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A Matter of Balance

Written by  Rick Piester

It seems like a usual day. Everything’s normal. Then it comes out of nowhere.

You’re stepping off a curb and suddenly the world seems to tilt. Or you’re going down the stairs and there’s no longer a step where you expect it to be.

And down you go.

In a flash, before you can even think about it, you’re among the one in three adults over 65 who will suffer a fall each year, more than 2.4 million older Americans treated in hospital emergency departments in 2012.

Maybe you’ll be lucky enough to escape serious injury, although there’s still a 50-percent chance that you will fall again soon, and next time you probably won’t be as lucky.

The greater chances are that you will suffer serious injury, serious enough to prevent your ability to walk a city block. And if you break a hip in the fall, as many do, there’s a pretty good chance (1 in 4) that you will die within a year.

Aging is no guarantee of a fall, but experts say that because of the aging process, the chances do increase dramatically.

Our sense of balance depends on a complicated combination of sensory factors that allow us to walk a straight line. There’s the inner ear, a sort of compass that keeps us on an even keel. There’s our vision, which provides continual clues as to where we are in space. And our muscles and joints, particularly our feet, which gives us a sense of strength, stability, and mobility.

As we become older, particularly in people who are inactive, our muscle mass deteriorates and joints and ligaments lose strength, limiting our range of motion.

Aging eyes can and often do develop problems such as cataracts and glaucoma, which can curb vision dramatically. Diseases like diabetes and kidney ailments can produce peripheral neuropathy, the loss of sensation in our feet.

A combination of medical causes — “co-morbidity” in medical-speak — can further accelerate the body’s inability to respond to the brain’s commands.

And medicines, particularly blood-pressure medications, can sometimes have a profound effect on our sense of balance.

Sometimes, we don’t really have a sense of deteriorating balance. We create unconscious accommodations to make up for it, such as lightly touching a piece of furniture while walking through a room. We don’t recognize the signs, or simply ignore them, until that first fall.

There’s a difference between dizziness and imbalance. Dizziness, or vertigo, is when the world seems to be going ‘round and ‘round. It’s often associated with disorders of the inner ear.

Imbalance is usually not announced by a feeling of dizziness. It’s a case of failures in the transmission of signals between your brain and your body, although the gradual, age-related decline of the vestibular system (the complex structure of fluid-filled tubes in the inner ear) can also result in problems with balance without a feeling of dizziness.

Either way, it can be a serious problem. Falls and the fear of falling are among the most serious health issues facing the growing population of older adults. And people who restrict their activities can further reduce their independence. It’s a vicious cycle — the more inactive you become, the less you are eventually able to do, and that can well damage your overall health.

Lynchburg physical therapist Andrew J. Tatom III, DPT, makes a strong case for avoiding falls. “Falls are the leading cause of both fatal and non-fatal injuries,” he notes, “yet they are probably among the easiest things to avoid if people know what to do and take responsibility.”

Dr. Tatom is site director for the Clifton Street office of Rehab Associates of Central Virginia. He says that he treats many people for orthopaedic ills, such as bad backs or painful joints, and that many times people are surprised that they have balance issues that are caused by the underlying orthopaedic problem. “We don’t practice balance anymore,” he says. “We sit and watch television, and we don’t get much exercise. Or if we do exercise, we grip the handles of our exercise bikes or hold on to the bars of our treadmills. That’s good cardiovascular exercise, but it doesn’t do much for our balance.”

So what are some of the signs that you might have a balance problem?

“Sometimes the signs are very subtle,” Dr. Tatom says. “You could be standing someplace and then start to move and need to touch the wall or a piece of furniture for balance. Or there’s a wash basket full of laundry and you’ll become more tentative about carrying it up or down stairs. And often, it’s the people around you who will notice things like that before you do.”

Even the simple task of moving from room to room at home can give a telltale sign, he says. “Your shoes are just millimeters above the floor,” he says, “so even a very thin threshold going from a wooden floor to a carpeted floor can be a risk.”

Physical therapists often ask new patients to stand on one foot for a moment or two, sometimes with their eyes closed. If you are unable to do that, you should speak with your physician about a possible problem with your balance.

Try walking a short distance backwards. If that doesn’t work, it may be a sign of diminished balance. Or try to walk a short distance using what’s called “tandem” walking. That’s walking with the toes of the back foot touching the heel of the front foot with each step.

Or, simply, talk with your physician about ordering a baseline physical evaluation, often done by physical therapists. Having the evaluation done, even in your 40s or 50s, can go a long way toward spotting little problems that may turn into big ones later on, and can set you on your way to helpful exercises that very likely will help avoid many problems as you grow older.

Imbalance is a problem that never gets better, but there are a number of measures older people can take to manage difficulties with balance and prevent falls. One of the first things Dr. Tatom and many other experts recommend is to get into an exercise program tailored to improve or preserve balance.

The American Geriatrics Society, in fact, recommends tai chi — the slow-motion Chinese exercises — as an effective way to prevent falls. Tai chi is based in part upon the correct alignment of the chest, pelvis and head to provide strength and maintain balance. The slow, controlled motions of tai chi are also a non-impact form of exercise that builds strength without raising the fear of falling. Yoga also lowers the stress and anxiety felt by people with balance problems. Water aerobics, exercise routines practiced in swimming pools, are undergoing renewed techniques and interest.

Daily supplements of vitamin D is increasingly recommended for a constellation of health reasons, muscle strength and balance among them. In a review of nine research projects, the United States Preventive Services Task Force found that a daily dose of 800 international units (I.U.) of vitamin D reduced the risk of falling by 17 percent, compared to people who did not take the vitamin. (As with all things medical, check with your physician or pharmacist before taking any kind of medication, to avoid the risk of harmful drug interactions.)

Health professionals offer a laundry list of things to be done at home to decrease the risk of falls. Among them:

  • Drink plenty of fluids during the day. A dehydrated body can suffer dramatic drops in blood pressure, which in turn can play havoc with your sense of balance.
  • Slow down a bit. Take a beat or two between standing up and further movement to be sure that you have your bearings. This is especially important when getting up in in the mornings. All night, you’ve been lying flat, with blood pumping nicely to your brain. You wake up in the morning and sit up, and all of a sudden the heart has to pump against gravity. That’s one of the danger times for falls. So take a minute or two for the heart and blood vessels to become adjusted so that they’re moving blood to your brain efficiently.
  • Be careful on stairs. Not surprisingly, stairs are among the most likely places for a serious fall. Put up handrails, on both sides of the stairs. It’s best for stairs to have no coverings, no carpet or runners. And keep them clear.
  • Use good lighting. Deploy plenty of night lights, and even motion-sensor lighting through the house, especially between bed and bathroom.
  • Be careful in the bathroom. Bathrooms are a big fall zone. Surfaces in the bathroom are hard and often slippery, an awful combination for bones of any age, but especially bad for the fragile bones of older adults. Install grab bars — the kind that are securely screwed in to wall studs, not the type with suction-cups — at easy-to-grab spots in the bathroom. Commodes that are built higher make sitting down and standing up easier and reduce the chance of losing balance.
  • Use a cane and, if you need it, a walker. There’s a lot of old-age stigma attached to them, but try to think of them as just another way to maintain contact with the floor or ground.
  • Keep floors clear. Newspaper and magazines, even pet toys and feeding dishes can be hazardous, as well as the pets themselves. Putting a bell on a pet’s collar or even a glow-at-night collar can reduce the chances of being tripped up by Fido or Fluffy.

Despite what some folks think, falling isn’t a natural part of aging. You can avoid falls by taking stock of your risk factors, getting the right kind of exercise, and removing the hazards that can cause trips and slips.

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