Addressing impaired balance

A novel Swedish study interviewed 84% of all Swedish twins aged 55 and older and asked them one simple question, “Do you have impaired balance?” Over time it was shown that those twins with self-reported impaired balance had three times the risk of hip fracture as the co-twin with normal balance. Overall, one-third of all hip fractures were attributed to impaired balance.

Proper postural balance while walking is a complex function. It involves somatosensory, visual, vestibular, and musculoskeletal components. Balance problems, along with the fear of falling and decreased mobility, are primary causes of institutionalization among the elderly. These concerns, in fact, account for 50% of nursing home admissions. Gait problems and balance problems such as increased amount of sway can develop slowly and can perhaps go unnoticed.

There is evidence that much of the decline in postural balance typically associated with aging is in fact not a result of aging at all, but rather the result of physical inactivity associated with a sedentary lifestyle. Studies clearly show that with therapeutic physical activity programs, postural balance can be enhanced and any aging decline in balance averted. An increase in quadriceps strength and a significant decrease in postural sway in older adults were reported following just 10 weeks of moderate aerobic and strength training exercises. In another study of postmenopausal women, significant reduction in lateral body sway and increases in both lower body muscular strength and lean leg mass were reported following 9 months of progressive walking while wearing a weighted vest. T’ai chi chuan is another healthful way to increase balance and reduce falls. Among men and women 70 years or older, those who undertook a 15-week, moderate t’ai chi practice experienced a 50% reduction in falls.

Nutrition habits can also affect balance. Skipping meals will cause blood sugar levels to fluctuate abnormally. This can lead to drastic decreases in energy, clarity of thought, and muscle control. An excess of stimulants such as coffee and soda also upset blood sugar levels, decreasing the brain’s ability to consciously control the muscles. Regular meals, snacks, and minimal stimulant use provide consistent energy, steady blood sugar levels, and indirectly sustain good balance. Alcohol and illicit drug use also impair balance, increasing the risk of fall.

Balance is also affected by poor vision. Many factors such as wearing the wrong prescription lenses, glaucoma, or cataracts limit vision. Since changes in eyesight often happen gradually, you may not notice a decrease in your visual accuracy. Poor depth perception and poor low-frequency contrast sensitivity (night vision) have both been found to increase a person’s risk of fracture from a fall.

Finally, many medications and mood-altering drugs can cause dizziness or lack of coordination and thus increase the risk of falling. For example, the use of long-half-life, mood-altering psychotrophic drugs like Valium® and Librium® have been associated with a 70–80% increased risk of hip fracture.

Medicines that may increase the risk of falling include:

  • Various heart medications
  • Antidepressants
  • Muscle relaxants
  • Sedatives or sleeping pills
  • Drugs that lower blood pressure
  • Anticonvulsants

If you are currently taking any medications that cause dizziness or lack of coordination, speak with your doctor. Perhaps there is an alternative medication available, or it might be possible to lower the dose of your current medication.

The top 13 environmental modifications to reduce the risk of falls

  • Use nightlights or motion-sensitive lighting throughout home.
  • Install adequate lighting in stairwells, doorways, and along walkways.
  • Install grab bars and railings.
  • Remove area rugs.
  • Eliminate clutter: put books on shelves, clothes in a hamper, towels on a rack, and shoes in the closet.
  • Keep wires behind furniture.
  • Highlight edges of steps with bright paint or tape.
  • Maintain proper furniture height.
  • Have minimal transitions on flooring surfaces.
  • Use non-slip mats on the floor of your bathtub and shower.
  • Wear shoes both inside and outside the house. Avoid going barefoot or wearing slippers. Choose shoes with rough or patterned rubber soles (not smooth).
  • Keep a flashlight next to your bed.
  • Add skid-resistant material to steps and stairs.

Using protective gear

Hip fractures are undoubtedly the most serious and life threatening of all osteoporotic fractures. In the US and many other Western countries, one in six Caucasian women over 50 will suffer a hip fracture as will 6% of all Caucasian men over 50. The fact that most occur as a result of falling sideways and not from compression has given birth to hip protective gear for the frail.

While there are several types of hip protectors, a Finnish study of 1,801 ambulatory but frail elderly tested whether protective oval shaped pads worn inside pockets on a stretchy undergarment helped to prevent hip fractures. The pads reduced the impact of a sideways fall, thus significantly reducing hip fractures. In this study there was a 60% reduction in hip fractures among those study participants assigned to the use of these anatomically designed external hip protectors. Even more, the authors concluded from their trial that the risk of hip fracture can be decreased by more than 80% if the protector is worn at the time of a fall.

Environmental modifications

A significant reduction in falls has been found with the elimination of hazardous factors in the environment. Most notably, it has been suggested that if uncarpeted wooden floors were replaced with carpeted surfaces in nursing homes, the risk of hip fracture would be reduced by nearly 80%. Even simple environmental modifications can go a long way in reducing needless falls and fractures.

Think about strength, think about balance

The origin of any osteoporotic fracture is multi-faceted and so is its prevention. Taking precautions to avoid needless falls and minimizing the impact of falls at any age are clearly powerful fracture-reducing interventions. Fortunately today we have access to a wide range of life-supporting interventions that allow us to regain balance and strength, even as we age. New branches of physical therapy, chiropractic and exercise therapy, and nutrition, as well as the ancient sciences of t’ai chi, qi gong, and yoga can indeed help bring us back “into balance” at any age.


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