April 25, 2014

Keeping balance critical as you age, health experts say

“As we age, balance is particularly important,” says Dr. Christine Villoch, who does physical medicine rehabilitation for the Baptist Center for Spine Care.

“As we age, balance is particularly important,” says Dr. Christine Villoch, who does physical medicine rehabilitation for the Baptist Center for Spine Care.

That’s because, as you get older, losing your balance can result in falls and fractures that, in turn, can kick off a downward spiral making it impossible to live independently.

In fact, falls are the leading cause of injury in people over 65, according to a 2005 report by the Centers for Disease Control and Prevention. Every 17 seconds, someone in this age group is treated in an emergency room for a fall. And every 30 minutes, one will die from the injuries received.

By 2040, an estimated $54 billion will be spent on healthcare in direct and indirect medical costs for falls, most of which occur in the home.

“You don’t realize how important balance is until you don’t have it anymore,” says Cathee Connor, an exercise specialist at Baptist Health’s Community Health.

To keep us in balance, our body relies on a complicated system that involves a variety of sensory inputs traveling to the brain where they are sorted out and used to send nerve impulses back to our arms, legs, feet and eyes. These are what help us stand on one foot or take a step up a stair without falling.

Sensory input comes from a number of sources. One is your eyes, where light striking the retina cues sensory receptors to send impulses to your brain with information about where you are in respect to other objects around you.

At the same time, nerves in your joints, skin and muscles send information about where the joints are in space, which is called proprioception. To experience it, close your eyes and bend your knee. You should be able to tell where you knee is and that it is bent, explains Renee Knoll, a doctorate of physical therapy at Memorial Rehabilitation Institute.

Finally there’s input from the vestibular system found in the inner ear. This combination of bones, canals and hair-like nerve endings detects circular motion and movement in a straight line, informing your brain you are starting, stopping or turning.

In the brain, all this information is combined with memories of how you responded to similar stimuli in the past. The brain also considers the automatic movements that it has learned from being repeatedly exposed to them. Think of a golfer who learns to balance while swinging by practicing that motion over and over.

In response to all this information, the brain sends nerve impulses back to the muscles that control movement of your eyes, head, neck, trunk, feet and legs. This allows you to not only maintain balance but also to have clear vision as you move.

“But unfortunately, like anything else, the system does change as we age,” says Dr. Keith Foster, a physiatrist at Memorial Rehabilitation Institute.

Over time, we may lose eye sight to conditions such as glaucoma or cataracts. We might have less sensation in our hands and feet because of peripheral vascular disease or diabetic neuropathy. As the nerves in the inner ear age, they also become less finely tuned, explains Foster.

Changes in your bones and posture also can cause balance issues. For example, spinal stenosis, which is common in people over 65, is a narrowing of the spinal canal that can cause pain. People with this condition may find it more comfortable to walk bent over, which pulls their center of gravity forward. This can make falls more likely, explains Knoll.

Weakened bones due to osteoporosis can make things worse. “In my practice I see a lot of people who have fallen and end up with a hip fracture and other traumatic injuries that can land them in the hospital,” explains Foster.

If you recognize small warning signs that your sense of balance is changing, seek help. These can be things such as nausea caused by vertigo, the use of a wall to support you as you walk (what Foster calls “wall walking”), the inability to stand on one leg to put on pants or a stumble over a curb or other obstacle.

“The earlier you go to your doctor, the safer you’ll be,” says Foster.

If you do have a fall or stumble but aren’t injured, think of it as a warning and let it motivate you to see your doctor before you have a serious problem. “If we can get you into our offices early, that’s certainly much better than waiting for an injury,” he says.

The doctor may do a number of tests to check your balance including something as simple as watching how you walk across a room. She also may see whether you can stand on one leg to test your balance and core muscle strength.

The doctor may test your proprioception by moving your toes up and down to determine if you know where they are in space. And he may check your vision and try to determine whether you have other medical issues that can be treated.

Conditions that may affect your balance include orthostatic hypertension (feeling dizzy when you stand up quickly), stroke, Parkinson’s disease, carotid stenosis (narrowing of the arteries in your neck), inner ear infection, high or low blood pressure, low blood sugar due to diabetes, arthritis and anemia.

“We try to rule out the big things first,” says Foster.

Pain medications also can cause balance problems and can often be adjusted. Poor eye sight can often be improved with surgery or glasses.

“If we can find something reversible, that is much better than just trying to make people cope or make them feel safe after a fall,” he says.

Once medical conditions are treated, your doctor may send you for physical therapy or suggest you start a safe exercise program including aerobics and weightlifting. Weights can help build muscle to support your body, keeping it aligned and in balance. Muscle tone also is important because, if you are bumped, it can help keep you from falling.

A therapist may give you simple exercises to do at home (see sidebar) that build muscle. And she can help you learn to use limited eyesight to better recognize obstacles in your way. You may even be fitted for a cane or walker to help you maintain your balance.

But instead of depending upon this kind of help once you have problems, think prevention.

“Keeping active is key,” says Foster, who recommends finding an activity you like and keeping at it.

Consider gardening, golfing, working out in a gym or walking. “Anything that keeps you on your feet and moving around is good for balance,” he says.

If your doctor gives you the go ahead, you also might try t’ai chi, yoga or a Silver Sneakers exercise program. Connor teaches Pilates in Baptist’s community health program where most of her students range from about 50 to 80. Each class includes a segment on balance.

Jose Gonzalez, 76, and his wife, Zoe, 66, regularly attend her classes and feel they have benefitted.

“Everyone our ages needs a program like this. It helps us keep our balance,” Jose says.

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