Every year, one in three older people in the U.S. and over one in four 65 years of age or older fall. One of the leading causes of disability among older adults is falling and this may happen due to gait and balance issues. Despite these alarming statistics, however, most falls can be prevented.

In this article, you will learn what causes balance issues, particularly in older adults, some of the most common balance issues older adults face, how to recognize when someone has balance issues and what to do about them to avoid falls, and the dangers they pose to health and safety.

Understanding Balance Issues

How you walk changes as you age. Your gait, stride, and other mobility factors can be affected by an array of both medical and lifestyle factors. After 50 years of age, balance issues can worsen when going from sitting to standing, walking around, or moving the head up and down or side-to-side.

If you experience balance issues that start negatively impacting your life, contact your doctor immediately.

What Is the Vestibular System?

The vestibular system, or the organ of balance, is a sensory system that provides the brain with information about spatial orientation, motion, and head position. It plays a pivotal role in motor functions that enable the body to maintain balance and posture and stabilize the body and head during movement. It is therefore an essential system for maintaining equilibrium and normal movement.

The ear is an intricate system of cartilage and bone. The vestibular system is located in the inner ear and is composed of three semicircular canals and two organs all filled with fluid. 

Each of the semicircular canals is involved with a different motion of the head:

• Moving up and down
• Turning left and right
• Tilting side to side

The two organs, or otolith organs, are similarly involved with the sense of acceleration and deceleration. 

As you move, the fluid in the semicircular canals and otolith organs changes position. Lining the inner walls of these canals and organs are tiny hairs that act as sensors, detecting these movements of fluid over them. 

These sensors then relay that information over nerves to the brain, thereby helping produce your sense of balance. 

How Does the Vestibular System Affect Balance?

When the brain receives signals from the sensors in the ear, it processes that information, then relays it to the muscles, joints, eyes, and other organs that use it to understand the position your body is in. 

By communicating the same information to all the involved body parts, the brain maintains a sense of balance. However, when certain circumstances send contradictory messages through the vestibular system to the brain (such as while sitting still in an airplane in rapid motion), it can throw off your sense of balance. 

What Causes Balance Issues in Older Adults?

Your ability to stay steady on your feet can become compromised by a range of factors, including:

• Weakened muscles – Particularly core muscles.
• Inner ear issues – The labyrinth is the part of the inner ear responsible for balance; when it gets inflamed, causing a condition known as labyrinthitis, imbalance and vertigo can result. (labyrinthitis can also be caused by certain infections and ear diseases.)
• Certain medications – If you discover any balance issues while taking any medications, inform your doctor right away; you may be able to safely reduce the dosage you’re taking, a different medication may be available for you to take instead or the doctor may have suggestions to offer of ways to reduce those undesired effects. Such medications include antidepressants, tranquilizers, sedatives, anti-seizure drugs, and blood pressure medications that could cause your blood pressure to drop too low.
• An illness, injury, chronic medical condition, or disorder – Such as stroke, heart disease, diabetes, or issues involving your nerves, vision, blood vessels, or thyroid.
• Alcohol – When there’s alcohol in the bloodstream, it can affect how the inner ear works, possibly leading to dizziness and other balance issues.

Each of these potential answers to what causes balance issues in older adults increases in likelihood as you grow older, thereby increasing your risk of falling due to one of these causes as you age. 

Some balance issues develop slowly and progressively over time, while others happen suddenly and seemingly without cause. 

What Are the Symptoms of Balance Issues?

As you lose your balance, there are a variety of related symptoms you may experience, such as nausea, dizziness, or unsteadiness. How you feel while losing your balance could differ significantly from how someone else feels when it happens to them. 

Some people describe feeling like they’re spinning despite that they’re actually standing still (otherwise known as vertigo, a type of vestibular balance disorder); others say it feels like they’re floating. Upon losing your balance, whatever symptoms you may feel could last from several minutes to several days. 

Other symptoms of possible balance issues include:

• Falling or feeling like you are about to fall
• Staggering as you attempt to walk
• Feeling faint or lightheaded
• Blurry vision
• Changes in blood pressure or heart rate
• Feeling anxious, afraid, or panicked
• Nausea or vomiting
• Diarrhea

Symptoms may be intermittent and only last for short periods or they may be chronic and lasting, ultimately leading to possible depression or fatigue. 

Speak with your doctor if you notice you’re having any of these symptoms, as any one of them can increase your risk of falling, tripping, and experiencing an injury. It can interfere with your life and give you anxiety. 

Symptoms Demanding Emergency Attention

Certain symptoms of possible balance issues could constitute an emergency requiring immediate medical attention, including:

• Sudden, debilitating headache
• Tightness or pain in the chest
• Severe vomiting
• Numbness in the arms, legs, or face
• Fainting
• Rapid or irregular heartbeat
• Trouble catching your breath
• Sudden differences in speech patterns
• Disorientation or confusion
• Double vision
• Hearing loss
• Seizures

Common Balance Problems

There are many different types of balance problems an older adult might experience. Below are several of the most common. If you or an older adult you know experiences any of these symptoms or conditions, seek medical aid immediately. 

Benign Paroxysmal Positional Vertigo (BPPV)

Most common in people over the age of 60, BPPV is a disturbance of the inner ear that could be due to an ear infection, head injury, or simply the process of aging, among other possible causes. It is marked by extreme vertigo while moving the head. It can even happen when rolling over in bed. 

Ménière’s Disease

A common sign of this disease is a feeling of “fullness” in the ear. Other symptoms may include vertigo, tinnitus (or a ringing in the ears), and periodic, intermittent loss of hearing.

Labyrinthitis

Labyrinthitis is an inner ear condition marked by inflammation and infection. It can often be traced to a case of flu.

Vestibular Balance Disorders

These are problems associated with the sensors in the inner ear that detect the position of the fluid in the ear canals and report this information to the brain in order to help establish a sense of balance. 

Chronic Conditions

Various chronic conditions can lead to balance issues. For instance, eye problems can make it harder to maintain your balance.

In addition, long-term medical conditions affecting the nervous system–such as Multiple Sclerosis, Alzheimer’s disease, and Parkinson’s disease–can also impair balance. Heart problems, arthritis, and certain medicines older adults may take for a chronic illness can contribute to unsteadiness as well. 

Ramsay Hunt Syndrome

Shingles is a skin condition produced by a virus to which older adults may be more vulnerable. 

When the shingles virus affects facial nerves close to the ear, it causes a condition called Ramsay Hunt Syndrome. Among the symptoms of this syndrome is vertigo accompanied by hearing loss and ear pain. 

Why Do Balance Issues Affect Older Adults?

Losing balance can be a symptom of some other health conditions, many of which occur more commonly as a person’s body changes with age. Any of the health conditions that follow could lead to balance issues.

• Sudden changes in blood pressure
• Poor circulation
• Neurological conditions
• Low iron levels
• Low blood sugar

Are There Any Treatments for Balance Issues

You can help alleviate some balance disorders with exercises involving moving the body and head in particular ways. A physical therapist or other healthcare professionals who understand what causes balance issues in older adults and how they relate to other bodily systems can help you devise the exercise program that can best address your balance issues. 

For example, to treat balance problems occurring due to high blood pressure, eat less sodium (salt,) exercise, and maintain a healthy weight. To treat those caused by low blood pressure, drink more water, avoid alcohol and be particularly cognizant of your body movement and posture (like avoiding standing up too fast.)

Before making any changes in your activity level or diet, consult your physician first. 

How to Identify Balance Issues

By answering a few pertinent questions, you can help determine whether or not a balance issue exists, specifically:

• Do you feel like you’re moving even though you know you’re actually sitting still or standing?
• Do you feel dizzy or like the room is spinning around you, even if only periodically and briefly?
• Do you get blurry vision?
• Do you feel unsteady?
• Do you feel like you’re falling?
• Do you lose your balance and fall?

If your answer to any of these questions was yes, then you may want to discuss with your doctor whether you have any balance issues or risk factors for balance issues and, if so, what to do about it.

How to Cope With Balance Issues

You may not always be able to completely relieve a balance issue, in which case you have to cope with it. With the help of a vestibular rehabilitation therapist, you can devise a customized treatment plan.

Fall Prevention

To prevent falls, start by closely examining the older adult’s home environment. Is the home an older one with more than one set of stairs and/or poor lighting? Follow these guidelines to make corrections as necessary in order to reduce the risk of falls.

• Discuss with your doctor all the potential side effects and interactions of the medications you’re taking.
• Use night lights, secure carpeting to the floors, and install grab bars in the bathroom.
• When standing, do it slowly to avoid getting dizzy.
• Perform balance and strength exercises.
• Regularly have your hearing and vision checked.
• If you require greater stability, use a walker or cane.

Recap

Balance issues can result from a number of different factors, many of which are more common among older adults.

If you believe you may have issues with your balance or have concerns that another condition or symptom you’re experiencing may lead to problems with your balance, call your doctor to set up a visit as soon as possible.

You may be referred to an otolaryngologist, a doctor specially trained in problems involving the neck, head, ear, nose, and throat.