Review/Mise au pointBalance disorders in the elderlyTroubles de l’équilibre chez les personnes âgées
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
References (147)
- et al.
Age related changes in visual acuity
Exp Gerontol
(1986) - et al.
The effect of age on human skeletal muscle. Studies of the morphology and innervation of muscle spindles
J Neurol Sci
(1972) - et al.
Dynamic and static sensitivities of muscle spindle primary endings in aged rats to ramp stretch
Neurosci Lett
(1995) Evaluation of age-related plantar-surface insensitivity and onset age of advanced insensitivity in older adults using vibratory and touch sensation tests
Neurosci Lett
(2006)- et al.
Accuracy of passive ankle joint positioning during quiet stance in young and elderly subjects
Gait Posture
(1993) - et al.
What is the cause of the ageing atrophy? Total number, size and proportion of different fiber types studied in whole vastus lateralis muscle from 15- to 83-year-old men
J Neurol Sci
(1988) - et al.
How early reactions in the support limb contribute to balance recovery after tripping
J Biomech
(2005) - et al.
Push-off reactions in recovery after tripping discriminate young subjects, older non-fallers and older fallers
Gait Posture
(2005) - et al.
Exercise effect on dynamic stability in older women: a randomized controlled trial
Arch Phys Med Rehabil
(1996) - et al.
Age and gender effects on postural control measures
Arch Phys Med Rehabil
(1995)
A clinical test of stepping and change of direction to identify multiple falling older adults
Arch Phys Med Rehabil
Changes in early ‘automatic’ postural responses associated with the prior-planning and execution of a compensatory step
Brain Res
Compensatory stepping in response to waist pulls in balance-impaired and unimpaired women
Gait Posture
Biomechanical gait alterations independent of speed in the healthy elderly: evidence for specific limiting impairments
Arch Phys Med Rehabil
Swing phase mechanics of healthy young and elderly men
Hum Mov Sci
Mechanical energy transfer during gait in relation to strength impairment and pathology in elderly women
Clin Biomech
Comparisons of plantar pressures between the elderly and young adults
Gait Posture
Postural stability and associated physiological factors in a population of aged persons
J Gerontol
Visual stabilization of posture. Physiological stimulus characteristics and clinical aspects
Brain
Clinical parameters associated with falls in an elderly population
Gerontology
Prevalence of low vision in elderly patients admitted to an acute geriatric unit in Liverpool: elderly people who fall are more likely to have low vision
Gerontology
Physiological factors associated with injurious falls in older people living in the community
Gerontology
Risk factors for recurrent nonsyncopal falls. A prospective study
JAMA
The Framingham Eye Study. I. Outline and major prevalence findings
Am J Epidemiol
Visual risk factors for falls in older people
Age Ageing
Visual risk factors for falls in older people
J Am Geriatr Soc
How Does the Vestibular Part of the Inner Ear Work
Disorders of the Vestibular System
Assessment and treatment of dizziness
J Neurol Neurosurg Psychiatry
Disequilibrium of unknown cause in older people
Ann Neurol
Falls in patients with vestibular deficits
Am J Otol
Dizziness in aging: a retrospective study of 1194 cases
Otolaryngol Head Neck Surg
Degenerative changes and anomalies of the vestibular system in man
Laryngoscope
Quantitative study of human Scarpa’s ganglion and vestibular sensory epithelia
Acta Otolaryngol (Stockh)
Effect of aging on the human initial interaural linear vestibulo-ocular reflex
Exp Brain Res
Age-related changes in vestibular function: a longitudinal study
Ann N Y Acad Sci
The dynamic gait index relates to self-reported fall history in individuals with vestibular dysfunction
J Vestib Res
Suppression of the vertical vestibulo-ocular reflex in older persons at risk of falling
Acta Otolaryngol (Stockh)
Observation of vestibular asymmetry in a majority of patients over 50 years with fall-related wrist fractures
Acta Otolaryngol (Stockh)
Proprioceptive, visual and vestibular thresholds for the perception of sway during standing in humans
J Physiol (Lond)
Peripheral neuropathy: disorders of proprioception
Diabetes mellitus and its degenerative complications: a prospective study of 4,440 patients observed between 1947 and 1973
Diabetes Care
Cervical articular contribution to posture and gait: their relation to senile disequilibrium
Age Ageing
Morphometric study of the human muscle spindle
Anal Quant Cytol Histol
The structure of human digital pacinian corpuscles (corpus cula lamellosa) and its functional significance
J Anat
A quantitative study of Meissner’s corpuscles in man
Neurology
Effect of age on vibratory sensibility
Arch Neurol Psychiatry
Effect of aging on the subjective magnitude of vibration
Somatosens Mot Res
Foot and ankle characteristics associated with impaired balance and functional ability in older people
J Gerontol A Biol Sci Med Sci
A study of thresholds in appreciation of passive movement among normal control subjects
Bull Neurol Inst
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