Watch out for these balance busters

Health problems, medications, and environmental hazards can throw off balance and increase your fall risk.

Our balance wanes as we age, putting us in jeopardy. The problem reflects a mix of issues that set us up for falls, which are a major cause of hip fractures, head injuries, and disability.

The good news is that you can fight back by recognizing and addressing potential balance busters. "Everything we do to maintain our health, alertness, fitness, and mobility will slow the trajectory of our declining balance," explains Dr. Steven Rauch, medical director of the Balance and Vestibular Center at Harvard-affiliated Massachusetts Eye and Ear.

What is balance?

Your balance is controlled by a miraculous system-one that involves your whole body.

"Your eyes tell you where you are in space. Balance organs in your ears read your head movements. Nerves send information about the position of your body. All these signals from your eyes, ears, and nerves are processed by your brain, which then sends messages back to your sensory nerves, muscles, and joints that help you keep your balance. As a result, you can walk, keep your gaze stable while you move, or catch yourself after tripping," Dr. Rauch explains.

These different parts of our balance system decline as we age. "Vision and hearing don’t work as well as they used to, messages in the nerves can get garbled, muscles shrink and get weaker, joints wear out, and our brain may not be as quick to make adjustments to maintain balance," Dr. Rauch says.

Health-related balance risks

Many health conditions can hurt balance. Here are some common culprits.

Vision problems. Eye diseases can reduce the ability to relay your location to the brain. Three conditions in particular become more common with age: cataracts (cloudy eye lenses), glaucoma (which causes loss of side vision), and macular degeneration (which destroys central vision).

Inner ear conditions. Some disorders can im­pair balance organs and trigger a sense of spinning (vertigo). Three common conditions are benign paroxysmal positional vertigo (caused by loose ear crystals), inner ear infections, and Ménière’s disease (in which fluid buildup leads to pressure and damage).

Neuropathy. This type of nerve damage, often caused by diabetes or compressed nerves in the spine, causes tingling, numbness, or pain in the limbs and limits your brain’s ability to sense your legs and feet.

Foot conditions. Anything that affects the way you walk threatens your balance, whether it’s a heel problem or fallen (painful) arches.

Orthostatic hypotension. This means your blood pressure dips too low when you stand up, which can make you feel dizzy and fall. It becomes more common with age and can be a side effect of medicines.

Mild cognitive impairment. This slight but noticeable change in memory and thinking skills is sometimes a precursor to dementia. The condition can affect your attention, reaction time, and ability to sense where you are in space.

Medication-related balance risks

Many medications can make you woozy and cause you to lose your balance. These include

• some antidepressants
• drugs to treat anxiety, such as benzodiazepines
• antihistamines
• blood pressure drugs, such as ACE inhibitors, angiotensin-receptor blockers (ARBs), and beta blockers
• diabetes drugs, such as insulin, glipizide (Glucotrol), and glyburide (DiaBeta, Glynase)
• drugs to treat irregular heartbeat
• prescription pain medications, such as opioids
• sleep medications, such as sedatives and hypnotics.

Environmental balance risks

Hazards in your environment threaten your balance and can make you trip and fall. Watch out for the following:

Outdoor hazards, such as icy walkways, uneven pavement, poorly lighted walkways or parking lots, paths blocked by shrubs or large tree roots.

Indoor hazards, such as floor clutter, throw rugs, poorly lighted hallways or stairways, furniture that blocks your path, extension cords, loose carpeting, loose handrails, slippery bathroom floors, broken steps, and tile floors.

Pets that can get underfoot, such as cats and small dogs.

Ill-fitting shoes that keep you from sensing the ground properly, such as shoes that are too loose or squishy.

What you can do

There’s plenty you can do to improve your balance and reduce your fall risk. Start at home: get rid of hazards and add anti-slip equipment. "Install grab bars by the tub and toilet, nonslip treads in places that get wet, night lights so you don’t bump around in the dark, and handrails that can support your body weight," Dr. Rauch advises.

Ask your doctor if any of your health problems or medications could be increasing your fall risk. Ask if you might benefit from physical therapy, and if an assistive walking device (like a cane or rollator) might improve your balance.

Wear supportive shoes with laces to keep them snug on your feet.

And hone your balance skills by challenging your balance safely. "Stand on one foot when you brush your teeth in the morning, then stand on the other when you brush at night — holding the sink counter for balance. Use the stairs instead of the elevator. And exercise: walk, cycle, do tai chi or yoga or dance," Dr. Rauch urges. "Use your balance, because there’s no question that good balance is a use-it-or-lose-it proposition."