DEAR DR. ROACH: I am an 88-year-old man losing my balance. Can you explain what might be causing this? — S.C.
ANSWER: Although the primary organs of balance are the semicircular canals in the middle ear, many systems have to work properly in order to keep one’s balance. The eyes need to tell us where we are in space — balancing with eyes closed is much harder. Proprioception is the sensation of where your body parts are. Without that, balance is a great challenge. Motor control and coordination require strength and smooth movement. Many parts of the central nervous system, peripheral nerves and even muscle and joint diseases can keep us from making the small adjustments we need for that smooth movement and even for staying in place.
Medications are an underrecognized source of balance problems. A long, careful look at medication lists can sometimes reveal medications that are more likely to cause harm than good.
Solving balance problems involves finding the part that’s not working properly, but more often balance problems represent several systems not working properly — especially for those in their 80s and older. Treatment starts with strengthening and balance exercises. A thorough evaluation by your regular doctor, sometimes with the help of experts including neurologists, and joint and eye specialists, is the place to begin. Because loss of balance can lead to falls, and because falls often lead to disability, searching for causes of balance problems and treating them promptly can prevent catastrophe.