Review/Mise au point
Balance disorders in the elderlyTroubles de l’équilibre chez les personnes âgées

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Summary

Good balance is an imperative skill for daily life that requires the complex integration of sensory information regarding the position of the body relative to the surroundings and the ability to generate appropriate motor responses to control body movement. Balance calls upon contributions from vision, vestibular sense, proprioception, muscle strength and reaction time. With increased age, there is a progressive loss of functioning of these systems which can contribute to balance deficits. Balance disorders represent a growing public health concern due to the association with falls and fall-related injuries, particularly in regions of the world in which high proportions of the population are elderly. Falls present one of the most serious and costly problems associated with older adulthood. Falls can mark the beginning of a decline in function and independence and are the leading cause of injury-related hospitalisation in older people. One in three people over the age of 65 years who are living in the community experience at least one fall each year and 10–15% of these falls are associated with serious injury. In economic terms, the direct and indirect costs associated with falls are large and will grow as the proportion of older people increases. Consequently, understanding age-related changes in the physiological systems imperative to balance is of utmost importance to prevent falls in older people and reduce the injury-related burden on individuals and society.

Résumé

Il est nécessaire de disposer d’un bon équilibre pour les activités journalières qui requièrent une intégration complexe d’informations sensitives à propos de la position relative du corps par rapport à l’environnement, d’une part, et, d’autre part, la capacité de produire des réponses motrices adaptées au contrôle des mouvements. L’équilibre dépend de la vision, du système vestibulaire, de la proprioception, de la force musculaire et du temps de réaction. Un moins bon fonctionnement de ces systèmes chez les personnes âgées peut entraîner des troubles de l’équilibre. Ceux-ci constituent un problème croissant de santé publique lié à l’accroissement des chutes et des lésions dues aux chutes, particulièrement dans les régions du globe où la population atteint des âges de plus en plus canoniques. Les chutes représentent l’un des problèmes les plus sérieux et les plus coûteux chez les personnes âgées. Elles peuvent constituer le point de départ d’un déclin fonctionnel ou d’une perte d’indépendance et constituent la principale cause d’hospitalisations consécutives à des traumatismes chez les personnes âgées. Une personne sur trois âgée de plus de 65 ans chute au moins une fois par an et 10 à 15 % de ces chutes sont associées à des blessures graves. En termes économiques, les chutes entraînent des coûts directs et indirects considérables qui ne feront que croître avec le vieillissement de la population. Par conséquent, il est impératif, si l’on veut prévenir les chutes des personnes âgées et ainsi diminuer la charge qu’elles représentent pour les individus et la société, de mieux comprendre les altérations dues au vieillissement des systèmes physiologiques gouvernant l’équilibre.

Section snippets

Sensory factors affecting balance

Instability in older people can result from impairment in sensory, motor and central processing systems. Impairments may be the result of a specific pathology affecting a particular component of these systems, or the general progressive loss of function due to normal ageing. Despite the cause, when a component of sensory, motor and central processing systems is deficient, there is a greater reliance on the remaining components and an increased challenge for balance control.

Strength

Starting in the mid-twenties, the human body begins a progressive loss of lean body mass, particularly of the skeletal muscles. Muscle mass diminishes considerably between the ages of 20 and 80 years. Lexell et al. [53] counted the number of fibres in autopsied vastus lateralis muscle and found an average 40% loss of muscles area and a similar loss of the number of fibres from the second to the eighth decade. The loss of muscle area seemed to show a preferential atrophy of fast-twitch fibres

Standing

Normal ageing is associated with decreased ability to maintain postural stability in standing and when responding to unexpected perturbations. Postural sway, the constant small deviations in centre of mass position, is a commonly used measure of standing balance. Control of postural sway involves continuous muscle activity (primarily about the leg and hip) in response to integrated sensory inputs [72]. The relative contribution of visual, vestibular and proprioceptive systems has been

Mobility and transfers

Mobility may be defined as moving by changing body position or location or by transferring from one place to another (WHO International Classification of Functioning, Disability and Health). Mobility inherently relies on balance. As a consequence, balance problems are often determined via clinical or functional tests of mobility, typically composite measures of balance, gait and transfer. Approximately 15% of community-dwelling adults aged 70–79 years have a mobility disability [107]. Numerous

Exercise

Numerous studies have shown that well-prescribed exercise can improve physical abilities in older people. Strength can be improved by resistance training [114], fitness training can improve endurance [115], [116] and vestibular rehabilitation can lead to reduced dizziness [117], [118], [119], [120]. Functional ability may also be improved by strength training, particularly among frailer older people [121]. Recent work has indicated the potential of task-related strength training to have greater

Interventions for maximizing vision

As visual loss is often correctable in older people [5], [144], [145], simple intervention strategies such as regular eye examinations, use of correct prescription glasses, cataract surgery and the removal of tripping hazards in the home and public places have the potential to prevent falls in older people. Bi- and multifocal glasses have been identified as a risk factor for falls in community-dwelling older people [10], which indicates that the use of single lens distance glasses instead of

Conclusion

Balance disorders are common in older people. Balance is an important risk factor for falls and is affected by the progressive loss of sensorimotor functioning with increasing age. Deficits in proprioception, vision, vestibular sense, muscle function and reaction time contribute to balance disorders and the risk of falls in older people. Balance disorders manifest in poor performances in standing, leaning, stepping, walking, responding to an external perturbation and tasks of mobility and

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