Balance Disorders in the Elderly and the Benefit of Balance Exercise
Suchitra Prasansuk MD, DLO, FICS, FCOT*, Chana Siriyananda MD, FCOT*, Apinan Na Nakorn MD, FCOT*, Suvajana Atipas MD, FCOT*, Samut Chongvisal MD, FCOT*
Affiliation : * Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University
Symptoms of balance disorders including ‘unsteadiness’, ‘dizziness and vertigo’ are common in the
elderly and commonly found in general practice in medicine. There are many causes of balance disorders
and vary from one person to another. Disorder of the internal ear or vestibular end-organ type is one cause.
Unsteadiness of somato-sensory or proprioception is common in the elderly so is degenerative disorder of
central control in brain. The elderly are prone to many chronic illnesses or disorders which are causes of
balance disorder or give rise to more rapid degeneration of the central nervous system i.e. high blood
pressure, diabetes mellitus, heart disease, proprioception and joint problems, arthritis and muscular weak-
ness due to lack of good health and exercise. The objectives of this research study were to find the etiologies
of balance disorders and how Balance Exercises and the ‘National Health Service’ can be of benefit in
helping to prevent them.
1565 elderly inhabitants (age > 60 years) of 20 communities adjacent to Siriraj Hospital were
selected for study. Among these, 625 persons had a history of balance disorders. Among those, 256 had
symptoms during the week selected for examination. The average age was 66 years old, women outnumbered
men with a ratio of 2.4:1. The common underlying causes were hypertension in 32.4%, diabetes melli-
tus13.8%, arthritis 8.1%, and heart disease 4.4% respectively. All are still taking one or more types of drug.
The subjects were randomly divided into two groups for the study purpose of effectiveness of balance exercise.
Group 1 did not perform the head balance exercise and Group 2 performed the head balance exercise.
Audiometric testing showed impaired hearing in 90% of the subjects. The majority slowed hearing loss in
high frequencies. Testing of middle ear function found 75% of Group 1 to have normal middle ear function
77% of Group 2. Brainstem Electrical Response Audiometry (BERA) showed normal response latencies of in
96% of group 1 and 94% of Group 2. Poor morphology of waveform was found in 12% of Group 1 and 16%
of Group 2. Doppler sonography for intra-cranial blood flow measurement showed abnormal flow of the ICA
in 17.6% of group 1 and 20.16% of group 2. Basilar arterial abnormal flow was found in 77.6% of Group1
and 80.6% of Group 2 respectively. The flow of ICA was improved after 8 weeks in both groups. The measure-
ment of balance by Posturography showed 86.7% abnormality in Group 1 and 83.5% abnormality in Group
2 (and the majority due to inner ear problems but many cases had a mixture of joints and CNS problems too).
Results of the self-evaluation (by questionaires) showed the elderly to have symptoms of light headedness in
51% and loss of balance in 29%, Vertigo with rotation occurred in 23.6%. 49% of the symptoms were
intermittent, 56.4% experienced a “fall”. On questioning about the benefit and performance of Head and
Neck Exercises, 82.8% found the exercises were easy to perform, 56.4% said the results were very beneficial.
Keywords : Elderly, Dysequilibrium, Balance disorders, Unsteadiness, Vertigo, Head-neck balance exercise, Differential diagnosis
