Balance, ageing and falls

August 29th, 2018 | by Jake Cooke | Posted in Balance

Movement is based on sensation.

The primary goal of your brain is movement. Movement is based on sensation. Your brain uses information from your eyes, ears and body to create a 3D map your body and environment. Once your know who you are and where you are, you can start to interact with your environment. This is fundamental to all else and because of this is an excellent indication of health and ageing. If you want a reliable indication of how your body is aging, don’t look in the mirror, look at your balance.

Normal balance.

In the table below, you can see the normal length of time that you should be able to stand on one leg with your eyes open or closed for your age. Before trying this test make sure that you are in a safe space, with something to grab in case you fall e.g. a sturdy banister. Don’t try it somewhere daft like the top the stairs or with toddlers running around your feet.

Age Seconds
Single leg stance, eyes closed. 18-39 9
40-49 7
50-59 5
60-69 3
70-79 2
80-99 1
Single leg stance, eyes open. 18-39 43
40-49 40
50-59 37
60-69 26
70-79 15
80-99 6

(Ref 1)

The effects of reduced balance.

The control of your balance is so complex that a huge amount of your brain is geared up to affect it. We evolved walking on our hands and feet like a monkey. In order to be able to stand upright we needed to evolve an incredibly powerful brain in order to control an upright posture.

Balance is so complicated that it takes up until your third decade of life to master it. Unfortunately, from there it steadily declines if you allow it. Everything in the human body is use it or lose it. Often as we get older we become more sedentary, and because we move less, we require less mastery of balance and so it declines. This is combined with normal changes in the spine and brain that make balance more challenging. As a result, risk of falls is one of the key causes of injury.

‘People aged 65 and older have the highest risk of falling, with 30% of people older than 65 and 50% of people older than 80 falling at least once a year’ (Ref 4). The research shows that reduced balance is associated with longer stays in hospital and predicts poorer rehabilitation outcomes (Ref 1).  We also know that 3-5/10 people suffer from some form of dizziness and this becomes more common as we get older (Ref 2 + 3).

The World Health Organisation reports that falls are the seconding leading cause of accidental injury deaths worldwide (Ref 5)!

NICE guidelines.

It’s essential that as you grow older you dedicate more time to practicing balance. Most people who fall for the first time don’t know their balance is compromised. This is why it’s important to have your balance regularly checked by a health care professional. The NICE guidelines state ‘Older people in contact with healthcare professionals should be asked routinely whether they have fallen in the past year and asked about the frequency, context and characteristics of the fall/s’ (Ref 4). Furthermore, they state that falls cost the NHS £2.3 billion per year. If you have noticed that you feel less confident on your feet, have started to trip or have had a fall, I highly recommend that you get in contact with myself or another suitable health care professional.

Risk factors.

The presence of more than one of the following risk factors puts you at risks for falls (Ref 4).

– falls history
– gait deficit
– balance deficit
– mobility impairment
– fear of falling
– visual impairment
– cognitive impairment
– urinary incontinence
– home hazards
– number of medications
– psychotropic and cardiovascular medications – muscle weakness.

Treatment.

Strength and balance exercises are recommended to improve balance. Unfortunately, brisk walking is not enough to improve balance (Ref 4). This means that you will most likely require some instruction on how to best optimise your exercises. The main systems contributing to your balance are your eyes, ears and muscles. Therefore, your exercises need to include all three systems. This is something I am very passionate about, as are other chiropractors and physio’s with a special interest in balance.

Conclusion.

I often find that bad balance is something that people laugh about, like it’s an embarrassing but amusing mistake. Preventing falls is essential to healthy ageing. I hope that after reading this article you will be encouraged to take your own balance and the balance of your friends and family more seriously. If you have any questions, please feel free to contact me. I work as a chiropractor with a special interest in neurology in Woking.

References:

1. Springer B et al. Normative Values for the Unipedal Stance Test with Eyes Open and Closed. Journal of Geriatric Physical Therapy Vol. 30;1:07 http://geriatrictoolkit.missouri.edu/balance/Normative_Values_for_the_Unipedal_Stance_Test_Springer-JGPT.pdf

2. Bisdorff A et al. The Epidemiology of Vertigo, Dizziness, and Unsteadiness and Its Links to Co-Morbidities. Frontiers in Neurology. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3605504/

3. Chuan-Ming Li et al. Epidemiology of Dizziness and Balance Problems in Children in the United States: A Population-Based Study. Journal of Paediatrics. 2014.

4. NICE guidelines. https://www.nice.org.uk/guidance/cg161/evidence/falls-full-guidance-190033741

5. http://www.who.int/news-room/fact-sheets/detail/falls

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