Understanding Age-Related Balance Issues: How Vestibular Rehab Can Help Prevent Falls

As we age, maintaining balance and preventing falls become increasingly important. Falls are the leading cause of injury in older adults (Rubinstein, 2006), often leading to both physical and emotional challenges like anxiety, depression, and a fear of falling. These concerns can further affect posture and increase the risk of imbalance. At PMC Physiotherapy, we believe that balance issues don’t have to be an inevitable part of ageing. Through targeted vestibular rehabilitation and strengthening exercises, we can help improve balance, boost confidence, and keep you moving safely.

The body relies on three primary systems for balance: the visual system, the proprioceptive system (which senses body position and movement), and the vestibular system (located in the inner ear). When all is working normally, these 3 systems coordinate to give our brain information to allow us to maintain our balance. Within the inner ear there are specialised nerve endings that send messages from the inner ear to the brain. This allows the brain to control balance and to control eye movements of the eyes, making it possible to see clearly while moving.

However, as we age, changes in these systems can lead to imbalance and an increased risk of falls. For example, the number of nerve cells in the vestibular system decreases after age 55, and blood flow to the inner ear also reduces. We have described in previous blogs how an individual may experience dizziness and balance problems when the vestibular system is damaged (e.g. vestibular neuritis). These issues tend to be on one side which creates an imbalance in the vestibular system and this results in dizziness or vertigo. Age related changes to the inner ear can result in balance problems without any dizziness as it tends to equally affect both sides. Therefore, the changes may be first detected as difficulty walking on an uneven surface or in the dark.

In addition to changes in the vestibular system, ageing also impacts the proprioceptive and visual systems, further reducing balance control. This leads to changes in postural control strategies. In older age, the strategy for maintaining balance after a slip moves from a rapid shift in weight coming from a shift in the position of the hips, to a ‘step strategy’. This is avoiding a fall by stepping rapidly. This can eventually lead to a total loss of the ability to correct in time to prevent a fall.

Our vision also deteriorates as we age. This deterioration in our proprioceptive and visual systems means that recovery from issues like vestibular neuritis or BPPV (benign paroxysmal positional vertigo) can be slower in older adults, as we are less able to compensate for the loss of function in one system with the other two.

To address these challenges, we tailor exercises specifically to each individual’s needs, focusing on improving vestibular function, proprioception, and overall balance. If walking presents difficulties, for instance, we guide patients through exercises that strengthen balance while walking as part of their rehabilitation. Our goal is to ensure that everyone, regardless of age, can maintain independence and confidence in their daily activities.

If you or a loved one is experiencing dizziness, imbalance, or a fear of falling, it’s never too late to take steps toward improving your balance and preventing falls. At PMC Physiotherapy, our experienced team is here to provide support and guidance through personalised vestibular rehabilitation programs designed to restore balance and enhance quality of life. Book a visit with us today, and together, we can help you regain stability, confidence, and freedom of movement.

References:
Rubinstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Aging 2006;35:ii37–41.

Johnson C, Hallemans A, Verbecque E, De Vestel C, Herssens N, Vereeck L. Aging and the Relationship between Balance Performance, Vestibular Function and Somatosensory Thresholds. J Int Adv Otol. 2020 Dec;16(3):328-337. doi: 10.5152/iao.2020.8287. PMID: 33136012; PMCID: PMC7901442.