Posture and balance are critical for human movement and function, and are closely tied to the coordination of the musculoskeletal system.
Good posture involves aligning the body to minimise strain, thus promoting health and confidence. Balance relies on sensory input and muscle control, with the brain integrating the signals to maintain stability. Loss of balance can be caused by various factors, including:
> Inner ear problems
The inner ear plays a crucial role in balance as it houses the vestibular system, which detects changes in head position and movement. Inner ear disorders, such as benign paroxysmal positional vertigo, vestibular neuritis or Meniere’s disease, can disrupt the signals sent to the brain about body position, leading to dizziness and balance problems.
> Neurological conditions
These encompass a wide range of disorders that impact the brain and nervous system, exerting significant effects on various bodily functions, including balance.
These conditions disrupt the intricate network of signals between the brain, spinal cord and peripheral nerves, leading to disturbances in coordination, muscle control and sensory perception. Examples of such neurological disorders include Parkinson’s disease, multiple sclerosis (MS), stroke, brain tumours and peripheral neuropathy.
> Musculoskeletal issues
Problems of the muscles, joints or bones pose significant challenges to balance and stability, making individuals more susceptible to falls and injuries. Arthritis, osteoporosis, muscle weakness, and injuries such as sprains or fractures, can all contribute to balance difficulties by causing weakness, stiffness or instability.
> Medications
Medications can significantly affect balance through various side effects, including dizziness, drowsiness, orthostatic (or postural) hypotension, blurred vision, muscle weakness, tremors, impaired coordination, cognitive changes and by altering sensory perception.
Classes of medications such as anti-histamines, blood pressure drugs, neurological medications, analgesics, anti-cholinergics, and psychotropic drugs such as serotonin reuptake inhibitors (SSRIs), can all contribute to balance disturbances.
Polypharmacy, i.e. the use of multiple medications, increases the risk of adverse effects and interactions that may further impact balance. Healthcare providers should carefully evaluate medication regimens, especially in older adults and those with existing balance issues, to minimise the risk of falls and injuries.
Patients should communicate any balance-related symptoms or concerns to their healthcare providers for appropriate management.
> Vision problems
Vision is crucial for maintaining balance as it provides feedback about the environment and spatial orientation. Visual impairments like cataracts, glaucoma and macular degeneration, can disrupt depth perception, making it challenging to navigate one’s surroundings safely.
Cataracts cause blurred vision, glaucoma affects peripheral vision, and macular degeneration impairs central vision. Early detection and interventions such as corrective lenses or surgical treatments, can help mitigate the impact of visual impairments on balance and enhance safety.
> Ageing
As people age, changes in the vestibular system, muscle strength, joint flexibility and sensory perception can affect balance. Moreover, age-related declines in muscle strength and mass – a condition known as sarcopenia – can significantly impact balance and mobility.
Muscles play a critical role in providing support and stability to the body, particularly in maintaining posture and executing movements. However, as muscle mass decreases and muscle strength diminishes with age, older adults may experience weakness and instability, making them more susceptible to balance impairments and falls.
Similarly, changes in joint flexibility and range of motion can contribute to balance problems in older individuals. Stiffness and reduced flexibility in joints – often associated with conditions such as osteoarthritis or degenerative joint disease – can impair the body’s ability to adjust and adapt to changes in position or terrain, increasing the risk of falls.
Furthermore, age-related conditions such as degenerative disc disease, characterised by the breakdown of spinal discs, can lead to spinal instability and impairments in posture and balance. Loss of disc height and integrity may result in spinal misalignment and decreased support for the vertebral column, further exacerbating balance issues and increasing the risk of falls.
> Environmental factors
External factors significantly contribute to the risk of falls, especially for individuals with balance issues. Uneven surfaces, poor lighting, cluttered spaces and inadequate footwear all increase the likelihood of falls.
Uneven surfaces disrupt the natural gait, poor lighting impairs visibility, clutter creates obstacles and inadequate footwear compromises stability. Additionally, environmental factors like wet or slippery surfaces, further heighten fall risks.
Addressing these hazards through home modifications, improved lighting, clutter reduction and proper footwear selection, is crucial for fall prevention, particularly among older adults and those with balance impairments.
Preventing falls
Falls among older adults represent a significant public health concern, often resulting in serious injuries and complications that can impact overall safety and well-being. As such, implementing effective fall prevention strategies is paramount to safeguarding the health and independence of older individuals.
These include:
> Regular exercise
This is a cornerstone in fall prevention efforts. Engaging in physical activities that focus on improving strength, balance and flexibility, can enhance muscle tone and coordination, thereby reducing the likelihood of falls.
Activities such as walking, tai chi, yoga and strength training have been shown to fortify musculoskeletal health and bolster balance mechanisms, making them invaluable components of any fall prevention regimen.
> Reviewing medications
As mentioned above, certain medications can induce side effects that affect our balance. Therefore, it is essential for older adults to speak to their doctor or pharmacist about the potential impact of the medications they are taking on their balance and coordination. Adjustments to medication regimens, when necessary, can mitigate these risks and contribute to overall safety.
> Maintaining optimal vision
Poor vision can impede depth perception and spatial awareness, increasing the likelihood of missteps and accidents. Routine vision check-ups and timely updates to prescription glasses or contact lenses are essential in ensuring clear vision and minimising fall hazards associated with visual impairment.
> Creating a safe home environment
Home safety modifications, such as decluttering living spaces, securing loose rugs, installing grab bars in bathrooms, and improving lighting, can significantly reduce fall risks within the home. Clear pathways and well-lit areas facilitate safe navigation and minimise the potential for accidents.
Furthermore, the use of assistive devices can provide additional support and stability for older adults, particularly those with mobility limitations. Canes, walkers, and handrails enable individuals to navigate their surroundings with confidence, reducing the risk of falls and promoting independence.
> Proper footwear
Wearing sturdy, properly-fitting shoes with non-skid soles enhances traction and stability, minimising the risk of slipping and tripping on various surfaces.
> Being aware of fall hazards
Being mindful of potential dangers in the surroundings, such as uneven surfaces, wet floors or obstacles, empowers individuals to take proactive measures to mitigate risks and prevent falls.
> Limiting alcohol consumption
Excessive alcohol intake can impair balance and coordination, heightening the risk of falls. Moderate and responsible alcohol consumption practices are essential for maintaining safety and minimising fall-related injuries.
> Learning about fall prevention
Participation in fall prevention programmes and workshops can provide valuable education and resources for older adults and their caregivers. These programmes often offer evidence-based strategies for reducing fall risks and improving safety awareness, empowering individuals to take proactive steps towards fall prevention.
> Staying active and engaged
Taking part in social activities and hobbies can contribute to overall well-being and resilience against falls. Physical activity and social engagement promote physical and mental health, thus enhancing mobility, cognitive function and emotional well-being, which are essential components of fall prevention.
In summary, preventing falls among older adults necessitates a comprehensive approach that considers various factors encompassing health, lifestyle and surroundings. By adopting the measures stated above, individuals can effectively mitigate their risk of falls, and uphold their independence and quality of life.
Collaboration with healthcare providers and caregivers is vital for devising tailored fall prevention strategies that address individual needs and circumstances. Ultimately, prioritising efforts to prevent falls can significantly enhance safety, well-being and longevity in ageing individuals.
By Datuk Dr Nor Ashikin Mokhtar
Published in Star Newspaper, 22 Apr 2024
