Poor balance and instability in the elderly have been described as “geriatric syndrome” because the specific cause of these complaints is often not obvious and can be the result of more than one factor.
The balance system has built in redundancy, which means that there are fall back systems in place if one system fails. For example, when walking in the dark, you may feel more stable if you run your fingers along the wall. Your sense of touch substitutes for the loss of visual information.
Multi-factorial disequilibrium occurs, when one system fails, the backup system also fails, and you lose balance. Over 50 percent of people who fall have four or five risk factors.
Common Risk Factors for Falling
- Vestibular disorders – Vestibular (inner ear) disorders can cause dizziness, vertigo or loss of balance.
- Use of prescription medications – Taking more than four prescription medications increases the chance of an adverse reaction, as the ability to predict interactions between medications decreases.Use of anti-depressant or anti-anxiety medications – These medications can affect reaction time.
- Drop in blood pressure when standing – Diabetes and medications for high blood pressure, irregular heart rate and bladder problems can cause a sudden drop in blood pressure when standing, lightheadedness and loss of balance.
- Weakness or numbness in the feet or lower legs – Numbness, tingling or feet that feel unusually hot or cold may be a sign of decreased nerve sensation in the feet and legs, a condition known as peripheral neuropathy.
- Degeneration of the cerebellum - The cerebellum is the part of the brain mostly responsible for balance and coordination. Stroke, medications or aging can interfere with the cerebellum and the balance system.
- Visual disorders – Vision is an important contributor to balance, so any visual compromise can increase the risk of falling.
- Depression – The use of anti-depressants increases the risk of falling.
- Impaired cognition – Lack of awareness of surroundings can increase the risk of falling.
Diagnosis and Management of Multi-Factorial Disequilibrium
Identifying and treating these risk factors can significantly reduce the risk of falling. Your doctor and other specialists will perform a comprehensive assessment and may recommend medications, balance retraining therapy and changes in your living environment to avoid falls.