By Katharine Forth
What’s wrong with current balance testing and our understanding of balance?
Have you ever had a balance test? Do you know anyone who has?
I’ll predict that if you can answer yes, the person in question had a fall before they had the test. Isn’t that a bit like checking someone’s blood pressure only after they’ve had a heart attack?
That, in a nutshell is the problem. Balance testing can be analogous to blood pressure testing in many ways.
In the days before blood pressure cuffs were standard in every doctor’s practice, pulse was used as a proxy to gauge some insight into blood pressure and risk of heart attack. It wasn’t perfect, and the development of a dedicated measure has driven greater understanding on an individual level, and therefore, more appropriate treatment for each individual.
The case with balance today is similar. The average physician has no real method to measure balance; those who specialize in geriatrics or who have access to physical therapy practices may use a proxy such as a test where a patient is timed getting out of a chair, walks a short distance, then sits back down. The test gives some indication of upper leg strength, and allows an experienced physician to assess gait. But the measure can be confounded by how the instructions are worded, whether the patient moves more slowly than usual.
Add in the fact that, like blood pressure, temporary factors can also impact the measurement on a given day. In the case of blood pressure, sometimes the anxiety of visiting a doctor drives blood pressure up (white coat syndrome).
Balance is far more dynamic than even weight or blood pressure. It can change daily. A more useful measure is to track it over time, and this is simply not available in any practical sense.
While there are sophisticated balance tests available today, they are accessed through specialist clinics, and normally only available to people with diagnosed balance problems. Often such problems are uncovered after a fall. But when 28% of those over 65 fall each year, and 35% of hip fracture patients do not survive the year after their injury, this help comes too late for many (CDC statistics, 2017).
Which brings us to the second part of the problem: we measure balance at the wrong time partly because of the belief that as humans age, balance naturally deteriorates to the point where falling is inevitable.
This is simply not true, any more than other myths about aging.
Some people develop health problems well before age 65 (our current nominated border into old age). Some people never develop them, right up to death.
It’s an old engineering truism that what gets measured gets attention. And what gets attention gets fixed.
While there is no magic wand for balance, there are several very effective interventions that are not expensive, and have minimal negative side effects. What’s missing is a simple, objective way of measuring everyone’s balance, as a matter of course.
Stop by Aging in America 2018 to meet Dr Katharine Forth, of Zibrio, and find out how we’re championing change in how people age.
Falling is Not a Normal Part of Aging: Golden Gate Room, Table 23 on Wednesday March 28th from 4.45pm - 5.45pm, Hilton San Francisco, Union Square
Katharine Forth, PhD, is CEO of Zibrio, the balance company.