Older Adults and Balance Dysfunction

Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA.
Neurologic Clinics (Impact Factor: 1.4). 09/2005; 23(3):785-805, vii. DOI: 10.1016/j.ncl.2005.01.009
Source: PubMed


All sensory systems that contribute to balance and integrity of postural control seem to undergo degenerative changes associated with aging. Disorders of balance and dizziness frequently are reported in older persons [17,72,80,82,99-101]. The mean age of patient samples from vestibular clinics is reported to be 60 to 65 years of age [91]. The most common vestibular conditions frequently reported in older adults include BPPV, vestibular neuritis, labyrinthitis, Meniere's disease, and central vestibular disorders [102,103]. These disorders can present with a wide range of functional limitations and levels of disability. A more complete list of factors and disorders that predispose older people to fall is included in Box 1. A thorough understanding of the sensory and motor decline observed with aging is important for the clinical management of postural instability and resultant falls [104]. It also must be considered that the contributions of higher central integrative functions have a significant influence on postural control. Balance with functional activity is the result of the quality of sensory information, integrity of motor responses, and how this information is integrated at higher levels [105]. As discussed previously, falling in older adults is recognized as a complex and multifactorial problem. There is general agreement that impaired postural control is associated with age-related sensory changes in older adults. This is the common mechanism that ultimately predisposes the older adults to increased likelihood of a fall event. The implementation of practical clinical management strategies for the prevention of falls and subsequent injuries is based on a thorough examination of the integrity of the sensory and motor systems and functional and social limitations imposed by these system impairments.

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    • "Shorter steps and longer double support times were associated with smaller sensorimotor regions within the motor, visuospatial, and cognitive speed domains. These findings suggest that measures of gait in older adults living in the community are not only the consequence of underlying age-related changes in peripheral systems (i.e., neuropathology) [49], but that they also indicate underlying focal, selective changes in brain structure [48]. In summary, older adults show larger postural sway, slower gait velocity, and increased stride-to-stride variability under single and particularly multi-task conditions compared to young adults. "
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    ABSTRACT: A continuously greying society is confronted with specific age-related health problems (e.g., increased fall incidence/injury rate) that threaten both the quality of life of fall-prone individuals as well as the long-term sustainability of the public health care system due to high treatment costs of fall-related injuries (e.g., femoral neck fracture). Thus, intense research efforts are needed from interdisciplinary fields (e.g., geriatrics, neurology, and exercise science) to (a) elucidate neuromuscular fall-risk factors, (b) develop and apply adequate fall-risk assessment tools that can be administered in clinical practice, and (c) develop and design effective intervention programs that have the potential to counteract a large number of fall-risk factors by ultimately reducing the number of falls in the healthy elderly. This paper makes an effort to present the above-raised research topics in order to provide clinicians, therapists, and practitioners with the current state-of-the-art information.
    Journal of aging research 01/2012; 2012(26):708905. DOI:10.1155/2012/708905
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    • "Indeed, Mion et al. (1989) identified impaired proprioception as a contributing factor to falls among patients in a rehabilitative setting. Therefore, the focus here will be on the effects of ageing on proprioceptive receptors even though age-related impairments have been proposed at every stage of the postural control system (Marchetti & Whitney, 2005). [For a detailed review on this topic, see Shaffer and Harrison (2007).] "
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    ABSTRACT: The ageing neuromuscular system is affected by structural and functional changes that lead to a general slowing down of neuromuscular performance and an increased risk of falling. As a consequence, the process of ageing results in a reduced ability to develop maximal and explosive force, as well as in deficits in static and dynamic postural control. A decrease in the number and size of type II fibres in particular accounts for the age-related decline in muscle mass (sarcopaenia) and strength performance. Multiple denervation and re-innervation processes of muscle fibres seem to be responsible for the reduced number of muscle fibres. Recently, it has been suggested that it is not the decline in motoneurons that accounts for the loss in number of muscle fibres but the disturbed potential of fibre regeneration and re-innervation. Furthermore, an age-related reduction in the number of satellite cells has also been associated with sarcopaenia. The ability to compensate for platform and gait perturbations deteriorates with ageing as reflected in longer onset latencies and inefficient postural responses. All sites within the somatosensory system are affected by ageing and therefore contribute to postural instability. However, morphological changes of muscle spindles appear primarily to be responsible for the impaired ability to compensate for balance threats in old age. Given these neuromuscular limitations in old age, it is important to apply adequate training interventions that delay or even reverse the onset of these constraints. Strength training has the potential to enhance maximal as well as explosive force production capacity. This is accomplished by neural factors, including an improved recruitment pattern, discharge rate, and synchronization of motor units. Furthermore, an increase in number of satellite cells most likely accounts for training-induced muscle hypertrophy. Recent studies have investigated the impact of balance training in old age on the ability to develop maximal and explosive force. In addition, the effects of balance training on reflex activity during gait perturbations were also examined. Increases in maximal and explosive force production capacity and an improved ability to compensate for gait perturbations were observed. It is evident from the literature that researchers are increasingly studying the effects of more specifically designed training programmes on performance in populations of older adults. Thus, in the near future, strength training could be replaced by high-velocity forms of power training and balance training by perturbation-based training programmes. It is hypothesized that this new approach is more efficient in terms of fall prevention than the traditional approach
    European Journal of Sport Science 11/2008; 8(6-6):325-340. DOI:10.1080/17461390802478066 · 1.55 Impact Factor
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