Keeping Your Balance

About eight million Americans have balance problems and one in three Americans over age 65 will fall every year. Injuries from falls, like a fractured hip, can change a senior’s life in ways seniors fear most—isolation and loss of independence. For seniors and caregivers, understanding keeping your balance and knowing when to get help can go a long way toward avoiding falls and the devastating consequences that may come with it.

“A balance disorder is a disturbance that causes you to feel unsteady, lightheaded, or as if you or the room is spinning. Balance disorders can be due to a disturbance in the inner ear, but they can also be caused by visual problems, skeletal problems, or nerve problems,” says Lawrence Meiteles, MD, medical director of The Balance Center at Northern Westchester Hospital in Mount Kisco, New York. “A balance disorder may also be a sign of a serious medical problem so symptoms should never be ignored,” warns Meiteles.

Symptoms of a Balance Disorder
Being able to maintain good balance means being able to keep a steady position while walking or standing. Someone with a balance problem may walk unsteadily, fall sideways when standing, or have trouble going up or down stairs. Common symptoms that go along with a balance disorder are:

  • dizziness
  • visual problems
  • confusion
  • anxiety
  • nausea

 Common Causes of Balance Disorders
“The most common cause is a combination of factors that go along with aging. We know from studying the inner ear that the cells responsible for maintaining balance start to degenerate with age. Aging and the diseases of aging also affect vision and the bones and joints. Good balance requires that all these systems work together,” explains Dr. Meiteles.

  • Positional vertigo. Vertigo is the false sensation of movement, usually described as spinning. Positional vertigo is caused by cell changes in the inner ear.
  • Labyrinthitis or vestibular neuronitis. The inner ear organ that controls balance is called “the labyrinth.” If this organ becomes infected or inflamed it causes vertigo and loss of balance. The main nerve that communicates balance signals to and from the brain is called the “vestibular nerve.” It can be affected by infection or inflammation.
  • Meniere’s disease. This is a condition in which the fluid inside the labyrinth increases. It affects both balance and hearing. Symptoms include hearing that comes and goes, a roaring sound, a sensation of fullness in the ears, and vertigo.
  • Other causes. Head trauma may cause a leak of inner ear fluid that causes vertigo. Some types of tumors can affect balance. Certain types of medications, circulation problems, neurological diseases, and arthritis in the neck can all be causes of a balance disorder.

Treatment of Balance Disorders
The first step is to see your primary care doctor to rule out common medical problems or medications that might be causing a balance disturbance. If your doctor thinks you need a specialist you will usually be referred to an ear, nose and throat specialist. Tests that may be run include blood tests and special imaging of the brain and inner ear. Depending on the diagnosis, some common treatments for balance disorders include:

  • Vestibular rehabilitation. These are special exercises that are done with the help of a therapist. “When you have a condition like positional vertigo, as soon as you feel dizzy you lie still. This does not allow your brain to learn how to adapt and turn off the dizzy signal,” says Meiteles.
  • Physical and occupational therapy. For people who have long-standing or recurrent balance problems physical therapy can help them strengthen the muscles needed for balance as well as learn techniques to compensate safely for balance problems.
  • Medications and surgery. Medications that calm dizziness, nausea and anxiety may all be useful. If medical therapy and physical therapy are not effective, a surgical procedure that interrupts the vestibular nerve may be needed.

Final Tips for Seniors and Caregivers
Pay attention to the way your loved one describes what he or she is experiencing to know when to seek a medical consultation.

  • Symptoms of dizziness can be hard to express and may be described as feeling unsteady, lightheaded, spinning, moving, giddy, or tipsy. Symptoms other than dizziness may be described such as nausea, blurred vision, anxiety, or confusion.
  • Watch out for any history of falls, a staggering gait, having to reach out and hold on, or trouble getting out of a chair or bed.
  • Seniors may need to rely more on visual cues for balance, so make sure hallways are lit at night.
  • Seniors may not compensate well for a slight trip, so clear walking areas of loose rugs, electric cords, and low furniture.

The ability to balance decreases with age, but losing your balance is not a normal part of aging. Most balance disorders can be treated and many falls can be prevented.

Adapted from an article by Chris Iliades, MD.
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