Balance is one of those things we rarely think about — that is, until we lose it.
Maintaining a good sense of balance is now being recognized as an important factor in overall health. Without it, standing and walking are difficult, if not impossible.
Unfortunately, our balance does tend to become problematic with age. The eyes, inner ear, and nerves in the feet are all involved, said Dr. Wayne Shen, a Salinas neurologist, who calls this “the three inputs for body perception in space.”
But as we get older, our vision is less reliable, the inner ear mechanism that helps with balance can become faulty, and peripheral neuropathy — a lack of sensation in the feet — is more common, said Shen.
Melanie Franke, a physical therapist at Community Hospital of the Monterey Peninsula, notes thatpoor balance not only puts people at risk for falls, but also makes them less confident about being active.
“It’s a vicious cycle,” said Franke, who specializes in balance disorders. “They are afraid of falling, and they become less mobile.” But with inactivity comes the likelihood of becoming more disabled, as muscles atrophy and joints become less flexible.
There are other causes for imbalance as well. When a patient complains of feeling disoriented, dizzy or of falling, physicians do a workup to try to determine the cause. Sometimes medication for other problems is at fault, Franke said; changing to a different dosage or another drug may help. Other factors such as strokes, heart problems or blood pressure issues must also be ruled out.
In older people, though, the culprits are often a change in vision — cataracts, or a new eyeglass prescription that takes some adjustment — as well as inner ear maladies.
Seniors are more likely than younger folks to suffer from benign paroxysmal positional vertigo (BPPV),caused by a disturbance within the inner ear, according to the National Institutes of Health.Sometimes the dizziness and disorientation of BPPV is associated with viral infections or nerve inflammation; other times it’s blamed on small particles or crystals inside the inner ear fluid that become dislodged and float around.
The third factor contributing to imbalance, peripheral neuropathy, is due to nerve deteriorationthat can occur because of diabetes, poor nutrition, or alcoholism, but sometimes due to unknowncauses. It is more common in people over age 60.
Balance becomes a serious matter where the elderly are concerned. According to the U.S. Centersfor Disease Control and Prevention, about a third of Americans over 65 falls each year, but fewer than half talk to their health care providers about it.
Falls resulted in nearly 20,000 deaths and more than two million emergency room visits in 2010.
Such injuries can change the course of a senior’s life. Injuries like hip fractures or head trauma can make it difficult for older adults to live independently, and increases the risk of early death,says the CDC.
The good news, says Franke, is that remaining active will help. The standard for good cardiovascular health — 30 minutes of vigorous exercise most days of the week — also help people maintain their sense of balance.
And for people who do have balance issues, exercise can be beneficial, as are physical and occupational therapy. Franke notes that tai chi and yoga are both ideal exercises for older adults and swimming is also very good, because the buoyancy of the water helps keep them upright andis gentler on painful joints.
In addition, Shen said, seniors need to rely on other cues and to be more cautious in certain situations.
For instance, walking on uneven ground, or an incline, is more hazardous for people with balanceissues, as is walking up or down stairs. Holding on to handrails or using a cane can provide needed support.
Even such ordinary activities as soaping your face in the shower are more dangerous for balance-impaired people; this takes away important visual cues, Shen said. A better choice is to have a shower chair handy, or to lean against a shower wall for support.
The first step, said Franke, is for people to talk to their doctors if they are having balance concerns or bouts of dizziness. After a full assessment, patients can be referred to physical oroccupational therapists for help.
Even better, though, is to head off balance issues long before they’re a problem.
“Staying active is the No. 1 way,” said Franke.
Sources:Interviews with Dr. Wayne Shen and Melanie Franke, October 2012
www.cdc.gov
www.nih.gov
