why do older people have balance problems

What are Balance Problems? Having good balance means being able to control and maintain your body s position comfortably whether you are walking, climbing stairs, standing, or even sitting still. The terms balance problems or balance disorders refer to a range of conditions with many different causes but similar sensations the feeling that you ve lost your balance or that your sense of up and down is gone. Most older people feel dizzy briefly at some time or other. In many cases, balance problems disappear on their own within about two weeks. But if you have strong or persistent feelings of dizziness, lightheadedness, faintness, or if you sometimes feel shaky, weak, unstable, or just generally physically insecure, you could have a balance disorder. To have good balance, your muscles have to work smoothly together in response to several sensory systems:
the sensations you get constantly from nerves in your skin, muscles, limbs, and joints (called proprioception) These sensory systems supply information about your position in space and the pull of gravity. Errors in any of these systems can produce balance problems. Even when all these systems are working perfectly, the messages still have to be processed, coordinated, and interpreted accurately by your brain and body. Then the right instructions have to travel back out along your nerves to your eyes and muscles. Only then can you keep your balance. Why Balance is Important Your feelings of dizziness may last only a few seconds or go on for days, weeks, or even longer. Whatever the cause or length of time, you will always find it hard to maintain an upright position while the feeling lasts.

You may not be able to carry out simple daily activities such as bathing, dressing, cooking, eating, or getting around your home. Your chance of having a problem with your balance may get worse as the years go by. In fact, balance disorders are among the most common reasons that people over the age of 65 consult their healthcare providers. It is understandable to feel concerned if you can no longer fully trust your sense of balance. Loss of balance also raises the risk of falls. This is a serious and even life-threatening complication. Falls are the leading cause of injuries including fatal injuries for people older than 65. Balance disorders are serious because of the risk of falls. But occasionally balance problems may warn of another health condition, such as a heart disorder, or a problem in the brain or nervous system. Because of all the possible causes and overlapping symptoms, balance problems can be quite tricky to diagnose. For these reasons, it is important to see a healthcare professional so that the source of your balance problem can be properly and promptly identified. Treatments, when needed, are usually simple and effective. The Most Common Types of Balance Problems Vertigo. A sensation that everything around you is spinning or moving, or that you yourself are spinning around. Lightheadedness or near fainting (presyncope). A feeling of weakness, or dizziness. Unsteadiness. A feeling of imbalance, disorientation, and occasionally a loss of your sense of time, or place The type of experience you have depends on the underlying causes.

How Common are Balance Problems? Nearly 8 million adults of all ages in the United States report balance disorders each year. About one-third of the older population reports difficulty with balance or walking; the numbers increase significantly after age 75. All in all, almost 40% of older adults are affected. In adults over age 65, balance problems are linked to falls. One-third of adults in this age group and over half of people over the age of 75 years fall each year. Men and women are affected about equally. The stability of posture and gaze during standing and walking is maintained by the rapid processing of vestibular, visual and somatosensory inputs in the central nervous systems, followed by outputs to the musculoskeletal and visual systems. Every factor in this system deteriorates during aging. Age-related deterioration of peripheral vestibular function has been documented by measuring the vestibulo-ocular reflex (VOR) using rotational tests and/or caloric tests, both of which reflect function of the lateral semicircular canals [ ]. Sinusoidal rotation tests in normal adults over the age of 75 years showed a decrease in VOR gain as well as the VOR time constant, especially with high velocity stimulation, as compared with young subjects [ ]. In a longitudinal study of normal subjects older than 75 years old, a progressive decrease in VOR gain and an increase in phase lead were observed during five annual examinations [ ]. Another study assessing performance in sinusoidal rotational tests and caloric tests in normal subjects from 7 to 81 years old reported a decline in the response amplitude and less of a compensatory response phase with increasing age in the rotational test, while the caloric test showed no consistent trends with age [ ].

These results suggest that age-related changes in vestibular system preferentially affect the high-frequency component of the VOR since the caloric testing reflects the low frequency component of the VOR. Age-related deterioration of peripheral vestibular function has been demonstrated in other vestibular tests. Vestibular evoked myogenic potentials (VEMPs) are short-latency muscle responses typically recorded from the neck muscles (cVEMPs) or from the eye muscles (oVEMPs) [ ]. Clinical and physiological studies have shown that cVEMPs reflect the function of the saccule and the inferior vestibular nerve whereas oVEMPs reflects the function of the utricle and the superior vestibular nerve [ ]. A cross sectional study of consecutive patients ranging from 7 to 91 years old showed an age-dependent decrease in cVEMP amplitude and an increase in cVEMP latency [ ]. Similarly, oVEMPs show an age-dependent decrease in amplitude and an increase in latency ( Fig. 2 ) [ ]. These results suggest that the function of the otolith organs as well as their central pathway also deteriorate with increasing age. Recently, Agrawal et al. (2012) measured the function of the semicircular canals, utricle, and saccule using the head thrust test, oVEMP, and cVEMP, respectively, in healthy subjects more than 70 years old [ ].

They showed that the function of the semicircular canals as well as the otolith organs decline with age, although the magnitude of impairment was greater for the semicircular canals than the otolith organs. However, deterioration of the results of the head thrust test might reflect an element of deterioration of oculomotor function as well as the semicircular canal function. Age-related changes in postural stability have been examined using posturography, in which changes of the center of pressure was measured during quiet standing [ ]. For estimating the role of different sensory inputs on postural control, dynamic posturography using a moving platform or a foam rubber surface have also been developed. In most studies, all measures of balance performance get worse in older subjects compared with younger subjects ( Fig. 3 ) [ ]. This age-related decline in balance control is correlated with deterioration of visual, vestibular, and sensorimotor function as well as reduction in strength of the lower muscles. Teasdale et al. (1991) have demonstrated that alteration in any two of the three sensory inputs (visual, vestibular and somatosensory) had a significantly greater effect on older subjects than in younger subjects whereas alteration in one input did not have a significant effect due to age [ ]. These results suggest that decreased inputs from the vestibular, visual and somatosensory systems in older subjects lead to a decreased capacity for compensation by the other inputs in order to maintain postural stability.

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