It is sometimes helpful to think of the body’s balance system as being run by a committee. The members of the committee are:
- The inner ears
- The eyes
- The receptors in feet, ankles, knees and hips
- The cerebellum (situated at the back of the brain)
Each of these has its function and the brain, which chairs the committee, is adept at choosing the members best suited for each situation.
If you stand still and close your eyes the brain relies on the receptors in the feet and leg joints to keep you upright.
When you walk, a combination of visual and ear information is used to keep you steady. In the dark you are more reliant on the ear information. In both of these situations the cerebellum is quietly adding helpful information.
Although in the young and healthy the system seems to work effortlessly, as we age certain committee members become less efficient. The inner ear balance function diminishes so that by the time we reach 80 it may be only half as good as it was at age 20. The eyes deteriorate so that it is more difficult to rely on their input. Hips and knees get replaced or just arthritic, altering or destroying the positional information they send back to the brain. Blood vessels get furred and in the brain this means less oxygen reaches the cerebellum reducing its efficiency.
In addition to the effects of ageing, smoking will increase the furring of arteries, whilst conditions such as diabetes will affect the eyes, ears, and signals from the legs.
Patients are often on medications for conditions such as high blood pressure. These will further influence their ability to cope when on their feet.
For elderly patients with imbalance it is therefore necessary to tease apart all the possible influences that may be impacting upon their condition. This requires an understanding of which areas of the balance system are most affected by different insults.
The amount of help given to patients with this problem is very variable. In some, changing a medication produces life-changing improvement. In others vestibular exercises will give benefit to allow a reasonable lifestyle. Treatment is customized to needs. It is important to look at the whole person rather than just the condition, and assess the level of balance function required, together with the chances of attaining that. Progress may take time and tends to require a combination of treatments.