29 replies to this topic

[ta5]

What causes elderly to lose their sense of balance? Is it simply part of cognitive decline?

What can be done about it?

Is there a term for the condition? I'm having trouble searching for it since people use the word balance for other things.

Thanks.

[tham]

Vitamin D status.


Urinary environmental chemical concentrations and vitamin D are associated
with vision, hearing, and balance disorders in the elderly.

http://www.ncbi.nlm....pubmed/23314200


25-hydroxyvitamin D and physical and cognitive performance in older people with chronic conditions.

http://www.ncbi.nlm....ubmed/22398393/



Vitamin D status in relation to postural stability in the elderly.

http://www.ncbi.nlm....pubmed/22456785


The effect of Vitamin D on falls and fractures.

http://www.ncbi.nlm....pubmed/22536766


Changes in balance, functional performance and fall risk following whole body vibration training and vitamin D supplementation in institutionalized elderly women. A 6 month randomized controlled trial.

http://www.ncbi.nlm....pubmed/21256028



This is why I was giving alfacalcidol or calcitriol rather than plain D3 to my father
at one time, despite some sources cautioning me that these metabolites bypass the
renal feedback loop.



Examination of effects of alfacalcidol vitamin D supplement and renal function on improvement in the physical fitness of pre-frail elderly persons attending a nursing
care prevention class]


https://www.jstage.j..._6_691/_article



Risk reduction of falls and fractures, reduction of back pain and safety in elderly high risk patients receiving combined therapy with alfacalcidol and alendronate: a prospective study.

http://www.ncbi.nlm....pubmed/21355445

[niner]

Thanks for those refs, tham. alfacalcidol looks good, although plain old D3 is good too. I prefer risedronate to alendronate, and am quite intrigued by the extra 5 years of life expectancy reported in bisphosphonate users, independent of fracture effects.

In addition to those, an exercise program is very helpful, particularly resistance exercise.

[ta5]

I prefer risedronate to alendronate, and am quite intrigued by the extra 5 years of life expectancy reported in bisphosphonate users, independent of fracture effects.

That's interesting. Is there evidence bisphosphonates improve balance?

Thanks.

[scottknl]

Elderly lose their balance because of muscle deterioration. The cell niche becomes polluted with extra cellular junk and the stem cells don't receive the proper signalling to rebuild muscle cells as happens in the younger set. The stem cells are still capable to create new muscle cells if they are put into an cleaner environment, so they're not out of telomere length or anything.

http://www.ncbi.nlm....pubmed/18462272

Declining stem cell function during aging contributes to impaired tissue function. Muscle-specific stem cells ('satellite cells') are responsible for generating new muscle in response to injury in the adult. However, aged muscle displays a significant reduction in regenerative abilities and an increased susceptibility to age-related pathologies. This review describes components of the satellite cell niche and addresses how age-related changes in these components impinge on satellite cell function. In particular, we review changes in the key niche elements, the myofiber and the basal lamina that are in intimate contact with satellite cells. We address how these elements are influenced by factors secreted by interstitial cells, cells of the immune system, and cells associated with the vasculature, all of which change with age. In addition, we consider more distant sources of influence on the satellite cell niche that change with age, such as neural-mediated trophic factors and electrical activity and systemic factors present in the circulation. A better understanding of the niche elements and their influence on the satellite cell will facilitate the development of therapeutic interventions aimed at improving satellite cell activity and ultimately tissue response to injury in aged individuals.

For those with an hour to kill learning about this topic here's an excellent you tube video from Dr. Rando

Edited by scottknl, 21 February 2013 - 07:23 PM.

[ta5]

Elderly lose their balance because of muscle deterioration.

That's an interesting theory, but that doesn't make sense to me. I know elderly who can jog 6 miles, but their balance is still noticeably worse than when they were younger. There's also the balance test where you close your eyes and time how long you can stand on one leg. My understanding is that the younger you are, the better your time, regardless of muscle strength. There's the related issue of reaction time, which I imagine is related. There again, the younger you are, the better your reaction time regardless of strength.

[scottknl]

Elderly lose their balance because of muscle deterioration.

That's an interesting theory, but that doesn't make sense to me. I know elderly who can jog 6 miles, but their balance is still noticeably worse than when they were younger. There's also the balance test where you close your eyes and time how long you can stand on one leg. My understanding is that the younger you are, the better your time, regardless of muscle strength. There's the related issue of reaction time, which I imagine is related. There again, the younger you are, the better your reaction time regardless of strength.

You're correct about the tests etc. One could certainly argue that muscle strength could come into it when it comes to aligning the skeleton to maintain balance. Also that weaker muscles would create a delay in the physical reaction time to a signal. The process of junking up the cell niche also occurs in the nervous system too. And I suspect, but cannot prove that a similar degeneration occurs in the brain also. I love to see studies if someone has run into neuro stem cell regeneration research somewhere.

Edited by scottknl, 21 February 2013 - 07:50 PM.

[Mind]

I'll just skip the fine details and give the simple over-arching explanation. The elderly lose their balance for the same general reasons that they lose their hearing, their muscles, their oxygen capacity, their sight, their bladder control, and even their mind....it is just aging. It is a disease. If we fix aging, we fix all of those.

I know, not too helpful for people dealing with those issues (including balance), but we have to also keep our eyes on the big goal of curing aging.

[niner]

I prefer risedronate to alendronate, and am quite intrigued by the extra 5 years of life expectancy reported in bisphosphonate users, independent of fracture effects.

Is there evidence bisphosphonates improve balance?

Not that I know of. If your balance is poor, you are more likely to fall, and if you are also osteoporotic, a not unusual situation for elderly people, then your risk of fracture is much greater.

[niner]

Elderly lose their balance because of muscle deterioration.

That's an interesting theory, but that doesn't make sense to me. I know elderly who can jog 6 miles, but their balance is still noticeably worse than when they were younger. There's also the balance test where you close your eyes and time how long you can stand on one leg. My understanding is that the younger you are, the better your time, regardless of muscle strength. There's the related issue of reaction time, which I imagine is related. There again, the younger you are, the better your reaction time regardless of strength.

There is undoubtedly a brain and nerve component to balance. I knew someone who was very athletic, then had a stroke, after which his balance was terrible. There may also be inner ear issues that crop up with age. The large muscles that are used in things like jogging are only part of the balance equation. There are also a lot of smaller muscles involved in balance and proprioception which will get weaker over time if they aren't exercised. Balance can be improved by specific exercises that work these muscles. Those exercises may be helping neural circuitry as well. If that elderly jogger did the right load-bearing exercises, they could probably improve their balance. I can stand on one leg with my eyes closed significantly longer than I'm "supposed to", given my age. That's probably because one of the exercises in my gym routine is doing one-legged squats while standing on a Bosu half ball. A good starting balance exercise for an elderly person might be stretching an elastic band (with one end attached to a wall or heavy object) while standing on a pillow or wadded up towel. They might want to graduate to standing on a half ball (with both feet) at some point.

[ta5]

Interesting, there may be a connection between density and balance.

Vertigo- Several recent studies have shown an association between “benign positional vertigo” (BPV) and lower bone mineral density (Vibert 2008, Jeong 2009, Vibert 2003). The inner ear, where balance is maintained, contains tiny bone particles (otoconia) that may be affected in osteoporosis (Vibert 2008). Some experts recommend that people with BPV should undergo screening for osteoporosis (Jeong 2009).

http://www.lef.org/protocols/metabolic_health/osteoporosis_01.htm

[niner]

Interesting, there may be a connection between density and balance.

Vertigo- Several recent studies have shown an association between “benign positional vertigo” (BPV) and lower bone mineral density (Vibert 2008, Jeong 2009, Vibert 2003). The inner ear, where balance is maintained, contains tiny bone particles (otoconia) that may be affected in osteoporosis (Vibert 2008). Some experts recommend that people with BPV should undergo screening for osteoporosis (Jeong 2009).

That's very interesting. The very people who are most likely to fall are the ones least able to withstand it, in this condition. I wouldn't wait for a BPV diagnosis to screen someone for osteoporosis. I think everyone who's even close to being at risk should be screened at least once. This would include post-menopausal women, but also skinny males and people on SSRIs. A BMD test is pretty cheap, and is pretty good insurance. If you're osteopenic or osteoporotic, you really want to know, because it puts you at risk for some really bad outcomes, and it is very treatable, but only if you know about it.

[ta5]

Another association with osteoporosis may be Hyperkyphosis ("dowager's hump") along with muscle strength.

Osteoporos' class='bbc_url' title='External link' rel='nofollow external'>http://pmid.us/15549266']Osteoporos Int. 2005 Aug;16(8):1004-10. Epub 2004 Nov 12.
Balance disorder and increased risk of falls in osteoporosis and kyphosis: significance of kyphotic posture and muscle strength.

This controlled trial was designed to investigate the influence of osteoporosis-related kyphosis (O-K) on falls. Twelve community-dwelling women with O-K (Cobb angle, 50-65 degrees measured from spine radiographs) and 13 healthy women serving as controls were enrolled. Mean age of the O-K group was 76 years (+/-5.1), height 158 cm (+/-5), and weight 61 kg (+/-7.9), and mean age of the control group was 71 years (+/-4.6), height 161 cm (+/-3.8), and weight 66 kg (+/-11.7). Quantitative isometric strength data were collected. Gait was monitored during unobstructed level walking and during stepping over an obstacle of four different heights randomly assigned (2.5%, 5%, 10%, and 15% of the subject's height). Balance was objectively assessed with computerized dynamic posturography consisting of the sensory organization test. Back extensor strength, grip strength, and all lower extremity muscle groups were significantly weaker in the O-K group than the control group (P <0.05), except right ankle plantar flexors (P =0.09). There was a significant difference in the anteroposterior and mediolateral displacements and velocities. The O-K subjects had less anteroposterior displacement, greater mediolateral displacement, reduced anteroposterior velocity, and increased mediolateral velocity compared with controls for all conditions of unobstructed and obstructed level walking. Obstacle height had a significant effect on all center-of-mass variables. The O-K subjects had significantly greater balance abnormalities on computerized dynamic posturography than the control group (P =0.002). Data show that thoracic hyperkyphosis on a background of reduced muscle strength plays an important role in increasing body sway, gait unsteadiness, and risk of falls in osteoporosis.
PMID: 15549266

→ source (external link)

[KoolK3n]

What about the cerebellum?

[maxwatt]

Practicing Taiji quan (Tai chi chuan) exercise when practiced by the elderly has been shown, in several Chinese and western studies, to improve balance in the elderly.

Health benefits of Tai Chi exercise: improved balance and blood pressure in middle-aged women.

Tai chi as a balance improvement exercise for older adults: a systematic review.


www.ncbi.nlm.nih.gov/pubmed/15570138

and dozens more.

[revenant]

My mother- in-law had a problem with calcium crystal. Though not necessarily associated with advanced age, calcium crystals within in the inner ear can become misplaced. http://www.npr.org/t...oryId=103463398 Also, among a host of other causes, dysfunction of the parietal lobe can be a cause too.The etiology varies.

[ta5]

Maybe Homocysteine.



Int J Neurosci. 2013 Jan;123(1):24-30.
Biological determinants of postural disorders in elderly women.
Postural control impairments and dizziness, which are major health problems with high secondary morbidity and mortality, increase with aging. Elevated homocysteine (Hcy) level is an age-related metabolic disorder, known to be involved in cardiovascular, neurological, and multisensory dysfunctions. Elevated Hcy level might be involved in sensory balance control systems impairment and dizziness occurrence. Dizziness, fitness Instrumental Activity of Daily Living scale (fitness IADL), systolic arterial pressure with ankle-brachial blood pressure index and homocysteinemia were studied in 61 noninstitutionized elderly women. Clinical balance tests (timed "Up and Go", 10-m walking and one-leg balance) and posturography (including sensory conflicting situations [SCS] and cognitive conflicting situations [CCS]) were performed. Clinical balance control was lower in dizzy women who presented particularly poor stability in SCS. Dizziness was related to low fitness IADL scores (odds ratio [OR] 0.452, 95% CI 0.216-0.946) and to elevated Hcy (OR 8.084, 95% CI 1.992-32.810). Elevated Hcy was correlated with balance disorders both in SCS and CCS. Dizziness is associated with a reduced ability in balance control management. Hcy is related both to dizziness and low postural performance. This relation between elevated Hcy levels and balance impairments, resulting in dizziness, may be explained by its angiotoxicity and neurotoxicity.
PMID: 22909193

[AgeVivo]

very good scientifico-medical level in this thread! In gerontological courses I too have been told that loss of muscle (stem cell recrutment signal poisoned) as well as artritis, join pain (inflammaging) and other pains and fear to fall (which creates a vicious circle) are obviously very strong components of why elderlies loose their balance; including also al sorts of aging troubles (sight, cardiovascular and internal ear flow, neuronal poisoning etc) contribute; yes old D3 works wonder (40% risk reduction of hip fracture, mostly through better balance rather than improved bone density! and activity such as Tai Chi, to reinforce the body but also to reassure against the fear to fall. don't have the PMIDs with me here) and yes biphosphonate seem to do much more to health than what they are supposed to do: something to investigate... (a mouse lifespan?)

Edited by AgeVivo, 02 June 2013 - 12:05 AM.

[ta5]

Maybe cataracts has something to do with balance in some cases. If you can't see very well, that would make it harder to walk, easier to trip and fall.



Rejuvenation Res. 2013 Feb;16(1):35-42.

Improvements in sleep quality and gait speed after cataract surgery.

Ayaki M, Muramatsu M, Negishi K, Tsubota K.
Department of Ophthalmology, International University of Health and Welfare, Mita Hospital, Tokyo, Japan.

BACKGROUND:
Gait speed and sleep quality are health indices related to longevity and mortality. In the present study, we measured sleep quality, quality of life, gait speed, and visual acuity before and after cataract surgery to evaluate the efficacy of the procedure on systemic health.

METHODS:
The study was conducted on 155 patients (93 women; average age 74.8 years) undergoing cataract surgery with the implantation of a yellow soft acrylic lens. Patients were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the National Eye Institute Visual Function Questionnaire 25 (VFQ-25; vision-related quality of life) before and then 2 and 7 months after surgery. Four-meter gait speed was also determined.

RESULTS:
Of the 155 patients, 68 (43.9%) were classified as poor sleepers (PSQI>5.5) prior to surgery. Significant improvements were noted in sleep 2 months after surgery (p<0.05, paired t-test), but thereafter the improvements were not significant. Prior to surgery, 117 patients (77.0%) were classified as slow walkers (speed<1.0 meter/s). Gait speed increased significantly in these patients 2 months after surgery (p<0.001, paired t-test). Multiple regression analysis revealed significant correlations between the preoperative VFQ-25 score and both PSQI (p<0.05) and gait speed (p<0.001). Postoperative increases in the VFQ-25 score were positively correlated with decreases in the PSQI (p<0.05). Improvements in visual acuity were correlated with improvements in the VFQ-25 score, but not with either PSQI or gait speed.

CONCLUSION:
Cataract surgery effectively improves sleep quality and slow gait speed.
PMID: 23145881

[ta5]

What about the cerebellum?

Yes, you're right.

Many anatomical and physiological changes have been suggested as reasons for the decrease in equilibrium found in the elderly population.9-11 Abnormalities have been identified in both the central and the peripheral nervous systems.12-15 Circulatory changes (eg, atherosclerosis) may reduce blood flow to the brain stem, cerebellum, or cerebrum, potentially resulting in ischemic signs and symptoms or lesions of the nervous system.13 Musculoskeletal abnormalities in the cervical region may affect the perception of the head's position in space.16 Muscle atrophy and weakness, especially of the postural muscles, are prevalent in the aged.17-20

Balance performance among noninstitutionalized elderly women.
Briggs RC, Gossman MR, Birch R, Drews JE, Shaddeau SA.
Phys Ther. 1989 Sep;69(9):748-56.
PMID: 2772037

[12 String]

Very interesting thread. Being elderly and athletic, I often rue the loss of balance. I used to think it was associated with hearing loss and inner ear deterioration, but have changed my opinion lately - it is loss of muscle fiber, specifically fast twitch fibers as touched on above by scottknl, niner, maxwatt, and others.

Slow twitch muscle fiber doesn't disappear much with age, hence there are good elderly joggers. Fast twitch however disappears really fast. There's a lot of literature supporting this.

I found that doing some resistance exercise on one leg exposes this problem and also seems to be a good way to attack it. Hence I agree with suggestions above about Tai Chai and other balance / coordination type exercises. I'm starting to think that long durations of just plain "balancing" might do as much or more for my fast twitch muscles as heavy resistance does.

[ta5]

I wonder what exactly the association is with dementia?

 

 

An abnormal "one-leg balance" test predicts cognitive decline during Alzheimer's disease.
Rolland Y, Abellan van Kan G, Nourhashemi F, et al.
J Alzheimers Dis. 2009;16(3):525-31. 
PMID: 19276547

 

A longitudinal study of change in falls risk and balance and mobility in healthy older people and people with Alzheimer disease.
Suttanon P, Hill KD, Said CM, Dodd KJ.
Am J Phys Med Rehabil. 2013 Aug;92(8):676-85. 
PMID: 23221675

Balance and mobility dysfunction and falls risk in older people with mild to moderate Alzheimer disease.
Suttanon P, Hill KD, Said CM, Logiudice D, Lautenschlager NT, Dodd KJ.
Am J Phys Med Rehabil. 2012 Jan;91(1):12-23. 
PMID: 22157433

 

Stroke. 2015 Jan;46(1):16-22. 
Association of postural instability with asymptomatic cerebrovascular damage and cognitive decline: the Japan Shimanami health promoting program study.
Tabara Y1, Okada Y2, Ohara M2, Uetani E2, et al.
BACKGROUND AND PURPOSE:
Asymptomatic cerebral small-vessel disease (cSVD) in elderly individuals are potent risk factors for stroke. In addition to common clinical risk factors, postural instability has been postulated to be associated with cSVD in older frail patients. Here, we conducted a cross-sectional study to understand the possible link between postural instability and asymptomatic cSVD further, namely periventricular hyperintensity, lacunar infarction, and microbleeds, as well as cognitive function, in a middle-aged to elderly general population (n=1387).
METHODS:
Postural instability was assessed based on one-leg standing time (OLST) and posturography findings. cSVD was evaluated by brain MRI. Mild cognitive impairment was assessed using a computer-based questionnaire, and carotid intima-media thickness as an index of atherosclerosis was measured via ultrasonography.
RESULTS:
Frequency of short OLST, in particular <20 s, increased linearly with severity of cSVD (lacunar infarction lesion: none, 9.7%; 1, 16.0%; >2, 34.5%; microbleeds lesion: none, 10.1%; 1, 15.3%; >2, 30.0%; periventricular hyperintensity grade: 0, 5.7%; 1, 11.5%; >2, 23.7%). The association of short OLST with lacunar infarction and microbleeds but not periventricular hyperintensity remained significant even after adjustment for possible covariates (lacunar infarction, P=0.009; microbleeds, P=0.003; periventricular hyperintensity, P=0.601). In contrast, no significant association was found between posturographic parameters and cSVD, whereas these parameters were linearly associated with OLST. Short OLST was also significantly associated with reduced cognitive function independent of covariates, including cSVD (P=0.002).
CONCLUSIONS:
Postural instability was found to be associated with early pathological changes in the brain and functional decline, even in apparently healthy subjects.

PMID: 25523051
 

[ta5]

Neuropathy, as from diabetes or chemotherapy, can make balance worse too. Random references are below. I guess it makes sense. If you can't feel your feet, it makes it hard to walk. I've had my foot fall asleep sitting a certain way, and if I get up and try to walk when I can't feel my foot, it's very hard to walk.

 

You need several senses to be able to walk normally. In addition to a working vestibular system, you need to be able to see clearly, and your nerves need to feel the ground and position of your limbs. Then, your brain needs to be able to process that information.

 

Balance impairments and neuromuscular changes in breast cancer patients with chemotherapy-induced peripheral neuropathy.
Kneis S, Wehrle A, Freyler K, Lehmann K, et al.
Clin Neurophysiol. 2015 Aug 14. pii: S1388-2457(15)00735-X.
PMID: 26350407
"Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment. Resulting sensory and motor dysfunctions often lead to functional impairments like gait or balance disorders."

 

Sensory Functions, Balance, and Mobility in Older Adults With Type 2 Diabetes Without Overt Diabetic Peripheral Neuropathy: A Brief Report.
Deshpande N, Hewston P, Aldred A.
J Appl Gerontol. 2015 Aug 30. pii: 0733464815602341. [Epub ahead of print]
PMID: 26324522
"Subtle changes in multiple sensory systems of older adults with T2D may reduce redundancy available for balance control while performing challenging activities much before DPN development."

 

Impact of Type-2 Diabetes Time Since Diagnosis on Elderly Women Gait and Functional Status.
da Cruz Anjos DM, de Souza Moreira B, Pereira DS, et al.
Physiother Res Int. 2015 Aug 18.
PMID: 26284942
"Type-2 diabetes mellitus time since diagnosis has a negative impact on gait speed and step length..."

 

The influence of diabetic peripheral neuropathy on local postural muscle and central sensory feedback balance control.
Toosizadeh N, Mohler J, Armstrong DG, Talal TK, Najafi B.
PLoS One. 2015 Aug 10;10(8):e0135255. doi: 10.1371/journal.pone.0135255. eCollection 2015.
PMID: 26258497
"Poor balance control and increased fall risk have been reported in people with diabetic peripheral neuropathy (DPN).... DPN participants were highly unstable compared to controls. However, as soon as they perceived the magnitude of sway using sensory feedback, they chose a high rigid postural control strategy, probably due to high concerns for fall, which may increase the energy cost during extended period of standing; the adaptation mechanism using sensory feedback depends on the level of neuropathy and the history of diabetes."

 

Diabetic peripheral neuropathy compromises balance during daily activities.
Brown SJ, Handsaker JC, Bowling FL, Boulton AJ, Reeves ND.
Diabetes Care. 2015 Jun;38(6):1116-22. doi: 10.2337/dc14-1982. Epub 2015 Mar 12.
PMID: 25765355
"Patients with diabetes with peripheral neuropathy have a well-recognized increased risk of falls.... Greater separations of the center of mass from the center of pressure present a greater challenge to balance. Therefore, the higher medial-lateral separations found in patients with DPN will require greater muscular demands to control upright posture. This may contribute to explaining why patients with DPN are more likely to fall, with the higher separations placing them at a higher risk of experiencing a sideways fall than nondiabetic control subjects."

Edited by ta5, 20 December 2015 - 05:00 PM.

[sthira]

What causes elderly to lose their sense of balance? Is it simply part of cognitive decline?

What can be done about it?
.

It's because they stop trying. "The elderly" (obviously a wild generalization) stop trying to balance (another wild one). What can be done about it is to start trying again. Unless clear individual structural problems (bones, tendons, ear infections...) mechanically retard "balance" then balance can be maintained well just like any other attribute. I know 90-year olds out-balancing 10-year olds, fwiw.

[Danail Bulgaria]

What causes elderly to lose their sense of balance? Is it simply part of cognitive decline?
There are many reasons. The most important is the neuronal regulation from the brain. It detoriates with the age, e.g. you are right - it is the cognitive decline.
 

What can be done about it?
Prevention of falls: remove things that the elderly can step wrong on. It will be best if elders especially demented not fiddle arround very much.

What can be done about it: Many things, including wheelchair.

Is there a term for the condition? I'm having trouble searching for it since people use the word balance for other things.
There are many terms since there are many reasons for elders falling.
 

[proileri]

The fast-twitch muscle loss and neurological decline in balance organs sound likely culprits to me, when it comes to falling. The cataract thing is easy to explain, as there's a visual component in holding your balance - that's why it's harder when your eyes are closed, obviously. 

 

Athletes do all kinds of drills to improve their speed and agility, I wonder if this kind of things could be adapted for the elderly as well. Make them play Dance Dance Revolution?

Edited by proileri, 22 December 2015 - 06:12 PM.

[xEva]

I think it's a common assumption that elderly people break their hips when they loose their balance and fall. But I heard specialists say it's usually the other way around. Instead, their bones are so weak that they break on their own or from a slightest exertion (like sneezing) which then causes elderly to fall.  

[Danail Bulgaria]

Unlikely. If their bones can break from a sneeze, then when they fall, their entire skeleton should turn into a bag of bone pieces lol.

[xEva]

Unlikely. If their bones can break from a sneeze, then when they fall, their entire skeleton should turn into a bag of bone pieces lol.

 

Maybe you should speak to the elderly who fell and specialists who tend to them -? 'cause what they say contradicts to what you seems likely to you.

 

btw, here you make another faulty assumption, that all bones deteriorate at the same rate. better watch out for those faulty assumptions

[Danail Bulgaria]

My personal opinion is that the majority of the falls are due to insuficiency of the receptors for the balance and the parts of the brain, that respond for keeping balance.

 

Old people fall down some times without to loose consciousness, and without to step wrong, or without to slip. They simply fall. I saw this several times with my late grand-mother. She broke her leg after the 6-th or the 7-th fall. This definately do not correlate with the point, that old people fall, because they break their legs before the fall. One of the falls she said it exactly as it is "Wow. I fell. Why is that?"

 

The reason is that the parts of the brain, that hold you straight don't work well anymore. Just like each part of the brain, that partivcular part gets age related degeneration too. Its neurons are simply no longer there.