Issue 5 Stories
Aging Well

Balancing Act

Helping Older Patients Improve Balance, Avoid Falls

Injuries among older people are, unfortunately, all too common—and often result in serious consequences. Falls among the elderly are linked to an increased risk for hip and other bone fractures, as well as head injuries, any of which can lead to less independence, early admission to a long-term care residence, and even death.

“Up to half of all people over the age of 65 experience a fall each year, says Anne Knox, a physical therapist and geriatric specialist at Sentara Martha Jefferson Hospital who specializes in vestibular and balance disorders. “Some fall doing things as simple as just getting out of bed.”

As we age, we can lose our sense of balance. In fact, balance problems are one of the most common reasons older adults seek help from a doctor, according to the National Institutes of Health.

“Our sense of balance is important,” she adds. “It helps us walk without staggering, get up from a chair without falling, climb stairs without tripping and bend over without tumbling to the ground.”

While many of us take balance for granted, according to Knox, it’s actually a highly specialized skill.

Imbalance isn’t caused by aging itself, but rather by the effects of the accumulation of problems across a person’s lifespan, such as injuries, chronic disease and inactivity.

Even peripheral neuropathy—nerve damage in the hands or feet due to diabetes, chemotherapy or other causes—can create balance problems.

“We need perfect sensation in our feet to send the correct signals to the brain,” she explains.

Falls are largely preventable, however, according to Knox. The causes of imbalance—and the ways to correct it—fall into two broad categories.

Intrinsic risk factors for falls come from within yourself, such as foot numbness, poor vision, weakness, dizziness or lack of attention to tasks you perform. Extrinsic factors are related to the environment, such as uneven ground, physical obstacles, inadequate lighting or slippery surfaces.

Treating the Root Causes

When patients come to Knox with balance problems, she starts by assessing them for contributing factors. She checks first for dizziness and vertigo, then for neuropathy in the feet or legs, and moves on from there.

The treatment for dizziness, vertigo or any type of disequilibrium depends on what’s causing the symptoms, says Knox. Vestibular symptoms originate from problems of the inner ear or from the balance center of the brain, in the cerebellum. The most common type of inner ear vertigo is called benign paroxysmal positional vertigo (BPPV), a condition that affects both younger and older people. BPPV is treated by manual maneuvers intended to reposition the loose inner-ear debris that causes the condition.

Another common inner-ear condition occurs when inflammation leads to loss of sensory function. In these cases, sensory input going into the brain becomes asymmetrical, leading to dizziness and vertigo when a person moves. Treatment often consists of exercises that involve specific eye and head movements to help the brain adapt to this new asymmetry.

Various other inner-ear and cerebellar disorders are also treated with an exercise-based approach.

“Outcomes from many of these problems are excellent,” notes Knox.

Often, people feel faint or dizzy when getting out of bed because their blood pressure changes while they’re lying down. So Knox trains them to sit up and wait for their blood pressure to adjust before standing.

Other causes of imbalance may be treated with gait and balance training, and by assisting patients in resuming an active lifestyle.

Mobility Factors

An exercise physiologist and fitness specialist at the Sentara RMH Wellness Center, Alison Snook frequently works with patients to help them improve their mobility.

“At age 70, there tends to be a natural decline in mobility and balance due to muscle loss,” notes Snook. “Sedentary, inactive people often have more trouble getting their mobility back once they’ve lost it.”

After retirement or a chronic health problem like diabetes, heart disease or obesity, or even after a hospital stay, older people often lose their strength.

“If a person isn’t doing much, becoming active again can be a big change,” Snook says. “People who develop balance problems after decreasing their activity level shrink their world, and that can have a snowball effect. Less activity leads to more balance problems, which leads to even less activity, and so on.”

Some people also have a mindset that when they reach a certain age, they shouldn’t do certain things like exercising. “Self-efficacy factors into this, because many people don’t feel safe exercising, or they think they’ll injure themselves, or they just think they can’t do it,” adds Snook.

Treating Mobility and Balance Challenges

Snook teaches a group class for older adults, called Fit Encore, at the Sentara RMH Wellness Center that incorporates exercises for balance, mobility, strength and flexibility. Her first task in the classes is to tell participants they can get back their mobility and strength.

“We should be able to stand with our leg strength,” says Snook.

In other words, a person should be able to withstand his or her own body weight.

“If, for whatever reason, one leg is weak, people tend to shorten their stride and not lift their legs very high off the floor,” says Snook. “That leads to shuffling, which raises the risk for falling.”

With that in mind, strengthening the leg muscles is part of the training. Snook has class members do “elevators,” where they stand with bent knees at various angles. She also integrates some tai chi into the class by having participants shift their body weight from one leg to the other.

Snook also helps class members with balance issues, such as how to properly get out of a chair or off the floor after a fall. In addition, she helps participants work on their walking speed and ability to change directions.

Many members come to the Fit Encore class after having a fall.

“Falling shakes people up,” says Snook. “That’s when they realize their balance has begun to worsen—and that causes them to lose their confidence.”

According to Snook, her own grandfather once fell in a parking lot and lay there for an hour before someone came to help.

Before teaching a class how to get up from a fall, Snook works on other exercises for several weeks to help them build up their confidence.

“By week eight they’re willing to get on the floor, knowing they’ll be able to get back up,” Snook says. “The only way to know how to do it is to practice. The key to the maneuver is, when lying on the ground, to shift your weight to all fours and crawl to something sturdy to lift yourself up.”

Our eyes also give us cues about balance, so proper lighting is important, as is just paying attention to our environment. To help participants practice dealing with some of these extrinsic factors, Snook sets up an obstacle course in her class, including a low balance beam, to simulate stepping up a curb and other hurdles.

Like Knox, Snook witnesses positive outcomes as a result of her training sessions.

“Participants tell me things like: ‘Now I can reach higher shelves in the grocery store and put things in my basket,’” Snook says. “Some who travel encounter unexpected challenges, like having to stand on a moving train. They tell me the class has helped them.”

Balance Important for Young and Old

Knox says that younger people—not just the elderly—should also be sharpening their balance skills.

“Studies have shifted from helping people with balance problems to encouraging people to develop balance skills across their lifespan,” Knox notes.

“It’s a skill we should develop when we’re young and then continue to work on,” Snook adds. “Balance takes practice!”

Make Your Home Safer

The following tips, adapted from WebMD, can help you reduce your risk of falling in your home.

•     Remove or fix things you could trip over, such as raised doorway thresholds, throw rugs or loose carpet.

•     Keep areas where you walk clear of electrical cords and clutter.

•     Use nonskid floor wax, and wipe up spills right away.

•     Keep your house well lit. Use night lights (or keep an overhead light on at night) in hallways and bathrooms.

•     Put sturdy handrails on stairways. Make sure you have a light at the top and bottom of the stairs.

•     Store things on lower shelves, so you don’t have to climb or reach high.

•     Keep a phone and a flashlight by your bed. Check the flashlight batteries often to make sure they still work.

Independent Living, Peace of Mind

Falls are a real concern for older adults. Lifeline, a medical alert system that allows you to call for help with the push of a button, empowers seniors to live independently, while providing peace of mind for their loved ones. Feel more secure at home or on the go with one of our proven medical alert services.

No landline phone is needed.

•    No activation fee

•    Free installation

•    Local service included

•    $10 discount on the first bill

•    Good for the Sentara RMH and Sentara Martha Jefferson service areas

To learn more about the service, or to schedule an installation, call 540-564-5165. Please mention the code: PEACE OF MIND. Offer expires 12/31/17.

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