DEAR DOCTOR K: In a previous column you wrote about the importance of balance exercises as we age. But why does our balance get worse as we get older?
DEAR READER: A number of changes that come with aging can affect our balance.
— Inside our ears is a balance center called the vestibular system that detects where our body is in space. Are we upright or lying flat; are we standing on our feet or performing a handstand?
The vestibular system is connected to centers in the brain that also control our balance. When the vestibular system and brain determine that we’re about to fall over, the brain directs the body to take corrective action. Maybe we twist back upright so we don’t fall. Maybe we’re too far off center to avoid falling, so our arms and hands stretch out to brace our fall.
As we age, cells in the vestibular system die off. This affects how accurately we detect our position in space. That, in turn, affects our ability to correct our position. For example, if we start to tilt to the right and the vestibular system doesn’t detect this quickly, it becomes harder for the brain to prevent falling to the right.
— Our sight, the ability to focus and see things clearly, diminishes with age. So do depth perception, night vision and sensitivity to contrast. Eye problems can impair, blur or distort vision. The loss of these visual cues compromises balance. Corrective lenses or surgery may help.
— Blood pressure can dip suddenly when you stand up, causing dizziness, lightheadedness, blurry vision, even fainting. Standing up slowly — sitting first on the side of the bed when you rise, for example — may help.
— We lose a lot of muscle mass and strength as we age. We also lose power — a function of strength and speed — which affects balance, too. If you start to trip, power helps you react swiftly. Exercise can help you rebuild strength and power, or at least slow the pace of decline.
— Our reflexes and coordination slow with age. Thus, you may be more likely to stumble — and take more time to react when you do.
Many health problems can interfere with balance. They include, but are not limited to, arthritis, stroke, Parkinson’s disease and multiple sclerosis.
Medications may also increase your risk of falls. They can cause blurred vision, dizziness, lightheadedness and drowsiness. Some medications may damage the inner ear, spurring balance disorders.
Along with regular aerobic exercise and weight training, balance exercises are important as we get older. Such exercises really can help you improve your balance. I’ve posted some of these simple exercises before, but I think it’s worthwhile to highlight them again. You can find them on my website, AskDoctorK.com.
Dr. Anthony L. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.
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