Balance and Falls Part I “What is Happening?”
Updated: Apr 6, 2021
One of the most common problems in aging adults is a decrease in balance and an increased risk for falls. According to the CDC, one in four Americans aged 65 and older fall each year, and in Texas, it is closer to one in three. Every eleven seconds, an older adult is treated in the emergency room for a fall, and every nineteen minutes, an older adult dies from a fall. In fact, falls are the leading cause of fatal injury and the most common non-fatal related hospital admissions among older adults.
One common question is, “Why am I having balance issues?” There are many different contributors that can lead to a decrease in balance and an increased fall risk, but there are several changes that happen as we get older. The three main systems that make up our balance system are Somatosensation, Vestibular, and Vision.
Somatosensation is how your body knows where it is in space. You get this information from the sensation in your feet, and proprioception cells in your joints. Now, as we age these cells and nerve fibers may not work as well; in fact, studies show that by ninety years of age there is an average of a 30 percent decrease in sensation, and proprioception. Peripheral neuropathy is a common issue with this system and can pose a problem with balance.
The vestibular system is a complex system made up of parts of the inner ear and nerves. It is responsible for telling us where our head is in space. The vestibular system is what helps us keep our balance on unsteady surfaces like loose gravel. There is a loss of about 40 percent of vestibular nerve cells by the age of seventy, and a 3 percent loss per decade of vestibular nucleus cells from age 40 to 90. This just means that the vestibular system starts to decline at around forty years of age.
The vision system is important as we age, and we typically become more dependent on this sense. Think about how it affects your balance when you are in a dark room or close your eyes. Unfortunately, this system starts decline as we age, as well. We need more light to see what we’re doing, and we just don’t see as well, especially if there are any cataracts or macular degeneration.
There are other things that contribute as well, such as loss of muscle mass, osteoarthritis, cognition, medications, decreased flexibility, pain, and fear of falling. These can all contribute to an increased risk for falls. Lower extremity strength can decrease by up to 40 percent from age 40 to 80, and there is an average of 50 percent less flexibility in 70 to 84-year-olds compared to 20 to 29-year-olds.
As you can see, as we get older, we have some things working against us when it comes to our balance systems. Everyone experiences this differently and will need a specific program to address their unique deficiencies. That’s why generic balance programs don’t tend to work too well. It’s not all doom and gloom, however, and the good news is that there are things you can do to improve your balance no matter your age. I will get into that in Part II of Balance and Falls, “What Can I Do?”