16 Apr 2018
Are you unsteady on your feet? Have you taken a fall and simply shrugged it off? If that sounds familiar, you should read on. According to American Family Physician, balance disorders are among the most common causes of falls in older adults, often resulting in injury, disability, or even loss of independence. And data from the National Center for Health Statistics indicates that falls are the leading cause of injury-related deaths in people over the age of 65.
COMMON CAUSES OF BALANCE DISORDERS
Dr. Cameron Budenz, a neurotologist (an otolaryngologist specializing in ears) and the medical director at Phelps Hospital Balance Center, says the most common balance disorder in seniors is benign paroxysmal positional vertigo. BPPV is caused when calcium crystals in the inner ear become loose and move to the wrong place in the inner ear. Causes can be age-related or a result of prior head trauma or infection. Easily treatable, BPPV can be diagnosed and handled in the doctor’s office, or fixed in one or two sessions with a vestibular physical therapist, who is specially trained in balance issues.
The second most common balance issue in older adults, attributed to the aging process, is multifactorial disequilibrium. This is a chronic feeling of being off-balance and is harder to treat because its causes are often not reversible.
“Our ability to maintain balance is dependent on a lot of different systems. Our ears play a big role and our vision; our ability to see our environment is important. The sensation that we have in our legs and feet is important because it’s constantly giving us information about where we are in space,” says Dr. Budenz. “If there are problems in any of these areas, you can have problems with vertigo… or just general imbalance,” she states.
Kate Walter, senior physical therapist in the outpatient department at Burke Rehabilitation Hospital, says as people age, they lose hearing and can have sight issues like macular degeneration or glaucoma, which all affect balance. “A lot of people over-rely on their vision to maintain their balance,” asserts Walter, “so the inner ear system gets underutilized. Just like a muscle, it can get weak.”
Medical conditions can be an underlying cause of balance problems common with aging. Diabetes can cause peripheral neuropathy, a condition where people lose sensation in their legs and feet. Parkinson’s disease, dementia, back problems, hip/knee replacements, stroke, and high/low blood pressure can create balance issues as well. Stress, depression, medication side effects, postural changes or trunk weakness can also affect balance.
Other balance disorders that can affect any age group are: vestibular neuritis (viral infection of balance nerve in ear) or labyrinthitis (infection of the whole inner ear), Meniere’s disease, or vestibular migraines.
Often, acute balance issues cannot be prevented, but there are still many ways to improve balance. Walter recommends staying active, walking 20-30 minutes up to five times a week, or riding a stationary bike. Practicing balance and strength exercise training – such as balancing on one foot, walking while bouncing a ball, and doing heel raises – can help prevent falls.
Dr. Meryle Richman, a physical therapist, therapeutic yoga instructor and senior director of physical therapy at Ivy Rehab, states, “One of the most important things that I do when I work with someone is to teach them self-awareness and to really start to get in touch with themselves. For instance, where are their feet when they are walking? It is important to know where your body is in space.”
Strength training and flexibility training such as tai chi, yoga, and pool exercise should be done two times a week. Getting regular medical, vision, and hearing check ups, as well as monitoring medications for side effects, helps identify and address balance issues before the condition deteriorates irreversibly.
Walter says that it is essential to make the home a safe environment to prevent falls. If you have a balance issue, make sure hallways, walkways and stairs have proper lighting and nightlights, and are free of clutter. Remove throw rugs that create tripping hazards and get rid of exposed electrical cords.
According to Budenz, “A lot of people get frustrated, and understandably so, with evaluations of dizziness and imbalance because there are so many different systems at play and, frequently, it involves evaluations with several physicians.” You may need to persevere to find a diagnosis and the correct treatment, but that could well be a life-saving course of action.