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Balance and its Clinical Assessment in Older Adults - A Review

dc.contributor.authorNnodim, JO
dc.contributor.authorYung, RL
dc.coverage.spatialUnited States
dc.date.accessioned2024-05-06T19:23:21Z
dc.date.available2024-05-06T19:23:21Z
dc.date.issued2015-01-01
dc.identifier.issn2469-5858
dc.identifier.issn2469-5858
dc.identifier.urihttps://www.ncbi.nlm.nih.gov/pubmed/26942231
dc.identifier.urihttps://hdl.handle.net/2027.42/193094en
dc.description.abstractBACKGROUND: Human beings rely on multiple systems to maintain their balance as they perform their activities of daily living. These systems may be undermined functionally by both disease and the normal aging process. Balance impairment is associated with increased fall risk. PURPOSE: This paper examines the dynamic formulation of balance as activity and reviews the biological mechanisms for its control. A "minimal-technology" scheme for its clinical evaluation in the ambulatory care setting is proposed. METHODS: The PubMed, Scopus and CINAHL databases were searched for relevant articles using the following terms in combination with balance: aging, impairment, control mechanisms, clinical assessment. Only articles which describe test procedures, their psychometrics and rely exclusively on equipment found in a regular physician office were reviewed. RESULTS: Human bipedal stance and gait are inherently low in stability. Accordingly, an elaborate sensory apparatus comprising visual, vestibular and proprioceptive elements, constantly monitors the position and movement of the body in its environment and sends signals to the central nervous system. The sensory inputs are processed and motor commands are generated. In response to efferent signals, the musculoskeletal system moves the body as is necessary to maintain or regain balance. The combination of senescent decline in organ function and the higher prevalence of diseases of the balance control systems in older adults predisposes this population subset to balance impairment. Older adults with balance impairment are likely to present with "dizziness". The history should concentrate on the first experience, with an attempt made to categorize it as a Drachman type. Since the symptomatology is often vague, several of the recommended physical tests are provocative maneuvers aimed at reproducing the patient's complaint. Well-validated questionnaires are available for evaluating the impact of "dizziness" on various domains of patient's lives, including their fear of falling. Aspects of a good history and physical examination not otherwise addressed to balance function, such as medications review and cognitive assessment, also yield information that contributes to a better understanding of the patient's complaint. Ordinal scales, which are aggregates of functional performance tests, enable detailed quantitative assessments of balance activity. CONCLUSION: The integrity of balance function is essential for activities of daily living efficacy. Its deterioration with aging and disease places older adults at increased risk of falls and dependency. Balance can be effectively evaluated in the ambulatory care setting, using a combination of scalar questionnaires, dedicated history-taking and physical tests that do not require sophisticated instrumentation.
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherClinMed International Library
dc.rightsLicence for published version: Creative Commons Attribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectBalance
dc.subjectOffice Assessment
dc.subjectOlder Adults
dc.titleBalance and its Clinical Assessment in Older Adults - A Review
dc.typeArticle
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/193094/2/nihms754637.pdf
dc.identifier.doi10.23937/2469-5858/1510003
dc.identifier.doihttps://dx.doi.org/10.7302/22739
dc.identifier.sourceJournal of Geriatric Medicine & Gerontology
dc.description.versionPublished version
dc.date.updated2024-05-06T19:23:18Z
dc.identifier.orcid0000-0002-8181-027X
dc.identifier.volume1:003
dc.identifier.issue1
dc.identifier.startpage003
dc.identifier.name-orcidNnodim, JO
dc.identifier.name-orcidYung, RL; 0000-0002-8181-027X
dc.working.doi10.7302/22739en
dc.owningcollnameInternal Medicine, Department of


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