For most of our adult lives, we strive for balance. In our younger years, this effort is aimed primarily at ‘life balance’ the complicated interplay between work, family, relationships and self-care. But as we age, balance in the literal sense becomes an increasing concern.
“Trouble with balance is common as we get older,” says Dr. Steve Jacobson, an internist with the St. Louis Medical Clinic. “This may be due to one particular problem, such as a stroke, but often is the cumulative effect of multiple small factors.”
Those factors involve several organs and physiological systems. One of those systems is vision, which deteriorates as a person ages. “Vision is part of our balance as it helps us identify the horizon,” Jacobson says. “Poor vision makes us more likely to miss seeing the crack in the sidewalk or toy on the floor and trip.”
Sensation is another factor. In addition to interpreting visual input, the brain’s vestibular system controls our ability to sense where we are in space, explains Dr. David Carr, an internist who specializes in geriatric medicine with Washington University Physicians.
Balance also depends on the ability to sense our surrounding environment, such as the type of surface we’re standing on, he adds. “Some medicines can cause irregularities in the vestibular system,” he says. “And certain types of disease processes can create balance-disturbing sensations, such as chronic vertigo or neuropathy that causes numbness in the lower extremities.”
Carr notes that even if the brain is able to interpret sensory input correctly, integrating that input can be problematic for people with dementia or those who have suffered a stroke or are taking medicines that affect these brain processes. And the complexities of balance don’t end there.
“After the brain integrates the sensory input, there are specific physiological pathways or systems that have to respond by making the muscles and joints work,” Carr says. “This can be compromised by muscle weakness from deconditioning due to inactivity, arthritis of the joints, or osteoporosis, which can alter the center of gravity.”
The array of issues that can affect balance make accurate diagnosis of balance problems a challenge for clinicians. “There are instances where we simply can’t pinpoint the cause because there are probably several things at play,” Carr says. “In those cases, we focus on helping the individual ambulate safely.”
Exercise is one key to maintaining balance and avoiding falls, says Helen Lach, Ph.D., R.N., a nursing researcher at Saint Louis University who studies balance issues and falls in the elderly. “As we age, we need to challenge our balance and move our bodies to keep our systems conditioned,” she says.
“We need to maintain our strength and endurance as we age, and we can overcome some inefficiencies due to aging by continuing to work on our flexibility and strength,” she says. Lach notes that Tai Chi and other types of motion-based activities can help improve balance, but she cautions older adults to start with gentle, safe exercises that are approved by their primary-care physician.
Lach advises looking for community exercise classes designed specifically for older adults and building up to more vigorous exercises over time. Her research indicates that people who are afraid of falling often decrease their physical activity, which compounds the risk because the muscles become weaker.
Physical and occupational therapists also may help in assessing individual abilities and suggesting interventions designed to minimize risk.
“It’s really a quality of life issue,” Lach says. “We want people to engage in meaningful activities, enjoying life and staying active as they age. So remember that even a little bit of activity is better than none, and every bit helps. You don’t have to just accept that balance problems are a normal part of aging, they’re not.”