Why is balance important?

Dizziness, poor balance and falls are a major threat to the health and independence of older adults. Falls are very common in people aged 65 and over, with 1 in 3 older adults falling at least once a year. Falls can be serious and are the number one cause of injury and hospital visits due to trauma.

Did you know?

Falls are the leading cause of injury related hospitalisation and death in adults aged 65 and over

Dizziness in older adults

Dizziness is very common in older adults and is one of the most common reasons to see a doctor for people over 65. Many things can make you feel dizzy, but older adults often get dizzy when:

  • Rising to stand
  • Looking up
  • Turning the head to the side

This can lead to instability and falls. Many causes of dizziness can be treated and you are more likely to have more than one cause of dizziness when you are older. By identifying and managing your dizziness, you can often reduce symptoms and improve your quality of life.

Did you know?

Older adults who fall over are more likely to have a problem in the inner ear balance compared to non-fallers (80% vs 19%)

How does the balance system work?

Having a good balance system means you can walk around safely, rise from a chair, climb stairs, bend over, dance, and look side to side clearly. For good balance, we all need:

  • Balance systems in the inner ear. This is called the ‘vestibular’ system. It is like a compass in the inner ear that senses all types of movement to maintain our balance.
  • Good vision
  • Strength and sensation from our muscles and joints
  • Functioning balance areas in the brain

How does our balance change as we get older?

As we get older there are many factors which can slowly affect the balance system, making us feel generally unsteady and ‘off- balance’ on our feet.

Vision starts to get worse, as our eyes:

  • Take longer to adjust to sudden changes in light and dark
  • Are more sensitive to glare
  • Are less able to judge distances and depth

This can make it difficult to judge the height of curbs and steps and walk into a dark room.  You are also more likely to develop eye conditions like glaucoma or cataracts as you get older. If you have noticed any changes or loss of eyesight, talk to your doctor as soon as possible.

Did you know?

Multifocal glasses increase the risk of falling. This is because the change in the lens can make it difficult to judge distances or edges and objects on the ground.

Top Tip

Consider having two separate pairs of glasses:

  • A pair of reading glasses or multifocal glasses for up close activities like driving
  • A separate pair of single lens distance glasses for walking and outdoor activities

Muscles start to get weaker. This can make it harder to walk up the stairs, slopes or across uneven ground.

Did you know?

We lose 1% of muscle strength a year after the age of 40

Any loss of inner ear balance can disrupt our balance. This means you need to pay more attention to perform normal everyday activities.

  • Balance pathways into the brain also start to slow down after the age of 40 (by 3% per decade).
  • The nerves that supply the balance system start to deteriorate after the age of 50, and by the age of 80 are about 40% less responsive.
  • The inner ear balance becomes less responsive as you get older.
  • Whilst walking speed can vary between people of the same age and sex, there is a consistent trend for walking speed to decline after the age of 60 years.

These factors can all gradually lead to a steady decline in balance which may make you feel unsteady as you walk, and may be even worse in busy places, on uneven ground, or in the dark. In some, this will also cause loss of confidence and may eventually leave you unable to go out.

Why is medication important?

Some medicines can make you dizzy or drowsy. People who are on 4 or more medications are at a higher risk of falling. Having a regular medication review can reduce this risk.

Top Tip

  • If you are on four or more medications, you should ask your doctor for a medication review every 6 months
What about other medical conditions?

By the ages of 60-64 years’ people have on average two medical conditions. Some conditions such as heart problems, diabetes, or neurological conditions like Parkinson’s disease can affect the balance system. No matter what your age, health or ability, you should try to do some form of physical activity every day. If you have another health condition that might limit your ability to exercise you should speak to your healthcare professional for advice before starting a new programme.

Why is fear of falling important?

About half of older adults are concerned about falling. This is very common if you have fallen before, or know someone who had a bad fall. You might also be concerned because you don’t feel steady on your feet anymore. If fear of falling is often on your mind then it might stop you from doing activities you enjoy. It also causes you to be more cautious when walking, which could make your balance worse. If you are fearful of falling:

  • Speak to your health professional about strategies you can take to reduce your risk of falling
  • Balance exercises can help to improve your confidence and balance
  • Try exercising with someone, before doing it on your own

Did you know?

Fear of falling can increase your risk of having a fall

What can be done to help my dizziness/balance?

Although there are natural physical changes that occur as we age, dizziness and falls are not “just part of getting older.” There are still things you can do to help. You should ask your doctor to refer you see a specialist physiotherapist interested in these problems. Physiotherapists have special training to look for the causes of your dizziness and/or unsteadiness and to see if you at risk of falling. Once a full assessment has been carried out a treatment plan will be discussed with you.

Vestibular rehabilitation is the branch of physiotherapy that deals with managing dizziness and balance disorders. It usually consists of several different exercises that can be performed in the clinic and at home. It has been shown to be beneficial in older adults with and without vestibular problems and can improve symptoms and reduce the number of falls. Usually a physiotherapist will monitor your progress over the course of a few weeks or months.

Top Tip

  • Find a physiotherapist in your area who sees people with dizziness and balance problems here: www.acpivr.com/providers

Are there other ways I can increase my activity levels?

Activities which are particularly good for balance include:

  • Tai Chi
  • Lawn Bowls
  • Dancing
  • Group exercise classes
  • Home exercises
  • Pilates
  • Yoga

It is also important to do activities that get your heart rate up and build fitness. These include

  • Aqua aerobics
  • Brisk walking
  • Golf
  • Group exercise classes
  • Swimming
  • Tennis
  • Badminton