Aging of balance and risk of falls in elderly

doi:10.15406/mojgg.2019.04.00216

MOJ

eISSN: 2574-8130

Gerontology & Geriatrics

Mini Review Volume 4 Issue 6

Aging of balance and risk of falls in elderly

Yeny Concha Cisternas^1,2

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¹Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile
²Pedagogía en Educación Física, Facultad de Educación, Universidad Autónoma de Chile, Chile

Correspondence: Yeny Concha Cisternas, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Pedagogía en Educación Física, Facultad de Educación, Universidad Autónoma de Chile, Chile, Tel 95097924

Received: November 19, 2019 | Published: December 2, 2019

Citation: Concha-Cisternas Y. Aging of balance and risk of falls in elderly. MOJ Gerontol Ger. 2019;4(6):255?257. DOI: 10.15406/mojgg.2019.04.00216

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Abstract

Aging is a universal, irreversible and individual processthat causes morphophysiologicalchanges in the musculoskeletal systems, central nervous system and sensory systems (visual, vestibular and proprioception), causinggreaterrisk of falls. The falls have a high prevalence and have become an important public health problem due to the high economic and functional costs they represent in the elderly. To avoid these events it isimportanttoknowtheanatomophysiologicalchangesassociatedwithaging and plan healthstrategieswherebone, muscle, somatosensory (proprioceptive) and cognitivestimulation is incorporated with the aim of avoiding functional impairment and disability.

Keywords: Aging, aged, falls, balance

Introduction

Aging is a biological, universal, individual, asynchronous and natural processthat causes morphophysiologicalchangesonbody systems.¹Currently the literature has shown that aging causes alterations in the musculoskeletal system, generating important modifications on motor skills necessary for the execution of functional activities such as balance, posture and gait.^1,2These changes and their consequences have been strongly associated with an increase in the risk of falling.

A fall is defined as a sudden and unexpected event that precipitates the individual to the ground against their will, becoming an important public health problem due to its high frequency in the elderly population.³Falls represent high economic costs for countries, and cause important health consequences, such as an increase in the number of hospitalizations, hip fractures, disability, functional impairment and even death.⁴About one third of elderly suffer at least one fall each year and the incidence increases with age.⁴In addition, falls have an impact on a psychological and social level causing fear of falling, loss of confidence and restriction of social activities and quality of life.⁴Therefore, theunderstanding of themorphophysiologicalchangessufferedbythe elderly due to aging are of relevance for the planning of prevention programs and promotion of integral health in this population.

Musculoskeletal changes

Muscle mass decreases on average 0.4-0.8 kg per decade after 20 years, this loss being greater in men (1%) than in women (0.5%).⁵There is also a decrease of approximately 40% in the cross-sectional area between the ages of 20 and 80 years.⁶At thesame time, thenumber and size of musclefibersdecreasesignificantlyafter 25 years of age.⁷Studies in thesoleusmuscle of agedrats and in therectusfemoris and brachialbicepsmuscles of elderlyshowed a decrease in theproportion and size of type II fibers, more specifically in typeIIb.^7,8Functionally, type II fibers are classified as fastcontractionfibers, adaptedtoperformanaerobicmetabolism and withhigh fatigue resistancecapacity, so thattheirreduction in muscles of olderpeoplecould cause slower motor responses and lessabilitytoperformactivitiesfunctionallong-term, leadingto a fall.⁹

Loss of musclemassassociatedwithagingiscalledsarcopenia.¹⁰Authorspointoutthatsarcopenia has a multifactorial etiology and mayresult as a result of the normal agingprocessorassociatedpathologies.¹¹Likewise, sarcopeniaisrelatedtoanincrease in therisk of sufferingdisability, slowingdown, impaired balance and a greaternumber of fall.^12-14Product of sarcopenia and ageisevidence of loss of strength and musclepower, termknown as dynapenia.¹⁵The new terminology is gaining support for use in clinical environments and research settings ; however, despite it’s growing popularity, there remains some resistance because such new terminology might confuse efforts for building a consensus decision algorithm for sarcopenia.¹⁶

The reduction of muscle tissue is accompanied by an increase and infiltration of non-contractile structures such as fat and connective tissue.¹⁷ Currently it has been proposed that adiposity and accumulation of fatty tissue could alter the normal mechanisms of force development, due to physiological and neuromuscular changes.¹⁸At the same time, the infiltration of fat in the muscle tissue would cause poor motor behavior, altering muscle activation patterns,conditioning a higher risk of falls.¹⁹

Capillarization of skeletalmuscle fibers decreases as age increases, which could result in a reduced supply of oxygen and nutrients to peripheral muscles, in addition to a lower oxidative capacity.²⁰All of the above, translates into a muscular disadvantage to take advantage of the oxygen supplied, leading to anticipated fatigue and, therefore, to less voluntary muscle control.

Regarding connective tissue, aging has shown changes in its structure, preferably associated with degenerative factors. It has been observed that tendons of elderly subjects have a higher stiffness, and with this, lower elastic capacity, mainly due to a decrease in the amount of collagen, which translates into modifications of the biomechanical function of the joints, limiting the mobility.^21,22Studiesperformedonthecalcanealtendonsuggestthatwith aging, its deformation capacity is reduced, which may cause changes in the ankle joint and in the pattern of walking, conditioning greater instability and falls.²³

As for bonetissue, itundergoeschanges in trabecular architecture and cortical porosity.¹³Theosteonespresent in the bone cortex decrease with age, inducing fragility, osteoporosis, falls and fractures.²⁴ In the elderly, the mostfrequent fracture occurs in the coxofemoral joint, duetovariations in the histological properties of the femoral neck such as cortical thinning and loss of spongy bone,^25,26causing a high level of morbidity, mortality and disability.²⁵It has also been reported that aging is accompaniedby a decrease in osteoblasticmodulation, whichnegativelyinfluencesbone mineral density and explains the high rates of fractures caused by falls in the elderly.²⁶

Structurally, the bone system undergoes changes with age. This is reflected in changes in the spine, such as the occurrence of hypercifosis, which is defined an excesive anterior curvature in the thoracic spine. This curvature has been associated with function limitations, decreased balance, falls, fractures and decreased quality of life in elderly.²⁷

Finally, with aging, a reduction in the number of mechanoreceptors of the sole has been reported, which is accompanied by a decrease in plantar sensitivity.²⁸This decline is exacerbated by footwear, which impairs awareness of foot position through decreased tactile feedback, generating difficulty in maintaining standing position and increasing the risk of falls.²⁹

Conclusion

Elderly have morphophysiological changes due to aging, which become factors that determine the risk of falls. These changes include the reduction in number and size of muscle fiber, loss of muscle strength, etc. The combination of these alterations translates into a greater vulnerability of the elderly in the face of disturbances in both static and dynamic activities. Therefore, it is recommended that fall prevention strategies incorporate activities that include multi-component stimulation in order to avoid functional impairment and even disability.