From the Guidelines
The initial evaluation for a 68-year-old with poor balance should include a timed Get-Up-and-Go test, as recommended by the US Preventive Services Task Force 1. This test is a simple and effective way to assess balance and mobility in older adults. The test is performed by observing the time it takes a person to rise from an armchair, walk 3 meters (10 feet), turn, walk back, and sit down again.
Key Components of the Evaluation
- A comprehensive medical history to identify any underlying medical conditions that may be contributing to poor balance
- A medication review to assess for any medications that may be causing or exacerbating balance problems
- A physical examination focusing on neurological, cardiovascular, and musculoskeletal systems
- Vital signs, including orthostatic blood pressure measurements
- Laboratory tests, such as complete blood count, comprehensive metabolic panel, vitamin B12, and thyroid function tests
- Vision and hearing assessments, as sensory deficits can contribute to balance issues
Importance of Early Identification
Early identification of contributing factors to poor balance is crucial to prevent falls and maintain independence in older adults. The US Preventive Services Task Force recommends that clinicians ask their patients yearly about falls and balance or gait problems 1. By using the timed Get-Up-and-Go test and conducting a comprehensive evaluation, healthcare providers can identify individuals at increased risk for falls and provide targeted interventions to prevent falls and maintain independence.
Targeted Interventions
Targeted interventions may include exercise or physical therapy, vitamin D supplementation, and multifactorial risk assessment with comprehensive management of identified risks 1. These interventions can help to improve balance, reduce the risk of falls, and maintain independence in older adults.
From the Research
Initial Evaluation for Poor Balance in a 68-Year-Old
To evaluate poor balance in a 68-year-old, several tests and assessments can be considered based on the available evidence 2, 3, 4, 5, 6.
- Medical History: A thorough medical history is essential to identify any underlying conditions that may be contributing to the balance problems, such as hypertension, diabetes mellitus, arthritis, or heart disease 3.
- Physical Examination: A physical examination should include an assessment of the patient's musculoskeletal and nervous systems, as well as their overall physical condition 5.
- Balance Tests: Several balance tests can be used to evaluate a patient's balance, including:
- Vestibular Function Tests: Tests such as the Head Impulse test, Headshake test, Dix-Hallpike test, and test of sensory interaction in balance can be used to assess vestibular function 6.
- Cognitive Function Tests: Tests such as the Montreal Cognitive Assessment can be used to assess cognitive function and identify any cognitive impairment that may be contributing to balance problems 6.
- Questionnaires: Questionnaires such as the Dizziness Handicap Inventory and the Activities-specific Balance Confidence Scale can be used to assess the patient's symptoms and level of disability 6.
Considerations for Evaluation
When evaluating a 68-year-old with poor balance, it is essential to consider the potential causes of the balance problems, including:
- Aging: Age-related changes can affect balance, including declines in sensory, motor, and cognitive function 2.
- Chronic Diseases: Chronic diseases such as hypertension, diabetes mellitus, and arthritis can contribute to balance problems 3.
- Vestibular Impairment: Vestibular impairment is common in older adults and can increase the risk of falls 6.
- Cognitive Impairment: Cognitive impairment can also increase the risk of falls and should be considered in the evaluation 6.