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Maintaining Balance

Falls are the most common cause of injury in elderly adults (age 65 and older). As many as one third of elderly adults fall each year and the risk of falling triples if you have a neurologic disorder like peripheral neuropathy. Twenty to thirty percent of older people who fall, suffer moderate to severe injuries, such as hip fractures and head traumas. These injuries can be life altering and evenly deadly. According to the Centers for Disease Control and Prevention, falls kill more than 18,000 older adults each year.

Often falls go unreported to caregivers and physicians because patients fear they will lose their independence but a study in the journal JAMA Internal Medicine reports that falls are on the rise with more seniors experiencing falls than they were 13 years ago. The study expected to see an increase in falls because the American population is aging (according to the 2010 Census, more people were 65 years and over in 2010 than in any previous census and the nation’s 90+ population nearly tripled over the past three decades!). Surprisingly the changing age demographic did NOT explain the increase in falls. In fact, the biggest spike was for those just over 65. The study was not able to determine the cause of the increase. It could be that older adults might be more likely to report it now than they were before or other risk factors like the side effects of medications, may be on the rise.

Why We Fall
Balance is the ability to maintain the body’s center of mass over its base of support. A properly functioning balance system allows humans to see clearly while moving, identify orientation with respect to gravity, determine direction and speed of movement, and make automatic postural adjustments to maintain posture and stability in various conditions and activities. Our balance depends on the coordination of input from multiple sensory systems:
• Visual system: sight provides information on the verticality of the body and spatial location relative to objects
• Proprioception system provides information from skin (touch) and joints (pressure and vibratory senses)
• Vestibular system: our sense organs that provide information on direction, motion, equilibrium and spatial orientation.

Our bodies need to integrate this sensory input and translate that into motor output to the eye and body muscles. Maintaining balance depends on information received by the brain from three peripheral sources: eyes, muscles and joints and vestibular organs. All three of these sources send information to the brain in the form of nerve impulses from special nerve endings called sensory receptors. Peripheral neuropathy (PN) is a disorder of the motor, sensory, and autonomic nerves. So in addition to aging, PN patients are at a greater risk of falling because numbness, decreased sensitivity to touch and muscle weakness can have significant adverse effects on their balance.

How to Stay on Your Feet
The keys to staying safe lie in taking care of yourself and being mindful of the spaces in which you live and work.

Start by talking to your doctor. Make sure to rule out other potential causes for balance issues including other medical conditions besides your neuropathy and any potential side effects from medications. Make sure ALL your doctors and your pharmacist are aware of every medication you are taking including over the counter medications. If you notice yourself feeling more drowsy or dizzy, speak to your doctor about changing medications or doses. And don’t forget to get your vision checked regularly!

Exercise is a must! Strengthening exercises for the back, legs and core improve balance. A 2012 study of balance disorders in diabetic peripheral neuropathy patients (Journal of Rehabilitation Research and Development 2012) showed that they could achieve better balance and stability through progressive balance training. They recommended that training be gradual and persistent so as to have long-term effects on the patient. Clinical studies have also shown that tai chi helps stabilize gait, improve balance and reduce falls among people with peripheral neuropathy.

Protect yourself in your home. Clear the clutter on your floor and stairs and be sure rugs are secured. Bath mats without non-skid backing are dangerous. Illuminate the path through your home. Check the height of your bed and chairs. You should be able to sit up while also having your feet securely and comfortably flat on the floor and be sure to wear appropriate footwear – slip on shoes can come off easily and catch on stairs, rugs, etc.

Move wisely. Think about how to move in the safest way possible before actually moving. Make sure your path is clear and you can see your feet. Don’t reach for things in an awkward position.

Get strong, be safe, and maintain balance.

Sources: Vestibular Disorders Association ( and Neurology News, January 2015