Why Does Balance Get Worse with Aging?

We have all lost our balance and fallen at some point in time either due to a slippery surface, tumbling, or being pushed by someone. The younger we are, the more we are able to maintain our balance in these situations. However, as we age, we lose physical strength, bone mass density and it is much more difficult for us to maintain balance. There are many reasons for this, but first, let us analyze how our body is able to maintain balance in these situations.

Our balance is dependent on the complex integration of many different systems in our bodies. There are three main systems in our body that provide sensory information about our environment and surrounding. The first one is visual, which is our eyes. This information is very important to know what obstacles or unstable surfaces are around us so we can avoid them or prepare in advance to not lose our balance. The second system is the vestibular system, which is the inner ear and semi-circular canals. These loop-shaped canals in our ear contain fluid and fine hair-like sensors that sense the very minimal movement of the head. The vestibular system monitors the position of the head and provides us with sensory information about linear movement (moving up and down or back and forth) or angular movement (rotation of the head). The third system is the somatosensory system which provides sensory information about the position of our joints in space such as the ankle, knees, neck, etc. This is how we know what position our joints are in (bent or straight) without actually looking at it. All this sensory information is integrated into the brain which then produces a finely tuned and coordinated response to the muscles to maintain our balance.

These responses allow us to keep our balance when something challenges our stability such as standing on one leg or walking on ice.

A fall occurs when the demands on postural control exceed our capability to maintain balance. This might happen when the sensory information is too slow or inaccurate, the complex integration of the sensory information in the brain is inadequate, or when the motor response of the brain is delayed, and the muscles cannot contract on time. Let us analyze each one of them separately:

1. With aging the quality of sensory information provided by the three senses mentioned above declines. The eyesight gets worse and the sensory feedback from the joints to the brain is decreased due to swollen feet or ankles or diseases of the leg joints such as arthritis. The vestibular system is also susceptible to ear infection and vertigo which causes dizziness and also increases the risk of falls. Certain medications may also lead to problems in the vestibular system. All this leads to misleading information to the brain which takes longer to process and integrate.

2. Secondly, with age and inactivity, this complex processing in the brain may not be able to integrate this information as efficiently or as quickly. Due to this, maintaining balance and preventing falls requires even more mental focus and attention. This also interrupts our ability to multitask as we walk leading to the ‘stopping walking when talking’ phenomena which means that we are not able to focus on maintaining our balance while performing another task.

3. Lastly, with aging, the muscles get weaker and are not able to contract as fast or as strongly to maintain our balance. There is also a loss of muscle mass with aging, which is called sarcopenia. This loss in muscle mass is aggravated by being sedentary and not performing the daily required physical activity.

All these age-related changes increase the likelihood of falls. Furthermore, the fear of falls, unfortunately, leads to more inactivity with aging which in turn leads to a greater reduction in strength and balance and an increased risk of falls.

The good news is that it is never too late to break this cycle and slow down this process of deterioration by improving our strength, balance, and reducing the risk of falls. It is important to stay active and perform at least 150 minutes of moderate exercise per week. Moderate intensity means feeling slightly out of breath and a bit warm. We should also perform exercises aimed at reducing falls such as strengthening our legs and challenging our balance. An active lifestyle will ultimately lead to a stronger body, a more independent lifestyle, and fewer falls.

References:

Aslan, U. B., Cavlak, U., Yagci, N., & Akdag, B. (2008). Balance performance, aging and falling: a comparative study based on a Turkish sample. Archives of gerontology and geriatrics, 46(3), 283-292.

Cullen, K., & Sadeghi, S. (n.d.). Vestibular system. Retrieved October 20, 2020, from http://www.scholarpedia.org/article/Vestibular_system

Dawn Skelton Professor in Ageing and Health. (2019, October 16). Explainer: Why does our balance get worse as we grow older? Retrieved October 20, 2020, from https://theconversation.com/explainer-why-does-our-balance-get-worse-as-we-grow-older-48197

Holviala, J., Kraemer, W. J., Sillanpää, E., Karppinen, H., Avela, J., Kauhanen, A., ... & Häkkinen, K. (2012). Effects of strength, endurance and combined training on muscle strength, walking speed and dynamic balance in aging men. European journal of applied physiology, 112(4), 1335-1347.

Sihvonen, S. (2004). Postural balance and aging: cross-sectional comparative studies and a balance training intervention (No. 101). University of Jyväskylä.