Balance difficulties can have a large number of contributing factors that need specialized testing to determine which factors are contributing most to the problem.

Falls Risk Increases with Age

• But falling is not an inevitable consequence of getting older!

Intrinsic Risk factors may include:

Gait changes

• feet not picked up as high
• slower (~1%/yr), shorter steps, less power
• Broader-based, more cautious gait

Postural instability

• slowed processing & proprioception leads to increased ­sway
• altered balance response “strategies”
• Particular after the age of 80
• Postural sway increases
• Righting reflexes diminish
• Reaction time increases
• Caused by decreases in •Vision •Hearing •Vestibular function •Proprioception

Impaired cognition 

• Increased interference with gait and balance
• Impaired recognition of danger

Impaired vision

• macular degeneration, glaucoma, cataracts, poor correction, diabetic retinopathy etc.

Vertigo:

• benign positional vertigo,
• acute labyrinthitis,
• Meniere’s disease

Lightheadedness:

• cardiovascular problems,
• hyperventilation,
• anxiety
• Orthostatic hypotension- Check blood pressure after supine for five minutes, then standing for one and three minutes

Vitamin D insufficiency common

• Vit D repletion reduced falls by 22%

Muscle and joint abnormalities

• Reduced muscular strength and tone 
•  Arthritis Foot deformities
•  Shoe problems
•  Proximal musclular weakness