We all know someone who has had a terrible fall and ended up in the hospital. If you don’t, you’ve at least heard stories. When you hear these stories though, are you surprised? Concerned and sympathetic, yes. But surprised? Or have we all just accepted falls as an inevitable part of getting older?
According to the World Health Organization, the instances of people over the age of 65 who will fall each year is 1 in 3. The odds that someone will fall once they hit 80? 50%.
The crazy thing is, falls are preventable. Prevention isn’t just about addressing your environment either. Sure, adding railings in the shower and removing rugs from the home will help, but the real trick is working on the vestibular system.
Alright, so now that we’ve tossed the fancy words out there. Let’s talk about what the heck they mean.
The Vestibular System (VS) is a sensory system that allows the body to create compensatory movements that provide a sense of balance. The compensatory movements that are created are in response not just the external environment but also to internal stimuli as well. For the most part, this system stays pretty well intact until later in life. Generally from 65 on the system starts to slowly degrade and becomes less efficient.
In english? The VS is our inner ear. The canals, hairs and small organs that make it up allow us to take in sensory information (both within and without) that helps us stay balanced and upright. A complex system but simple idea.
So, as we get older, the system starts to break down–just one of the many joys of aging.
When the system starts breaking down, a person might start to notice:
- balance issues (that can range from mild to debilitating)
- dizziness
- disequilibrium
- vertigo
- nausea
- pallor
- diaphoresis
- malaise
- emesis
- feelings of physical, mental and emotional isolation
The good news is that research has shown that vestibular rehabilitation is possible; even people as old as 99 saw an improvement in their balance of up to 42% with treatment. So maybe we can’t teach an old dog new tricks but it looks like we can teach him to do old tricks well long into life.
The Tools
Alright, so how do we stop this old dog from falling over? Well, there are a couple of things we can do:
Well, to start, much of the data seems to subscribe to a “use it or lose it mentality”, meaning it isn’t enough to continue or introduce strength and aerobic exercise routines as a way of maintaining or improving vestibular health. While these are both important to overall health, the VS should be treated with specific rehabilitation exercises and drills such as practicing safe falls in a controlled environment (a form of Perturbation-based balance training).
Tools you can use at home:
- Walk, especially on uneven surfaces or with a practitioner who will mimic imbalance at unexpected intervals
- Run, on a treadmill with accelerations and decelerations happening at random intervals
- Practice yoga
- cawthorne-cooksley exercises
Cawthorne-Cooksley Exercises
These exercises were some of the earliest exercises that addressed issues with the vestibular system. They are designed, for the most part, for home use. They include exercises that require the eyes to move independently from the head, practicing balance in everyday situations, triggering bouts of dizziness and nausea to help develop compensations, and more.
An example:
Sit on the edge of your bed, relaxing your neck and going very slowly, move your eyes up and down (without moving your head). Once you have the hang of this, repeat moving your eyes side to side (remember, don’t move your head). Finally, hold your finger roughly 3 feet from your body and focus on it. Maintain focus as you slowly move your finger in toward your face. Stop when about 1 foot away. Repeat in the other direction.
Once you have the hang of these you can progress to additional exercises in the sequence. They get significantly more challenging in terms of coordination and balance. Track your progress as you move through them so that you can watch your improvement over time.
Why is all of this important?
Ultimately, falls can be life-ending. There’s no beating around the bush. Not only that, but falls can have social and economic impacts (not just to the victim of a fall, but to their loved ones and society as a whole).
According to the WHO, “falls lead to approx. 30% of mild to serious injury and are the cause of 15% of all emergency department visits.” That’s a lot of pressure on our already taxed healthcare system that we now know isn’t necessary. It’s a lot of taxpayer dollars. Our population is only getting older. As the baby boomers become seniors and begin to retire, the financial and social burden of these fall will land squarely on the shoulders of younger generations.
The WHO estimates that by 2050, 2 billion people on the planet will be 60 and over. That’s a crazy amount of people who are beginning to or experiencing vestibular decline.
So, with all that said, when should you start working to improve or maintain this system? Well, the VS starts to breakdown at 65, therefore, anyone over that age is technically a fall risk. So why wait? Incorporating balance training into your life now will payback in spades down the line.
If you need help or know someone who is a fall risk that could benefit from training with one of our practitioners, don’t hesitate to contact us.
Questions or concerns? Leave them in the comments below.
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References:
Deems, D. A., Deems, R. O., & O’Malley, B. W. (2019). Managing challenges in an aging vestibular system: Rehabilitation Strategies Normalize balance function in a cohort of patients up to 99 years. Ear, Nose & Throat Journal, 98(1), 37–43. https://doi.org/10.1177/0145561318824541
Gerards, M. H. G., McCrum, C., Mansfield, A., & Meijer, K. (2017). Perturbation-based balance training for falls reduction among older adults: Current evidence and implications for clinical practice. Geriatrics & Gerontology International, 17(12), 2294–2303. https://doi.org/10.1111/ggi.13082
Hain, T. C. (n.d.). Vestibular rehabilitation therapy (VRT). Vestibular Rehabilitation Exercises. Retrieved November 21, 2022, from https://dizziness-and-balance.com/treatment/rehab.html
Lambrou, D. D. (2020, August). What is balance therapy: Northeast spine & sports medicine. Northeast Spine and Sports Medicine. Retrieved November 18, 2022, from https://www.northeastspineandsports.com/blog/what-is-balance-therapy/
Vestibular rehabilitation exercises. Brain & Spine Foundation. (n.d.). Retrieved November 17, 2022, from https://www.brainandspine.org.uk/our-publications/our-fact-sheets/vestibular-rehabilitation-exercises/
Zalewski, C. (2015). Aging of the human vestibular system. Seminars in Hearing, 36(03), 175–196. https://doi.org/10.1055/s-0035-1555120