Keeping Your Balance

About eight million Americans have balance problems and one in three Americans over age 65 will fall every year. Injuries from falls, like a fractured hip, can change a senior's life in ways seniors fear most — isolation and loss of independence. For seniors and caregivers, understanding balance disorders and fall prevention along with knowing when to get help can go a long way toward avoiding falls and the devastating consequences that may come with it.

A balance disorder is a disturbance that causes you to feel unsteady, lightheaded or as if you or the room is spinning. Balance disorders can be due to a disturbance in the inner ear, but they can also be caused by visual problems, skeletal problems or nerve problems.

Being able to maintain good balance means being able to keep a steady position while walking or standing. Someone with a balance problem may walk unsteadily, fall sideways when standing or have trouble going up or down stairs. Some common symptoms that go along with a balance disorder are dizziness, feeling as if you are going to fall, visual problems, confusion, anxiety, and nausea.

The most common cause of falls is a combination of factors that go along with aging. We know from studying the inner ear that the cells responsible for maintaining balance start to degenerate with age. Aging and the diseases of aging also affect vision and the bones and joints. Good balance requires that all these systems work together. Other common causes include:

• Positional Vertigo — Vertigo is the false sensation of movement, usually described as spinning. The symptoms usually come on suddenly and are caused by cell changes in the inner ear. The main symptom is a sudden attack of vertigo when you change your head position such as looking over your shoulder or rolling over in bed.
• Labyrinthitis or Vestibular Neuronitis — The inner ear organ that controls balance is called "the labyrinth." It is a bony structure that contains fluid and the nerve cells for balance. If this organ becomes infected or inflamed, such as from a viral upper respiratory infection, it causes vertigo and loss of balance. The main nerve that communicates balance signals to and from the brain is called the "vestibular nerve." It can also be affected by infection or inflammation.
• Meniere's Disease — This is a condition in which the fluid inside the labyrinth increases. Meniere's disease affects both balance and hearing. Symptoms include hearing loss that comes and goes, a roaring sound and a sensation of fullness in the ears and vertigo.
• Other Causes — Head trauma may cause a leak of inner ear fluid that causes vertigo. Some types of tumors can affect balance. Certain types of medications, circulation problems, neurological diseases and arthritis in the neck can all be causes of a balance disorder.

If you are experiencing any symptoms or feel "unbalanced" the first step is to see your primary care doctor to rule out common medical problems or medications that might be causing a balance disturbance. If your doctor thinks you need a specialist you will usually be referred to an ear, nose and throat specialist or ENT.

In most cases balance disorders can be successfully treated and in many cases this can prevent a fall-related injury. A balance disorder may also be a sign of a serious medical problem so symptoms should never be ignored. You should pay attention to the way one describes what he or she is experiencing to know when to seek a medical consultation. Symptoms of dizziness can be hard to express and may be described as feeling unsteady, lightheaded, spinning, moving, giddy or tipsy, while symptoms other than dizziness may be described such as nausea, blurred vision, anxiety or confusion. Watch out for any history of falls, a staggering gait, having to reach out and hold on or trouble getting out of a chair or bed. Seniors may need to rely more on visual cues for balance, so make sure hallways are lit at night. They may not compensate well for a slight trip, so clear walking areas of loose rugs, electric cords and low furniture.

The ability to balance decreases with age, but losing your balance is not a normal part of aging. Most balance disorders can be treated and many falls can be prevented.