Wednesday, March 21, 2018

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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 were 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.

But the 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 when you 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.

“As we age, our sense of balance does get worse,” notes Luis F. Eljaiek Jr., MD, medical director of the senior services emergency department at Bon Secours St. Mary’s Hospital in Richmond. “Muscle mass and tone and conditioning of the body can diminish,” he says, “and we see deterioration of the core muscles”. Core muscles are those in the back, side, pelvis and abdomen that form a strong central link between the upper and lower body. A weak core drains the power and stability from many of the body’s movements.

VCU Medical Center orthopaedic surgeon Gregory Golladay, MD, says that he and his colleagues frequently see the same lack of flexibility in the body’s core, as well as disorders around the hip joints that cause people to limp or tilt to one side. Additionally, arthritis or other problems with joints in the feet or knees can force changes in the way we walk and lead to problems with our balance, he says

There’s a difference between dizziness and imbalance, the physicians note. 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.  However, the gradual, age-related decline of the vestibular system (the complex structure of fluid-filled tubes in the inner ear) can also result in balance problems 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.

Dr. Eliaiek explains that 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 give 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 such problems 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.

So what are some of the signs?

Physical therapists such as Kshitija Raje, DPT, of the Bon Secours homecare department 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 to walk 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.  If you have the evaluation done, even in your 40s or 50s, it can go a long way toward spotting little problems that may turn into big ones later on.  And, it can set you on your way to helpful exercises that very likely will help avoid many problems as you grow older.

The three Richmond-area health professionals say there are a number of measures that older people can take to manage difficulties with balance and prevent falls. One of the first things health experts recommend is to get into an exercise program tailored to improve or preserve balance.

The American Geriatrics Society recommends tai chi — 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 is also great, because it also lowers the stress and anxiety felt by people with balance problems.

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 reduces the risk of falling by 17 percent, compared to people who do 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.)

Every health professional who works with older patients can recite a laundry list of things to do at home to reduce 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 the morning. 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 the bedroom 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.