Balance and the older adult
Many of us have experienced the anxiety of having to deal with an older member of the family or a friend incurring injury as a result of a fall. History of a fall among older individuals have been accepted and viewed as unavoidable accidents. But this is not necessarily so. The physical and psychological damage done as a result of the fall can be averted if proper precautions are taken.
Hip and fracture neck of femur are the most devastating, especially in older women with osteoporosis. Even if the physical injury is not debilitating, the damage to the psyche is tremendous, leading to fear and self-imposed exile from any kind of activity which in itself leads to a decrease in health and fitness. It is like a self-fulfilling prophecy — they are afraid they will fall, restrict activity, incur muscle atrophy, loss of strength and balance, and therefore fall once again when they try to get around even to navigate the most minor tasks.
Some of the most common causes of falls are:
— The immediate physical environment
— Poor fitness levels in terms of strength, balance, gait, agility and speed and reaction time
— Intake of sedating medication or anything that alters cognition
— Middle ear imbalance leading to vertigo and dizziness
— Vision problems
— Other medical problems like Parkinson’s, diabetes, multiple sclerosis etc
— Improper footwear
— Lack of mindfulness.
Many of the above factors can be addressed by making simple modifications to the immediate environment and intervention to improve fitness levels, strength and balance.
Use antiskid tiles wherever possible. Fix railings in the bathrooms for support. Wet bathrooms are dangerous. Bathrooms must be kept dry.
Steer clear of carpets that may be tripped on, sharp edges and corners, flimsy stools and chairs, wet areas, stairs without railings and poorly designed or ill-fitting footwear. Ensure good lighting and clear delineation of steps and level changes on the floor. Tables, chairs and beds should be regularly checked for stability.
Some forms of medication like sedatives, antihistamines, antihypertensives can lead to dizziness, postural hypotension and hence a tendency to lose balance. Blood sugar fluctuations while on anti-diabetic medication can lead to dizziness and loss of balance.
Older individuals who have been active all their lives, participated regularly in fitness programmes and maintained their weight within the optimum range while also maintaining optimum muscle mass have a lower incidence of falls and injury when compared to the unfit, overweight person.
An exercise programme for the elderly should include a balance and strength routine besides basic cardio.
“Use it or lose it”. This is the dictum for any aspect of fitness including muscle mass/strength. Deterioration is evident with disuse and sedentary living. A strength training programme that targets the major muscle groups can improve leg and hip extensor strength. This improves ability to walk easier, climb stairs, arise from a seated position in a chair or on the floor or bend to pick up something from the floor. Upper body strength, which tends to diminish rapidly due to neglect, is required to perform simple tasks like lifting, reaching and carrying. Strength training can be performed using resistance bands that are colour-coded to differentiate levels of strength, or with other forms of external weights like ankle weights, wrist bands or even dumbbells under guidance.
Large bulky muscles and enormous strength do not directly translate to great physical balance. However, weak muscles definitely render an individual more prone to falling down as a result of poor balance and the inability to support one’s own body weight properly. Movements of the body mandate a certain level of equilibrium and the ability to accommodate this shift in centre of gravity. For instance getting up from a seated position changes the centre of gravity from a lower to a higher level from the floor, thereby decreasing stability. Adequate balance and strength of leg muscles will ensure that one doesn’t tip over during the process.
Special exercises using the Bosu ball, Swiss ball, stepper when incorporated into an exercise routine can improve balance. Yoga is also a great way to increase both flexibility and balance. The twists and turns, one legged stance and inverted postures challenge the body in ways that it is not accustomed to.
Middle ear imbalance
In order to improve balance, ensure good vision, absence of vestibular (middle ear) problems and an optimum somatosensory (sensations from hands, feet), system. This system enables the body to understand its position in relation to its environment through a sophisticated neuromuscular network. The body is constantly kept informed of its position and contact with other objects like the floor or a chair. If there is any compromise in this mechanism (and it has been found that the sensory system diminishes with age), balance may be affected.
Poor eyesight can lead to unnecessary accidents. You can miss a step or trip over a stool you did not see. The power in your eyes changes with age. Getting your vision checked regularly is important to prevent falls.
Uncontrolled diabetes can lead to poor sensation in the feet/hands. It’s important to keep feet healthy, check for blisters or non-healing ulcers. Neurological disorders such as Parkinson’s disease or multiple sclerosis will have problems with balance and the patients need to be cautioned accordingly.
Ensure good quality, well-fitted footwear. This is the simplest and most effective step to prevent accidents. Check for wear and tear and change footwear when needed. Walking with bare feet to improve sensation in the feet is also highly recommended. Walk on different surfaces like mud, grass and sand.
Sometimes it is just sheer carelessness that creates accidents. Rushing around mindlessly, being unaware and almost unconscious of your environment can cause silly accidents that could be avoided. Mindful meditation is a great way to train the mind to stay in the present.
Simple tasks like standing on one foot for as long as possible, standing with feet as close together as possible, with heel to toe, putting on pants while standing up, walking on a straight line, getting up from a chair and walking forward, turning and coming back to sit in the chair as fast as possible can be practised to improve balance.
Specific tests are available to assess balance, strength and proprioception. Tests such as the one leg balance test, and ‘get up and go’ test, act as guidelines to structure the routine for a client. Please note that older adults with poor balance should never be allowed to exercise or perform any of these moves unsupervised.
— Be sure to include strength, balance and flexibility exercises into your routine.
— Train with a trainer who can deal with older people
— Include yoga
— Check your blood sugars
— Make sure you understand the side effects of any medication you may be consuming.
— Ensure your immediate environment is free from clutter and is risk free.
— Stay mindful of your actions and movement.
The author is a lifestyle medicine physician. firstname.lastname@example.org. www.drsheelanambiar.com