Balance

Balance problems and disorders

Balance is an easy thing to take for granted, especially when you’re young. The complex processes by which you stay upright and move gracefully through space are barely noticeable when functioning properly. But balance problems often begin to appear in a person’s later years. It may start with a feeling that your equilibrium is off, and can worsen to the point that a fear of falling limits your everyday activities.

Balance issues in older adults are a serious problem. According to the CDC, each year there are about three million emergency department visits due to falls in older people. The vast majority of hip fractures happen when an older person slips and falls. Falls are also the most common cause of traumatic brain injuries.

One of the most pernicious aspects of balance issues in seniors is that, once a person’s balance starts to diminish, they can enter a cycle of deterioration — being unsteady or feeling dizzy makes them refrain from physical activity. This can exacerbate the underlying age-related changes that cause the deteriorating balance. After a fall, some seniors develop a fear of falling that makes them tense up, shuffle when they walk, and restrict movement in a way that actually increases the risk of a fall.

Because so many body parts and systems are involved in maintaining balance, balance disorders may arise from a wide range of conditions. Small nerve fibers in the feet become less sensitive, which can make people unsteady. A severe cold can cause a temporary disruption of your inner ear balance. Medications can cause dizziness. But physical changes due to aging are the most common reason for declining balance.

What causes balance problems?

Loss of balance can be tied to changes (either temporary or long-term) in different organs and systems of the body.

A key area implicated in balance problems is the inner ear’s vestibular system. Movement of fluid within a series of structures including tiny canals, reservoirs, and hairlike cells sends signals to the brain communicating the head’s position. Miniscule grains of calcium carbonate move to apply pressure on the hairlike structures whenever the head tilts, alerting the brain to the body’s movement through space. When these structures are damaged, or when vestibular nerve cells decrease with age, we are more likely to experience dizziness and vertigo.

Eyesight is another important balance-related function, since we need a clear sense of our surroundings to stay on our feet (If you doubt this, try standing on one foot with your eyes closed). When someone develops vision problems, their ability to judge distances and depth of field can lead to their losing balance.

Throughout our muscles, joints, and tendons, nerves called proprioceptors tell the brain about subtle changes in conditions that call for adjustments, as when you step onto a patch of ice. With lightning speed, the brain sends instructions for how to react. When our muscles and tendons are weak, stiff, or slow, we are less likely to avoid a fall.

While aging can affect any of the above systems, so might prescription medications. Drugs can make you feel sleepy (dulling your reflexes), can cause you to feel dizzy, can make your vision blurry, can alter the fluid in your inner ear, and can introduce damage to nerves. Some common drugs associated with balance problems are antidepressants, antihistamines, blood pressure meds, diabetes drugs, heart medications, painkillers, and sedatives. Taking multiple drugs further increases risk of balance-related complications. If you’re worried about falls, be sure to ask your doctor about your medications, and balance problems that could arise as side effects.

When should I call the doctor about balance problems?

Although it is natural to notice a decrease in your sense of balance starting in your 50s, you should not consider a severe loss of balance to be an inevitable result of aging.

Any new balance issues or dizziness should prompt a call to your doctor. Talk to your doctor if you notice increased dizziness, lightheadedness, or vertigo (the feeling that the room is spinning).

You should always tell your doctor if you’ve fallen, even if you weren’t hurt. Similarly, report any uptick in near-falls. Falling is the leading cause of injury for people ages 65 and older. It’s important to seek help for any balance problems before experiencing severe consequences of a fall such as bone fractures or head injuries.

How are balance problems diagnosed?

Your doctor will perform a physical examination, paying special attention to your blood pressure (lying down and standing), watching you walk, and checking nerve sensitivity in your feet. He or she will also review the medications you’re taking to see if there are balance-related side effects to individual meds or to drug combinations.

Depending upon the results of the physical exam, the doctor may refer you for further testing. For example, age-related changes of the inner-ear structures are a common cause of balance issues in seniors, and may be evaluated by an otolaryngologist (ENT) or otologist.

How to improve balance

Although it’s typical for balance to diminish with age, there are things you can do to improve it.

First, you and your doctor will address any underlying condition or issue that may be negatively impacting your balance.

Review your medications with your doctor in case one or more is contributing to poor balance. Get periodic eye exams even if you haven’t noticed any vision changes.

Make sure you are consuming enough fluids, since dehydration can contribute to dizziness and loss of balance.

Many activities can help you maintain — or even improve — balance as you age. For example, yoga can improve your flexibility, as well as your ability both to hold your body steady and to perform disciplined movements. Tai chi, a series of fluid, choreographed movements and poses, increases your balance while building muscle strength and stamina. Pilates exercises build strong core muscles and flexibility, essentials for good posture and balance. Because muscle strength is crucial, you can build balance with strength training — using free weights, machines, bands, or simply your body weight — through activities like stair-climbing, walking, and cycling. Stretching and core exercises help improve posture and balance.

There are also specifically designed balance exercises for seniors. Some balance exercises can even be performed while seated. A personal trainer or physical therapist can recommend specific exercises for balance targeted to your fitness level and needs.