Aging & Health A to Z

Balance Problems

Causes & Symptoms

Even healthy older adults usually have less secure balance than they had when they were younger.  Older adults may be taking many medications or are coping with chronic conditions that can interfere with balance.

Often several conditions can conspire to produce balance problems.  Some of those chronic conditions are:

• inner ear problems, including vertigo
• eye problems (cataracts, glaucoma, diabetic retinopathy, macular degeneration)
• numbness in feet and legs (neuropathy)
• arthritis
• heart or blood circulation problems
• long-term diseases of the nervous system (multiple sclerosis, Parkinson’s disease, Alzheimer disease, others).

Inner Ear Problems and their Symptoms

Your inner ear contains many tiny structures that together make up the vestibular system ( your balance control center). These structures include the fluid-filled semi-circular canals of the labyrinth in the ear. The semi-circular canals are lined with tiny hairs and also contain many nerves. The hairs and nerves work together so you automatically have a sense of the position of your head, as well as the movements of your body and the pull of gravity. There are also calcium crystals inside the labyrinth that help you sense movement and gravity.

Researchers report that the number of nerve cells in the vestibular system drops after the age of 55 years. This decline gets worse the older we get.

Vertigo

If you have vertigo—the feeling that you or everything around you is spinning—you probably have a problem in the labyrinth of your inner ear. The most common inner ear disorders that produce vertigo are:

• benign paroxysmal positional vertigo (BPPV)
• labyrinthitis or acute vestibular neuritis
• Meniere’s disease
• migrainous vertigo
• acoustic neuroma.

Benign Paroxysmal Positional Vertigo (BPPV)
Sometimes, the calcium crystals in your inner ear break loose— either because of an ear infection, a bump on the head, ear surgery, or aging. The crystals can then travel into one of the semicircular canals. When you move your head, these misplaced crystals can shift position. If this happens, incorrect messages may be sent to your brain about your head position.

BPPV comes on suddenly and powerfully.  It is the most common cause of vertigo in older people.  Moving, standing up, turning in bed, or slightly changing your head position makes it worse. The intense symptoms usually come and go, and last for less than a minute. But they tend to reappear frequently over the course of many days. Along with the vertigo, you may also experience

• dizziness and lightheadedness

• unsteadiness and loss of balance

• blurred vision

• rapid side-to-side eye movements that are involuntary

• nausea and vomiting

• migraine

Labyrinthitis (acute vestibular neuritis)
Inflammation and swelling in your inner ear—called labyrinthitis—can cause intense, constant vertigo that starts suddenly and can last for days. Its main causes are upper respiratory infections and other viral infections, but stress, fatigue , allergies , smoking ,or alcohol use  can raise your risk for labyrinthitis. You may also have nausea, vomiting, loss of balance or hearing loss.

This condition usually clears up on its own after a few days, but you may have to stay in bed until your symptoms disappear.

Meniere’s disease
Much less common than BPPV or labyrinthitis, Meniere’s disease can show up at any age, although it usually appears in adults in their 40s or 50s. It is a long-term condition caused by a buildup of fluid in the inner ear, which can result from viral infections, allergies, or any number of other factors.

Meniere’s disease can cause the following symptoms:

• sudden feelings of vertigo lasting for 30 minutes to several hours

• hearing loss that comes and goes, but resulting eventually in some permanent deafness

• buzzing, ringing, whistling or roaring sound in the ear (tinnitus)

• a feeling of fullness in the ear

Vestibular Migraine
Some people who get migraine headaches also experience vertigo and other types of dizziness during the migraine or between migraine headaches.

Acoustic Neuroma
This is a non-cancerous (benign) growth on the nerve that connects the inner ear to the brain. Symptoms of an acoustic neuroma may include vertigo, hearing loss and tinnitus in one ear

Other Causes of Vertigo

Vertigo can also be a signal of a stroke, brain hemorrhage or multiple sclerosis.

However, with these serious conditions, you will have other symptoms along with the vertigo —severe balance problems, double vision, slurred speech, facial weakness or numbness, and others—that will be quickly recognized by a healthcare professional.

Lightheadedness or “Near Fainting” (Presyncope)
Sudden lightheadedness or feelings of faintness without losing consciousness (also called presyncope) happens to older people quite often. Chronic physical conditions such as heart disease or diabetes are often involved. Because these feelings can bring on a fall, it’s important to be promptly evaluated if you feel faint or lightheaded.

The most common causes include sudden low blood pressure, inner ear disorders, or anxiety disorders.

Sudden low blood pressure (orthostatic or postural hypotension)
A sudden drop in blood pressure when you stand up is called orthostatic hypotension. This kind of low blood pressure causes lightheadedness within three minutes of standing. It lasts from a few seconds to several minutes. Along with the feeling of faintness, you may feel nauseated and have pale or clammy skin.

When you stand up quickly after sitting or lying down, gravity makes your blood collect in your legs. Then there isn’t enough blood for your heart, your brain, and the rest of your body.

Normally, when you stand quickly, your nerves and arteries work together to counteract the force of gravity and keep your blood evenly distributed. Your heart beats faster, your arteries narrow, more blood circulates, and blood pressure stabilizes. But many conditions and medications common in older people can interrupt this natural process. This can cause your systolic blood pressure (the upper number in your blood pressure report) to drop suddenly.

Examples of some conditions that can bring on sudden low blood pressure include:

• Dehydration – from not drinking enough fluids, fever, diarrhea,  vomiting, medications such as diuretics (water pills), or very hot weather.
• Heart problems – including heart failure, atherosclerosis, heart attack, slow heart rate (bradycardia). or heart valve problems.
• Diabetes – frequent urination in uncontrolled diabetes, nerve damage.
• Nervous system disorders – such as Parkinson's disease.

Sudden low blood pressure can also be caused by certain medications (anti-Parkinsonian drugs, some anti-depressants, medications for erectile dysfunction), long-term bed rest, age-related nerve problems, anemia (not enough red blood cells), or incorrect feedback from the nerves in your body.

Anxiety Disorders
Lightheadedness can also be linked to feelings of anxiety, especially panic attacks, hyperventilation, and other severe emotional states.

Unsteadiness
Unsteadiness (disequilibrium) or loss of balance when standing or walking are often experienced along with vertigo and other types of dizziness. The causes include:

• Inner ear problems.  These can cause sensations of floating or unsteadiness, especially in the dark. 
• Vision problems.  Cataracts, macular degeneration, glaucoma and weakening eyesight (reduced visual acuity) are risk factors for disequilibrium.
• Numbness.  Numbness (peripheral neuropathy) in the legs and feet comes from nerve damage, a result of simple aging or diseases like diabetes. Your nerves can no longer send signals to your brain about the position of your legs and feet, which can cause unsteadiness.
• Other nerve problems.  Neurological disorders such as Parkinson's disease, ataxia, spinal cord disorders, and other chronic diseases increase risk for balance problems.
• Joint and muscle problems.  Most people experience at least some arthritis, joint pain, or muscle weakness with advancing years. These can interfere with your body’s ability to move and react quickly to changes in posture or position.
• Medications.  Many older adults take quite a few different medications each day—both prescription and over-the-counter products. Your sense of balance may be affected by some of these drugs, such as:
• anti-epileptic drugs
• sedatives and tranquilizers
• beta blockers (type of heart medicine)
• blood pressure medications
• drugs to treat Parkinson’s disease
• some antidepressants
• nitroglycerin (a heart medicine) if taken with erectile dysfunction drugs containing sildenafil (Viagra or Cialis)
• narcotics (pain drugs)
• sleep medications

Combining drugs or drinking alcohol along with any of these medications is may intensify your unsteadiness.

Updated: March 2012
Posted: March 2012