Balance Problems As We Age 
By: Dr. Rina Caprarella

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Falls pose a large health concern as we all age. The risk of falling increases with age and is at its highest after the age of 80. This typically stems from problems with walking that result from poor balance that is commonly described as an unsteady gait. Balance difficulties are usually related to many cases and can be due to:

1. Decreased visual acuity from cataract formation, glaucoma, or macular degeneration so routine eye exams are necessary.

2. Vestibular system disruption (balance center of the brain) and can present with vertigo that is a sensation of either the room spinning or the patient spinning. This is typically more abrupt in onset. One of the more common causes includes benign paroxysmal positional vertigo (BPPV). It occurs due to the presence of normal but misplaced calcium crystals in the inner ear that is used to sense movement. This leads to a miscommunication between the inner ear and the brain leading to a sensation of motion.

3. Neurological abnormalities such as strokes are more commonly seen in the elderly population. This can impact gait by affecting the pathways of the brain that control strength, sensation, balance, and vision.

 4. Movement disorders such as Parkinson’s disease result in a slow, shuffling gait with small steps, difficulty in turning, and a tendency to fall backwards.

 5. Normal pressure hydrocephalus is more commonly seen after age 65. This results from a build up of cerebrospinal fluid, which is normal fluid in the brain. Due to the increased pressure on the brain, a triad of symptoms develop and include: Magnetic gait (the patient walks as if their feet are glued to the ground), Urinary incontinence and Dementia.

 6. Peripheral neuropathy is a common entity that impacts gait stability. This describes damage to the peripheral nervous system. Typically, symptoms include numbness, “pins and needles” sensation, unsteadiness, and burning pain beginning in the feet and legs. Common causes include diabetes and vitamin B12 deficiency.

 7. Musculoskeletal weakness can involve impaired range of motion of the joints and decreased strength and flexibility. This is why exercise is so important.

 8. Spinal stenosis is a narrowing of the spinal column due to arthritic changes that become more common with age. This results in pressure on the spinal cord or a narrowing of the openings where the spinal nerves exit to travel to the rest of the body. Symptoms involve pain in the legs and lower back with numbness/weakness/poor balance.

 9. Impaired cognition that is seen in dementia leads to gait difficulties due to the inability to anticipate or adapt to changes in the environment.

 10. Cardiovascular limitations in the setting of low blood pressure can also result in a sense of unsteadiness while walking.

 11. Medication interaction/side effects need to be evaluated as an appropriate change can significantly improve gait safety.

Precautions for the home environment can also be helpful in preventing falls in the elderly patient:

– Improve lighting

– Install grab bars in the bathroom

– Remove hazardous conditions on floors such as loose rugs

– Improve stairway safety

– Walking aids such as a cane or walker can be considered and should be matched to the need of each patient by a healthcare provider

Overall, continuity of medical care, awareness of a deficit for early treatment, and physical activity can sustain gait health and prevent falls