Staying balanced in advanced age.
I grew up believing that advanced age is not associated with a decline in mobility or activity level. As a child, this belief was based on my dad’s wonderful enthusiasm for life, never give-up attitude, and incredible level of physical activity. My dad was 56 years old when I was born, but he did everything with us that a father in his 20s could have done; that continued into his early 90s. He is the reason I chose the field of physical therapy. I wanted to help everyone maintain their physical activity level and mobility, just as my dad was able to do. As an adult, I recognize that my dad was blessed with good health, but I’ve also been encouraged by the mountains of data confirming that age is simply a number. Biologic age is different from chronological age and there is remarkable diversity among individuals of similar “age.”1
Quality of life is strongly associated with the mobility of elderly people; those who stay active report being much happier. Falls often result in restricted mobility, a reduction in activities of daily living (caring for oneself independently), and an increased risk of long-term care placement. More than 1 in 3 seniors over the age of 65, and 1 in 2 over the age of 80, will experience at least one fall this year, often with disastrous consequences.3 It is important to note that this statistic can be greatly improved, by community awareness of fall risks, medical management of underlying disease processes, balance/mobility assessments, and retraining of impaired balance components.3
Risk factors associated with falls are: advanced age, balance or walking problems, poor vision, weakness in legs or trunk, pre-existing medical conditions (such as Parkinson disease, stroke, or diabetes), taking more than four medications simultaneously, using an assistive walking device (cane, walker, etc), and a past history of falls.3 Some of these risk factors are intrinsic (things we can’t change); however, we can often reduce their effect on mobility. Other factors are more readily addressed. It is important to note, that although age is a risk factor for falling, falls are not an obligatory part of aging.
Falls result from a loss of balance. Balance is vital to every day activities such as getting out of a chair, walking, bending, bathing, driving, etc. It is a complex process that is dependent on three main components: (1) Sensory input provides information about the body’s position relative to the environment (vision, vestibular – inner ear, and sense of touch – feet, ankles, joints). (2) Musculoskeletal system includes range of motion, flexibility, and strength. (3) Central Processing Control includes cognitive status, selective attention, and reaction time.4 If one or more of the components of balance described above are impaired, overall balance is diminished.
A person’s assessment of their own mobility and balance undoubtedly has an impact on how much they walk and which activities they participate in. Those who perceived their overall health and balance as “good” walked much more than those who perceived the same factors as “poor.” A vicious cycle can easily and quickly begin. The less active one is, the more impaired those components of balance will become, in turn reducing confidence and further undermining mobility and balance.3
Loss of balance and reduced mobility can be successfully prevented, reversed, or delayed at any age.5 John Glenn’s experience with balance difficulties provides a great example of this. After his space flights in the 1960s, he experienced balance problems that disqualified him from space travel. After participating in a rehabilitation program that targeted the specific components which were impaired, he returned to space at the age of 77.
A comprehensive balance assessment performed by a physical therapist identifies which factors are contributing to loss of mobility, fall risk, and/or decreased confidence. Many of these factors can be corrected with a program designed by a physical therapist, occupational therapist, and/or speech therapist. My dad always said, “practice makes perfect.” I have found this to be true. I have seen many faced with what seemed to be insurmountable odds, but overcame them with determination. That is our passion as therapists, to inspire that sense of determination in all our patients.