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Impaired
Balance and Fall Risk |
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Impaired balance
or unsteadiness is a frequent complaint among
older individuals and represents an important
cause of falling. Balance problems contribute
to the risk of falling either directly or
indirectly (i.e., many individuals with unsteady
balance tend to restrict their activities,
which can lead to muscle weakness and, in
turn, increased fall risk). Balance impairment
is also strongly associated to the risk of
injurious falls, particularly hip fractures.
Fall-related hip fractures occur as a result
of a number of interrelated factors:
Loss of bone strength
and hip padding (i.e. fat and muscle)
Loss
of balance
Delayed protective responses resulting in a
fall
Inability to break the impact of a fall
Falling on to or near the hip
Severity of impact of the fall
Floor surface hardness
Mechanisms
Balance is maintained by inputs from the sensory
and musculoskeletal systems. Sensory information,
consisting of visual, vestibular and proprioceptive
feedback (i.e., the sense of position), and
muscle strength and joint flexibility in the
legs are all important in helping to detect
and correct balance loss. The loss of any
one system, but especially the loss of two
or more, effects balance and subsequently
increases the risk of falling.
Causes
Many factors are responsible for unsteady
balance, and older individuals may have many
reasons for impaired balance. Important conditions
that affect balance include:
Cataracts, glaucoma,
macular degeneration, and diabetic retinopathy,
which all affect vision.
Diabetic peripheral neuropathy, which affects
position sense in the feet and legs.
Neurological disorders, such as Parkinson’s
disease and stroke.
Arthritis or other diseases of bones and muscles
can compromise strength.
Cognitive factors, such as fear of falling,
dementia, and depression.
Lastly,
medications, such as sedatives, tranquilizers,
antidepressants, pain relievers and sleep
medications, and environmental hazards (e.g.,
poor lighting, slippery or unstable floor
surfaces, faulty footwear, excessive clutter,
lack of grab rail support and defective walking
devices) can contribute to balance loss and
falls.
Strategies to Maintain Balance
Maintaining balance generally requires a multifaceted
approach and consists of the following strategies:
Chronic Health Conditions
It’s important to treat and manage all
medical conditions, especially those associated
with balance loss and fall risk. Review all
medications on a regular basis and reduce
any unnecessary drugs (i.e., consider disease-specific
benefits and adverse effects of individual
medications). Monitor high-risk medications,
such as psychoactive drugs (e.g., tranquilizers
or antidepressants) for adverse effects (i.e.,
impaired balance is one of the most common
manifestations of adverse medication effects).
Canes and Walkers
Walking aids help maintain balance by increasing
an individual’s base of support. When
providing a cane or walker, it’s important
to tailor the aid to the individual, paying
attention to proper style, length and use.
Footwear
Sneakers are a good choice; they provide stable
traction when walking on slippery floor surfaces.
Wearing shoes with thick, soft soles (e.g.,
jogging shoes) that can affect balance and
proprioception or become a tripping hazard
by catching in carpeting and should be avoided.
Environment
Making available handholds or enablers for
beds (side rail or transfer bar), chairs (armrests),
and toilets (attached grab rails) is crucial
to support balance when rising from a sit-to-stand
position, especially in those individuals
with unsafe transfers.
Exercises
Muscle strengthening and proprioceptive training
can increase balance, while weight-bearing
exercise such as walking or weight training
can help minimize bone loss and reduce fracture
risk.
Strategies to Reduce Injurious Falls
In those individuals who remain at risk for
balance loss, strategies to reduce risk of injury
include:
Bed/Chair Alarms
To avoid the risk of falls and injury, individuals
with balance impairment often require staff
assistance with mobility. Alarms are tools that
alert or let nurses know when individuals who
shouldn’t be getting out of bed or up
from a chair without assistance are doing just
that. There are a variety of bed and chair alarms
available; all detect unsafe egress. Targeting
the type of alarm (e.g., sensor pad, pull string,
infrared beam, etc.) to the individual’s
clinical condition can greatly improve the effectiveness
of alarms.
Hip Protectors
Most hip fractures occur as a result of falling
sideways. Hip protectors (i.e., padded underwear
that fits over the bony prominence of the hips)
are designed to shunt away or absorb the energy
of a impact against the hip bones. Targeting
the type or style of hip protector to the individual’s
clinical condition helps improve adherence with
protectors.
Calcium and Vitamin
D
These nutrients help keep bones healthy. Optimizing
calcium and vitamin D intake through diet or
supplementation forms the basis for prevention
and treatment of osteoporosis. Calcium supplements
should provide 500 to 1,000 mg of elemental
calcium per day, and vitamin D supplements should
provide 400 to 800 units/day. |
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