Is it a little more difficult to stand up from a chair than it used to be? Perhaps walking on uneven surfaces, like grass or gravel trails, makes you a tad apprehensive? Or maybe you just feel clumsier playing tennis, dancing, or golfing? How we move in space can change for many reasons. The signs may be subtle but shouldn’t be ignored. Addressing them may increase your quality of life by reducing your future fall risk.
“Having one fall increases the risk of having another, not only because of vulnerability from the injury, but also because people often become scared,” explains physical therapist and geriatric clinical specialist Susan Stich, MSPT, UCLA Therapy Services. “Increased fear can lead to reduced physical activity, resulting in a weaker body and leading to more falls. It’s a vicious cycle.”
According to the National Council on Aging, one in four Americans ages 65+ falls each year. Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall. Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults.
In broad terms, your sense of balance comes mainly from the eyes, ears, and information from your muscles and joints, says Stich. If any of those systems are not functioning properly, balance can go awry. In addition, certain medical conditions and treatments for them may cause dizziness or other symptoms that compromise balance. The more you know, the better you can address and manage risk factors. To follow are some of the most common reasons why balance may be challenged and some interventions that can help you overcome the balance issues.
Chronic Conditions
It’s estimated that 50 percent of people with diabetes have some form of nerve damage. Diabetic neuropathy is a type of nerve damage that most commonly occurs in the legs and feet. It reduces the ability to feel the feet, making it difficult to sense the ground, so walking becomes wobbly. Nerve problems can develop any time within the first 10 years of diagnosis. Uncontrolled glucose levels hasten the process. People with diabetes should monitor glucose levels and take medications as prescribed. Lifestyle changes can be quite helpful and may reverse the disease.
Some studies have shown that medications for controlling high blood pressure may actually increase fall risk by excessively lowering blood pressure. There is truth in that, but the more germane message is to avoid aggressively lowering blood pressure. This makes at-home blood pressure monitoring important, especially when starting a new medication. Research from Kaiser Permanente published in the American Journal of Preventive Medicine found that if patients with hypertension taking prescribed medications experienced unusually low blood pressures (systolic blood pressure under 110 mmHg), they were twice as likely to experience a fall or faint as compared to people whose treated blood pressure remained 110mmHg and above. According to the researchers, older adults are also are more susceptible to the side effects of low blood pressure. For example, they are more likely to experience orthostatic hypotension, which is a sudden drop in blood pressure upon standing, leading to dizziness.
Cardiovascular diseases also may create disruptions in balance. For example, abnormal heart rhythms (heart arrhythmias), narrowed or blocked blood vessels, a thickened heart muscle (hypertrophic cardiomyopathy), or a decrease in blood volume can reduce blood flow and cause sensations of severe lightheadedness and fainting. Long-term medical conditions that affect the nervous system, such as Parkinson’s, Alzheimer’s, and multiple sclerosis can disrupt balance. Arthritis affects bones and joints, which can compromise movements. This can lead to poor body mechanics, such as limping to favor one leg over another. Avoiding arthritis joint pain may lead to inactivity, which ultimately exacerbates the problem. Working with a physical therapist can help people regain strength, correct imbalances, and reduce pain.
People with chronic conditions often take several medications, which can interact in ways that make a person feel unsteady, sleepy, or dizzy (a common side effect). Always ask your doctor about a medication’s side effects, so you know up front what may occur. Report any side effects as soon as possible. There may be alternative medications to try.
And finally, consider vision. The eyes send information to the brain about the environment. If you can’t see well, it’s more difficult to navigate and move confidently. Annual eye exams help catch early onset of diseases, such as macular degeneration or cataracts. Vision does change through the years, so updating prescriptions for eyeglasses and contacts is needed periodically. If you wear bifocals, be especially mindful when moving. Don’t wear them while going downstairs, for example, as this can lead to missteps.
Balance Disorders
Some balance disorders are caused by problems in the inner ear. Benign paroxysmal positional vertigo (BPPV) occurs when calcium crystals in your inner ear are dislodged from their normal positions and move elsewhere in the inner ear. BPPV is the most common cause of vertigo in adults. Symptoms include a spinning sensation when turning in bed or tilting the head back to look up. Physical therapists can perform and teach particular head maneuvers that often resolve BPPV.
The part of the inner ear that is responsible for balance is the vestibular system, also known as the labyrinth. A condition called labyrinthitis occurs when the labyrinth becomes infected or swollen. It is typically accompanied by vertigo. Labyrinthitis can result from upper respiratory infections, other viral infections, and, less commonly, bacterial infections. Treating those infections usually restores balance. Head injuries, motion sickness, and migraines are other common causes of dizziness that can disturb the inner ear system and increase fall risk.
Physical Fitness Matters
Muscle strength diminishes slowly through the decades. However, the rate of loss is accelerated by poorly managed chronic conditions, sedentary lifestyles, and nutrient-deficient diets. But with effort, those risk factors can be mitigated. “There are a lot of studies that show that a regular exercise program that includes muscle strengthening can help lower the risk of falls,” says Stich.
Consider setting up a home gym with a few inexpensive items. A lot can be accomplished with some dumbbells of various weights and/or flexible bands or tubing. What’s needed most is a defined routine and a dedicated practice. For example, it’s generally recommended to do resistance training two to three times per week. Comprehensive programs that include strength and balance routines can be found online at SilverSneakers.com and at the National Institute on Aging at http://tiny.cc/qmc3oz.
Weight-shifting exercises can be especially important. A Canadian study published in the Gerontologist reported that 41 percent of falls in long-term care facilities were due to incorrect weight shifting. Researchers also noted that incorrect weight transfer caused twice as many falls as tripping. While these findings do not address the probable existence of underlying medical conditions that may have contributed to the mishaps, the biomechanics of the falls were recorded on video and added to the body of knowledge of how falls occur. As a result, some preventive strategies were developed. For example, adding weight-shifting exercises (see below) are a smart addition to your daily physical fitness routine.
“We commonly give patients weight-shifting exercises and train them on different surfaces, such as foam pads, to challenge their balance reactions,” says Stich. “Also make sure your home is free of clutter, with clear pathways for walking. In addition, nonskid rugs, good lighting, and grab bars in the bathroom reduce fall risk by creating a generally safer environment.”
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