the individual’s ability to effectively retain his body position or restore the
center of mass over time.
is a vital skill for daily life it involves the complex combination of sensory
information about body position relative to its surrounding and the ability to
produce proper motor responses to control movements of body. Balance depends on
contributions from vision, vestibular sense, proprioception, muscle strength
and reaction time. With increased age balance deficits occurs, because of
progressive loss of functioning of these systems.
Balance disorder is a disturbance
due to which individual feel unsteady and is accompanied by dizziness.1
Balance disorders affects
both the health and quality of life of the old people .3–5
Balance impairment and
are among the most
common chronic issues experienced
by the elderly
population and reported to physicians.1,2
Balance disorder is
associated with impaired vision, decreased hearing, vestibular dysfunction,
poly-neuropathy, diabetic neuropathy and many chronic diseases and disorders
i.e. cerebral and cerebellar disorders, cerebrovascular disease, spinal cord
disorders, intervertebral disc disorders, psychological factors, dementia, heart
disease, high blood pressure, arrhythmias , postural hypotension, diabetes
mellitus, , proprioception, joint problems, arthritis and muscular weakness.
conditions are linked with aging process and this is the reason old individuals are at increased
risk of fall.
Also the side effects
of many medications commonly prescribed among elderly can also cause dizziness
and balance disorder.
A major risk factor for falling in a prospective
study conducted by Neil B. Alexander, MD is a high number of balance and gait
abnormalities and more than 36% of those aged 75 complain of postural
disturbances, mostly unsteadiness.” While 13% of people aged 65 to 69
living in the community complain of balance difficulties while walking, 46% of
those 85 years and over have the same complaint.’
Almost 30% of elderly
population will experience a fall annually, and 20% to 30% of them will
resulting in loss of mobility and independence. The rate of hospitalization for
fall related trauma in persons aged 65 and above was 13.5 per 1000 persons
which was five times that of non fall related trauma.
28-35% elderly population aged 65 years
or older fall. With increasing age an increase in fall rate has been reported
to 40% for population aged 75 years or older.
Annually about 424,000
individuals die from falls globally and over 80% of them are in low and middle
income countries. Greatest number of fatal falls occurs in adults above 65 age.
In a study a total of 100 participants
were included, male and female ratio was 2:3. 45% of participants had a history
of fall while 55% had no history of fall.
Currently, 6% of the population
of Pakistan is over the age of 60 (7.3 million people) (Government of Pakistan
In a cross sectional study done
in Islamabad Pakistan balance problems were more common in females (66%)
compared to males (42%). Amongst the patients who had problems with balance,
33% of the population experienced falls. Common age for balance problems was
Almost 20% of older
adults in the United
problems with dizziness or balance.
With respect to quality-of-life and
functional impact, 27.4% ± 1.8% reported that balance problems specifically
prevented them from participating in activities including exercise (61.2% ±
3.5%), social events (45.8% ± 4.0%), driving (47.1% ± 3.8%), and work/school
(37.7% ± 7.8%). Furthermore, 25.7% ± 3.5%reported that their balance problem
affected their activities of daily living (bathing, dressing, eating, and
Approximately 75% of elders above 75 year
age have limited activities due to functional impairment each year; 40% of
elders experience restricted activity in two consecutive months. Almost 50% of
people 85 years of age and older require assistance in one or more ADL
Maarsingh and colleagues found that an
adverse drug effect was the cause of 23% of elderly patients presenting to a
primary care physician with dizziness symptoms. Psychoactive medications,
includes hypnotic, anxiolytic, antidepressant, and antipsychotic agents.
It is estimated that by the age of 65 years 1 in 3 elderly
persons suffers from some form of loss of vision which results in decreased
ability to perform daily life activities, a loss of independence, and an
increased risk of depression.
When there is sensory information conflict, specially due to vestibular
dysfunction, the signs and symptoms of balance loss become common .Elderly with
vertigo and dizziness due to vestibular dysfunction express their symptoms as
postural instability, increase in postural sway, reduced stability, gait
impairments, falls, and reduction in functional capacity.
Vestibular dysfunction causes vertigo and dizziness in 5% to 10% of the
world’s population, representing the most common symptoms after the age of 65 years-old,
and affecting 80% of the older adults.
With increasing age
disability in walking occurs due to muscle weakness and decreased joint
proprioception, walking disability in 65 to 69 year age is 6% and in 85 years
or older the percentage reaches to 40. With diseases such as arthritis, 35% of
older adults have walking difficulty of one-quarter mile.
Aging process is an
important topic regarding its associated problems but only few studies have
been conducted and reported globally including Pakistan .In this study we
quantified the prevalence of balance disorder in elderly population and
determined the impact of this balance disorder on their daily life and
activities .This data about the prevalence of balance disorder and its impact
on elderly population is of particular importance with anticipated aging of
Pakistan population in the next few years. The presence of balance disorder
will not only affect quality of life of increasing older population but will
also influence the health care resources consumption among the elderly.