Vestibular Dysfunction and Aging: Why Older Adults are at Risk, and What You Can do to Stay Balanced
It probably doesn't surprise you to hear that our bodies go through many changes as we age. You may already be experiencing some of those changes, and unfortunately they're not all enjoyable.
Just like hearing, vision, bone density and cognition, our vestibular system declines over time. The vestibular system is responsible for maintaining balance and orientation to where we are in space. Vestibular dysfunction is actually one of the leading causes of dizziness and balance problems in older adults.
Dizziness and balance problems can result in falls which can put people at risk of hospitalization and loss of independence. In fact 20-30% of seniors experience at least one fall a year. With the aging population, the number of falls occurring will continue to increase, increasing health care costs and having negative impacts on our society.
The good news is, it doesn't have to be this way! Understanding vestibular dysfunction and managing these symptoms can help reduce the risk of falls and the complications that come along with these falls.
What is the Vestibular System?
Our body uses 3 systems to maintain balance.
- 1. Visual system
- 2. Somatosensory system
- 3. Vestibular system
The vestibular system is an expansive system located in the inner ear and throughout the brain that helps the body maintain balance and spatial orientation.
It consists of:
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As we age, the vestibular system undergoes changes that can lead to declines in balance, coordination and sense of awareness of where our body is in space, making vestibular disorders more prevalent in seniors.
Age Related Changes
Presbyvertigo is the term used to describe age related changes in the vestibular system. Some of the changes that occur are:
- Hair cell loss: hair cells are a cell in our inner ear that bends with motion and sends signals to the brain about what direction our head is moving. With age, these hair cells naturally degenerate so our vestibular system becomes less sensitive to movement.
- Crystal degeneration: We have crystals in the inner ear that move with gravity and give us information about head position. It is thought that these crystals degenerate with age making them more likely to be dislodged to cause BPPV.
- Reduced gaze stability: This impacts our ability to focus our vision and keep our eyes steady while the body is moving.
- Changes to the brain: As we age, we lose some neurons, causing brain signals to slow down. This affects the brainstem and cerebellum, which are responsible for coordinating these signals from the vestibular system and help us maintain balance.
These factors can make it more likely for older adults to develop vestibular disorders such as BPPVand feelings of general disequilibrium.
Chronic conditions and the use of medications also become more common as we age. The following factors can further contribute to increases likely hood of developing vestibular or balance disorders:
- Osteoporosis: There may be a link between osteoporosis and developing BPPV.
- Osteoarthritis/degenerative disc disease: Joint pain and stiffness, especially in the neck, can affect balance and make it more difficult to coordinate head and body movements.
- Diabetes: can lead to neuropathy in the feet. This loss of sensation affects input to the vestibular system and can increase the risk of falling.
- Sarcopenia: This term refers to the loss of muscle mass as we age. Good muscle strength, especially in our legs and core is important in helping us to maintain our upright posture and stability as we move around.
- Hearing and vision loss: what we are seeing and hearing around us can help us to better orientate ourselves and if these senses are dulled, it can contribute to loss of balance.
- Cardiovascular disease: can affect blood flow to the brain or the inner ear
- Poly-pharmacy (taking over 5 medications): some medications or the interactions of certain medications can result in dizziness/lightheadedness as a side effect.
Consequences of Vestibular Disorders and Loss of Balance
Dizziness and balance problems can play a major role in increasing risks of falls, which can have dangerous consequences. Falls are the leading cause of injury for older adults in Canada. These injuries can be serious leading to hospitalizations, pain or reduced mobility, which can negatively impact someone's daily life and independence. Even just the fear of falling can have negative impacts on one's quality of life by reducing confidence in moving around or even leading to social isolation.
So What Can We do to Prevent Falls?
Let’s first talk about vestibular rehabilitation.
Vestibular physiotherapy aims to treat vestibular disorders to restore balance and improve feelings of dizziness.
- Eye tracking exercises and gaze stability exercises that will help keep the eyes steady as you move
- Adaptation and habituation exercises to reduce sensitivity of your symptoms to specific movement or stimuli
- Balance and coordination exercises
- Head position manoeuvres to try and reset the inner ear and displace any crystals that could be causing vertigo
- Neck exercise and manual therapy as the neck pain and stiffness can play a role in dizziness.
It is important to note that falls are multifactorial, so it is important to address the risk factors that contribute to an individual's risk of falls.
Falls Prevention should also include:
- Exercise and nutrition
- Stay active and do strengthening/balance exercises to improve strength and balance
- Eat and drink enough water to prevent dehydration and dizziness
- General health and medications:
- Get your vision and hearing checked regularly
- Have regular check ups with your doctor to ensure chronic conditions are being managed. Medications should be reviewed yearly.
- Talk to your doctor about taking vitamin D and calcium supplements to promote bone health
- Assistive devices:
- Wear your glasses and hearing aids as prescribed
- Use a mobility device such as a cane or a walker if you feel unsteady. Our physiotherapists can help you find the mobility device that works best for you, and fit it to your needs
- Where a medical alert device if you are worried about having an emergency when you are alone
- Home modifications:
- Modify your home to eliminate tripping hazards (loose rugs, clutter, excess furniture)
- Brighten darker areas
- Install grab bars
- Wear supportive footwear in the home
- Install a shower seat and hand held shower head
Even though vestibular disorders and falls become more common with age, there are ways we can intervene to help improve our overall balance and minimize the risk of falling and sustaining injury. If you are experiencing a vestibular disorder or having dizziness of any kind, we have vestibular trained physiotherapists who can help to identify the cause and provide vestibular rehabilitation.
If you would like more information on what you can be doing to reduce your risk of falling, we have developed a falls risk assessment based on the latest fall prevention guidelines that can stratify you into a risk level, identifying your unique risk factors and then we develop an individualized falls prevention program based on your needs.
Vestibular issues and falls can be prevented and addressed through a proactive approach! It's never too late to get started.
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Ally Ferguson is a Physiotherapist with additional training in concussion management and vestibular rehabilitation. She helped develop the Fit For Life Physiotherapy Falls Risk Assessment and has a passion for helping older adults maintain their independence and live full lives! If you're interested in working with Ally, book your appointment here or call us at 905-333-3488. |