Postural Imbalance in the Elderly: Main Aspects

Natália Moya Rodrigues Pereira and Marcos Eduardo Scheicher

## Abstract

The aging of the population is an unprecedented world phenomenon. Numerous physiological changes occur with aging, and one of the most common situations is postural imbalance and, consequently, the occurrence of falls. Balancing is the process of controlling the body's center of mass with respect to its base of support and depends on the integration of sensory systems (visual, vestibular, and somatosensory) with the central nervous system (CNS). Each system is prone to deterioration with advancing age and is influenced by age-related diseases and use of some types of medications and polypharmacy. As with any good clinical evaluation, a detailed history and a thorough physical examination are essential to evaluate postural balance. The evaluation of balance must be done with tests that are quick and with relatively little equipment and training. The improvement of postural balance can be done in many ways, and exercises are a type of this treatment and can be done with video games or a treadmill, for example.

Keywords: aging, postural balance, sensory systems

#### 1. Aging of population

The aging of the population is an unprecedented world phenomenon. The projections of the World Health Organization indicate that by 2050, all ages will increase by 35%, people aged 65–84 will increase by 164%, older people aged 85–99 will increase by 301% and centenarians will grow by 746% [1].

Increasing longevity also contributes to an aging population. Globally, life expectancy at birth is projected to increase from 69 years in 2005–2010 to 76 years in 2045–2050 and to 82 years in 2095–2100 [1] (Figures 1 and 2).

Physiological changes are observed with aging, increasing the risks of developing chronic diseases and dependence care. Auditory, visual, and movement problems may be present in people 60 years or older. In addition, some conditions such as dementia, heart disease, stroke, respiratory disorders, diabetes, and musculoskeletal conditions (osteoarthritis and back pain) are more frequent in this age group [2].

One of the most common situations for the elderly is postural imbalance and, consequently, the occurrence of falls, representing a significant health problem in older adults. Each year, approximately 30% of community-dwelling older people

fall at least once and 10–20% fall twice or more [3]. The incidence among institutionalized older people is even higher, with a mean percentage of residents who fall each year of over 40% [4].

2. Postural balance

may result in falls [7].

with the postural balance.

more on their proprioceptive information [7].

2.1.1 Cataract

2.1.2 Glaucoma

the body sway [16].

177

2.1 Vision and postural balance

and the vestibular information is 20% [5].

Postural Imbalance in the Elderly: Main Aspects DOI: http://dx.doi.org/10.5772/intechopen.79830

Balancing is the process of controlling the body's center of mass with respect to

Each system is prone to deterioration with advancing age, and this is influenced

The role of central and peripheral vision information in the control of movements and posture was examined in some studies [8, 9]. These authors suggested that peripheral vision is used for postural control and most particularly for stabilization of fore-aft sways, while the central vision is more often used for foot trajectory planning, targeting, obstacle avoidance, and stabilization of lateral sways.

Visual impairment is an important health problem and a major cause of injury in the elderly. Cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy are the most common diseases related to the elderly and can interfere

Cataract, affecting mainly visual acuity and contrast sensitivity, contributes to about 50% of visual impairments in the elderly [10, 11]. The consequences include decreased ability to perform activities of daily living (such as reading, watching television, driving, and interacting socially), depression, increased number of falls, and increased mortality [10, 12]. The impact on patients is comparable with that of major systemic conditions including stroke, diabetes, and arthritis. In a study in patients with cataract, Pasma et al. found a higher proprioceptive weight compared with healthy elderly participants, which means that the elderly with cataract rely

Glaucoma is a progressive optic neuropathy characterized by degeneration of retinal ganglion cells and their axons with consequent vision loss and blindness. This condition leads to a characteristic reduction in the visual field (VF), with good central visual acuity. Previous studies have reported a higher risk of falling in patients with glaucoma compared to normal subjects [13–15]. In the study by Black et al., a cohort of glaucoma subjects was examined to assess body displacement of the trunk and the results showed that the worse the visual field defect, the greater

by age-related diseases and use of some types of medications, in addition to polypharmacy [6]. Systems can partially compensate for each other's deterioration. Failing compensation strategies may eventually result in impaired balance, which

its base of support, whether in a static or dynamic situation. It depends on the integration of sensory systems with the CNS. Sensory information from somatosensory, visual, and vestibular systems must be integrated to interpret complex sensory environments. Each system interacts with each other to maintain balance in a closed loop, with an interrelation of cause and effect. When the sensory environment is changed, the CNS needs to re-weigh the contribution of each of the senses in postural balance. In an environment with good lighting and a firm surface, the contribution of somatosensory information is 70%, the visual information is 10%,

Figure 1. Total population by broad age group. Courtesy: World Health Organization.

Figure 2. Life expectancy at birth by sex. Courtesy: World Health Organization.
