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.

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.

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.

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

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.