Aging Begins at 30

Balance and Falls in the Elderly

Have you tried standing on one foot recently? It's harder than you thought. Older people place their feet further apart when they stand. Unsteadiness occurs in 12% under 70, 30% over 75, and 46% over 85. Impaired balance will ultimately result in falls. Can this unsteadiness be reversed?

About 30% of elderly women, twice as often as men, fall at home each year. Falls cause two-thirds of accidental deaths over 75. Accidents are the fifth leading cause of death over 65.

The brain's data integrating center receives messages from peripheral areas, from the eyes, from the cerebellum (the small coordination brain), and from two sets of 3-way carpenter's levels called labyrinths in the inner ear.

There are ten main categories of poor balance and falls: after trauma (head injury or whiplash), infective ("viral labyrinthitis"), anemia, stroke-associated disorder, heart related imbalance, visual problems, central nervous system disorder, degenerative diseases such as Parkinsonism or Meniere's disease, skeletal changes, psychogenic problems, and physician caused (iatrogenic) disorders. Dizziness is not normal in the elderly, but sway is. Young adults sway side-to-side one inch and the elderly one and one-half inches. With the head tilted 45° backwards, the sway increases. Remember what happened when you tried to hang some pictures?

Short-lived attacks of dizziness with nausea and vomiting or when the patient seems to move or the world around them moves, often arise from the labyrinths. This is one category. Unsteadiness of insidious onset, usually a central brain problem or a general medical disorder. Episodes of vertigo (dizziness) of less than an hour suggests blood vessel trouble. If more than an hour, but less than 24 hours, it is commonly associated with migraine or Meniere's disease (deafness, ear ringing, and imbalance).

Disturbances of balance in the elderly are similar to those in younger patients but often inappropriately diagnosed as age related. Changing drug regimens, providing glasses and a cane, and starting a regular exercise program can improve balance and prevent institutionalization. Are you training to prevent a fall? If not, why not? Strength training can be incorporated with everyday needs such as stair climbing or getting up and down out of a low chair. Neck exercises and one leg standing help too. A reliable test for imbalance is the "get up and go test." Sit in a straight back chair ten feet from a wall, get up and walk quickly to the wall, turn without touching it, return to the chair, turn and sit down.

Fallers are often ill and they need a careful medical check-up. About a fourth have falls of blood pressure on standing. About 55% of falls are due to medical disease and 37% to environmental hazards. A house checklist to eliminate trip hazards should be used.

Doctors should routinely ask the elderly, "Have you had any falls recently?"

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See related Patient Topics Brain and Nervous System, Dizziness and Vertigo, Ear, Nose and Throat, Falls, Safety, Seniors' Health or Symptoms and Manifestations.

See related Provider Topics Brain and Nervous System, Dizziness and Vertigo, Ear, Nose and Throat, Safety, Seniors' Health or Symptoms and Manifestations.

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