The Science of Balance & Fall Prevention
- Ana Souto
- Mar 19
- 5 min read
The Growing Challenge of an Aging Population
Improvements in healthcare measures and both nutritional and medical advances have contributed to higher longevity which has been evident in demographic studies. Available data shows this tendency to continue for future years, predicting 20% of the global population to be over 65 years old in 2050. This brings serious challenges, not only for the economy but also for healthcare systems that must adapt to meet the needs of an aging population [1] [2].
As life expectancy increases a very important issue arises – the challenge of maintaining quality of life in older people. This is intimately related to the concepts of healthy longevity or healthy aging and functional ability.
Healthy aging
The World Health Organization refers to healthy aging as creating the environments and opportunities that enable people to be and do what they value throughout their lives. This is deeply linked to functional ability which we can describe as the ability to perform daily activities necessary for independent living, depending on intrinsic factors, such as mobility, muscle strength, balance, and cognitive functions, as well as extrinsic factors, such as environmental factors related to space accessibility (WHO, 26 October 2020 | Q&A).
Falls pose one of the greatest risks to the quality of life for older adults, impacting independence and health through loss of function in activities of daily living. But why do older people fall? It is far from simple [3].
Contributing factors:
Biological - disease, and the natural aging process.
Behavioral - use of unsuitable or poorly maintained assistive devices, and use of certain medications (Polypharmacy).
Social and economic - social isolation, poverty, poor access to healthcare.
Environmental factors in the community (e.g., building entrances, lack of handrails), at home (e.g., type of furniture), and related to weather.
Key Contributors to Balance Issues
Aging is a natural process that brings a gradual decline in different body functions. Among the most common alterations in the elderly that contribute to balance deficits and falls are cognitive decline, motor impairments, and multisensory deficits.
Aging affects every sensory system in the body, leading to what is commonly referred to as multisensory deficits. This term describes a collection of age-related changes that collectively reduce the quality and quantity of sensory input, meaning a less accurate postural orientation. To top this, the motor system is often compromised by the gradual deterioration of muscle strength, joint range of motion, and spine rigidity affecting the quality of the postural adjustments needed for postural stability. The cognitive decline also weighs heavily on this, with decreases in spatial memory, spatial orientation, and attention, resulting in a higher risk of falling in attention-draining environments [4], [5], [6], [7].
The Importance of Balance Screening as a “Biomarker” for Elderly Health
Balance reflects multi-system integrity, capturing the cumulative effects of aging on the different resources needed for balance control. Research has shown that poor balance is strongly associated with higher fall risk, frailty, cognitive decline, and even mortality, making it a powerful indicator of biological aging [8]. Here is where posturography analysis can be a very helpful tool [9], [10], [11], [12].
Posturography-based balance assessments provide objective insights into Static, Proactive, and Reactive Balance, enabling:
Early detection of balance impairments and fall risks.
Development of personalized interventions to enhance balance and prevent falls.
Recognizing balance as a biomarker could shift clinical practice toward earlier intervention, helping to maintain independence and quality of life in aging populations.
Ana Souto
Meet Ana, a physiotherapist with a master's degree in human physiology, currently specializing in neurobiology.
Ana currently serves as the clinical specialist at PhysioSensing, a cutting-edge Balance Assessment and training device. Her approach is firmly rooted in the latest scientific findings, ensuring that PhysioSensing users receive the most effective and up-to-date care. In addition to her role in designing tailored programs, Ana plays a pivotal role in guiding new clients through the learning process of using PhysioSensing. She also provides advanced training and support to existing customers seeking to further deepen their clinical practice knowledge and stay on top of the latest scientific advancements.
References
[1] A. Vancea, M. Iliescu, K.-A. Aivaz, M. N. Popescu, C. Beiu, and L. Spiru, ‘Improving Functional Capacities and Well-Being in Older Adults: Strategies in Physical Medicine and Rehabilitation’, Cureus, Aug. 2024, doi: 10.7759/cureus.66254.
[2] The Lancet Healthy Longevity, ‘Ageing populations: unaffordable demography’, The Lancet Healthy Longevity, vol. 3, no. 12, p. e804, Dec. 2022, doi: 10.1016/S2666-7568(22)00272-0.
[3] J. Pillay et al., ‘Falls prevention interventions for community-dwelling older adults: systematic review and meta-analysis of benefits, harms, and patient values and preferences’, Syst Rev, vol. 13, no. 1, p. 289, Nov. 2024, doi: 10.1186/s13643-024-02681-3.
[4] F. B. Horak, ‘Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?’, Age and Ageing, vol. 35, no. suppl_2, pp. ii7–ii11, Sep. 2006, doi: 10.1093/ageing/afl077.
[5] C. Zalewski, ‘Aging of the Human Vestibular System’, Semin Hear, vol. 36, no. 03, pp. 175–196, Jul. 2015, doi: 10.1055/s-0035-1555120.
[6] J. Coto et al., ‘Peripheral vestibular system: Age-related vestibular loss and associated deficits’, Journal of Otology, vol. 16, no. 4, pp. 258–265, Oct. 2021, doi: 10.1016/j.joto.2021.06.001.
[7] M. K. Chepisheva, ‘Spatial orientation, postural control and the vestibular system in healthy elderly and Alzheimer’s dementia’, PeerJ, vol. 11, p. e15040, May 2023, doi: 10.7717/peerj.15040.
[8] J. Paterson et al., ‘Balance and Strength Measures are Associated With Mortality in Older Men’, Journal of the American Medical Directors Association, vol. 24, no. 10, pp. 1527-1532.e2, Oct. 2023, doi: 10.1016/j.jamda.2023.03.038.
[9] F. Quijoux et al., ‘A review of center of pressure (COP) variables to quantify standing balance in elderly people: Algorithms and open-access code’, Physiol Rep, vol. 9, no. 22, p. e15067, Nov. 2021, doi: 10.14814/phy2.15067.
[10] A. Soto-Varela et al., ‘Can we predict the risk of falls in elderly patients with instability?’, Auris Nasus Larynx, vol. 42, no. 1, pp. 8–14, Feb. 2015, doi: 10.1016/j.anl.2014.06.005.
[11] H. Tomita, S. Kuno, D. Kawaguchi, and O. Nojima, ‘Limits of Stability and Functional Base of Support While Standing in Community-Dwelling Older Adults’, Journal of Motor Behavior, vol. 53, no. 1, pp. 83–91, Jan. 2021, doi: 10.1080/00222895.2020.1723484.
[12] M. H. G. Gerards, C. McCrum, A. Mansfield, and K. Meijer, ‘Perturbation‐based balance training for falls reduction among older adults: Current evidence and implications for clinical practice’, Geriatrics Gerontology Int, vol. 17, no. 12, pp. 2294–2303, Dec. 2017, doi: 10.1111/ggi.13082.
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