your balancing coordination. I thought they were pretty straightforward when I read them. My results changed my mind….
- Hold on to the backrest of a chair set against a fixed surface such as a wall or the dining table for safety. Balance on one leg for up to 30 seconds if you can.
- Your goal is to maintain your center of gravity over your ankles.
- Try balancing on each foot for up to 30 seconds. You should be able to do this. If you are unable to do so and you feel unsteady or wobbly, there is definitely room for improvement.
- The ultimate goal of this exercise is for you to build strength and improve your balance by being able, over time, to eventually only hold onto the chair with one hand, then one finger and finally, let go completely as you do the exercise.
- Stand about 12 inches away from a wall where there is no clutter, or beside your kitchen counter for. Both will serve as a safety net to hold onto if you feel unsteady while doing the exercise.
- Place one foot directly in front of each other and try to walk in a straight line from point A to point B.
- If you feel unsteady or wobbly, there is room for improvement.
- Continued practice should eventually allow you to conduct this exercise and improve muscle strength and balance without needing any support
How Does Our Body Help Us Maintain Balance?
Good balance is usually associated with having stable posture. To maintain balance, your muscles need to be strong enough and work efficiently in response to sensory information when you get out of bed, walk around, stand up from your chair and navigate different types of terrain (rough, smooth, mixed) every day to keep you from falling.
HOW DOES THIS WORK?
Three systems help coordinate nerve signal information between our bodies and our surroundings to maintain balance. These are the eyes, inner ear and semi-circular canals (vestibular), and sensory feedback from nerves in your skin, muscles, limbs, joints in ankles, knees, spine and neck.
1. Eyes (Visual System) – Sensory information coming from our eyes provide information about your surroundings such as what type of terrain is this; are there any obstacles in my way that I will need to navigate? Good vision is essential for this.
2. Inner ear (Vestibular system) – The fluid-filled snail shell shaped semicircular canal in the inner ear transmits sensory information about the position of the head and its movement relative to gravity – are you wanting to sit down, stand up, bend down, dance or do acrobatics? This is the organ of balance (Medicinenet 2019).
3. Sensory feedback from the musculoskeletal system made up of the limbs, joints, ankles and hips help maintain a stable stance for however you may want to move.
To maintain balance, all three systems must work efficiently together as the sensory information from each are rapidly and continuously coordinated by the brain.
The speed of processing by the brain becomes slower in aging adults and is one reason why they may be prone to falls. Falls are the leading cause of injuries – including injuries-for people older than 65 (HealthinAging 2017)
What are the Causes of Balance Problems or Disorders?
Balance problems are among the most common reasons that older adults seek help from a doctor, with vertigo being a common symptom (National Institute on Aging 2017).
Poor balance can result in temporary or long-term balance problems, depending on the cause.
Because balance problems may be caused by several factors, treatment may sometimes be difficult. General causes include the wearing of poorly fitting footwear, specific injury, a disorder, or a disease.
Symptoms include feeling faint or lightheaded, sense of motion or spinning (vertigo), dizziness, unsteadiness, vision changes, and confusion (Mayo Clinic 2020)
We will start by looking at some of the more obvious causes.
More Obvious Causes of Balance Problems
1. NORMAL BALANCE RELATED TRIPS & FALLS
You may lose your balance if you accidentally trip over something, or when forcefully pushed as in a crowded mall.
2. SEDENTARY BEHAVIOR
A sedentary behavior (becoming a couch potato) due to aging changes to the body accelerate diminishing muscle strength, balance, loss of bone and an increased risk of falls.
3. POORLY FITTING SHOES
Distorted or painful feet and poorly fitting shoes can pass misleading information to the brain about the type of terrain you are walking on and therefore the nature of required contact with the ground when you are walking.
4. POOR VISION
Eye problems such as cataracts, glaucoma, or macular degeneration worsen your eyesight. They can cause increased susceptibility to glare and poor estimation of depth or height resulting in inaccurate judgment of distance, which can result in poor balance. If there are significant vision problems dizziness may occur and can lead to poor balance.
Less Obvious Causes of Balance Problems
These include cognitive decline, medical conditions, circulation issues, medications and inner ear infections.
With age and inactivity, processing of sensory signals by the brain may become slower due to cognitive decline. As a result, maintaining balance and preventing harmful falls may require ever greater mental focus and prove more fatiguing.
There are many medical conditions in older adults that can affect balance. The normal sensory feedback from your joints to the brain is reduced by swollen feet and ankles and poor flexibility.
- Arthritis – stiffness in the weight bearing knee joints may cause errors in foot placement.
- Diabetes can cause nerve damage or loss of blood circulation to the legs and feet.
- Multiple Sclerosis is a neurological condition which could cause poor balance in elderly adults with the disease.
- Alzheimer is a type of brain disorder that causes problems with memory, thinking and behavior which may cause poor balance.
- Parkinson’s Disease – As the sufferer loses the ability to control muscles, balance can become a challenge.
- Ramsay Hunt Syndrome, while rarer than other diseases mentioned, can also cause balance problems. The disease occurs when the shingles’ virus attacks the vestibular nerve in the ear.
- A sudden drop in blood pressure and other circulation issues can lead to balance problems. Standing or sitting up suddenly from a bed or a chair may cause light-headedness and dizziness (postural hypotension) and can lead to a sudden loss of balance in elderly adults.
- Dehydration, fever, diarrhea, vomiting, use of diuretic medications, very hot weather are other known causes of light-headedness
- A decreased blood flow to the brain, possibly from clogged arteries (atherosclerosis), heart problems (heart attack, slow heart or issues with the heart valves) or, long term neurological conditions (diabetes, Parkinson’s) may cause numbness to the face, arms or legs along with symptoms like hearing loss, double vision, or blurred vision (NHS (2020).
Many medications such as tranquilizers and anti- depressants may cause side effects of dizziness or vertigo. Some commonly prescribed medications among the older population are thought to be linked to dizziness, light-headedness, and increased fall risk (HealthinAging 2017).
These include benzodiazepines, sedatives/tranquilizers, narcotics/opioids, sleeping pills, anti psychotics, blood pressure medicines, anti epileptics, and antidepressants
INNER EAR INFECTIONS
Abnormalities in the inner ear or inner ear infections can cause vertigo which can also affect balance and increase the risk of falls. NHS (2017).
Four Ear-Related Balance Problems
a. Benign Paroxysmal Positional Vertigo (BPPV) – The National Institutes of Health (NIH) state that BPPV is one of the most common types of balance disorders. Most people have never heard of BBPV, but it frequently presents in adults over 60 due to a head injury or an ear infection. Its main symptom is intense vertigo when moving the head and may even be triggered by rolling over in bed.
b. Ménière’s Disease – This causes a sensation of feeling “full” accompanied by vertigo, ringing in the ears (tinnitus), and sporadic hearing loss. Hearing loss can affect balance and increase the risk of falls.
c. Labyrinthitis – When the inner ear becomes infected and inflamed, the result can be balance problems. Labyrinthitis is an inner ear infection often linked to a case of the flu.
d. Ramsay Hunt Syndrome – Older adults may be more prone to shingles’ which is a skin condition caused by a virus. In some cases the shingles’ virus can affect facial nerves near the ear. This causes vertigo, ear pain and loss of the ability to hear.
Aside from the more obvious balance problems being easily prevented, treated or mitigated, many other balance problems are difficult to prevent. Management is primarily through lifestyle changes (see Article).
Simple preventative tips include
- Avoid smoking
- Avoid exposure to anything that can congest your sinus.
- Sit or lie down immediately you feel dizzy and relax
- Prevent low blood pressure by drinking more water and avoiding alcohol. Avoid high blood pressure by exercising regularly, limiting your salt intake, and maintaining a healthy weight.
What Can I Do?
Obviously, if you are experiencing problems with your balance or having frequent episodes of dizziness, you must consult with your doctor or Healthcare provider. A comprehensive diagnosis can then be conducted, and treatment options recommended.
Though there are often many factors involved with poor balance as seniors age, a lot of this decline is sometimes just simply due to inactivity. The good news is that this can usually be improved with exercise and training.
Training will involve improving your body strength along with challenging your balance system daily with activities that require you to use the three systems involved in balancing.
Seniors should aim to be active every day, walking as often as they can, and build up to 150 minutes of moderate exercise a week, which should make you feel slightly out of breath and a bit warmer. This time can be accumulated in ten-minute bursts.
At least two of these short bursts should build strength and balance: examples include lifting weights, yoga, Tai Chi, Otago or postural stability classes, and dancing.
It’s never too late to start! What do you think about this and what are your related experiences? Leave your comments in the Comment Box below and I will respond.
- NHS (2017) Vertigo https://www.nhs.uk/conditions/vertigo/)
- NHS (2020) Dizziness https://www.nhs.uk/conditions/dizziness/
- HealthinAging (2017) Balance problems https://www.healthinaging.org/a-z-topic/balance-problems/symptoms
- 14 Exercises for Seniors to Improve Strength and Balance https://www.lifeline.ca/en/resources/14-exercises-for-seniors-to-improve-strength-and-balance/
- Medicinenet (2019) Balance Disorders https://www.medicinenet.com/vestibular_balance_disorders/article.htm
- Mayo Clinic (2020) Balance Problems – Symptoms and Causes https://www.medicinenet.com/vestibular_balance_disorders/article.htm
- Harvard Health Publications (2020) Preserving your balance https://www.health.harvard.edu/staying-healthy/preserving-your-balance