Dear Dr. Roach: Apparently, it is common for older people to have balance issues. Do these balance problems usually stem more from muscular issues or inner-ear issues?
It is often a combination of issues that lead to balance problems in older adults. Inner-ear problems, where the organs of balance are located, are a major cause. However, balance problems are exacerbated by muscle weakness, vision problems, arthritis and medications, to name a few common ones.
The body has many safeguards to keep us from falling. If the balance system can’t tell us our exact position in space, our eyes can, and the neurological system uses fine muscle control to keep us upright and safe. We can often do well even with one system not working properly. When multiple systems are affected, falls are more common.
Improving balance and reducing fall risk often involves multiple interventions. One is working on balance directly. This can be achieved with home exercises; group exercises, such as tai chi and yoga, which have the added advantage of increasing muscle control; or with a skilled therapist such as physical or occupational therapy. Making sure vision is as good as possible and staying on top of joint, muscle and neurological conditions will help reduce fall risk.
Medications are so often the source of balance and fall problems that many medical practices (including mine) review medications at every visit to look for errors, medicines that have combined toxicities, medicines that are less safe in older adults and any medicines that might safely be discontinued.
Dear Dr. Roach: I have a lot of moisture in my eyes. I have to keep wiping them. My previous doctor gave me a prescription eyedrop that helped. After I moved, my new doctor didn’t give me the same thing. I got “dry eye” drops, which didn’t help at all. Do you have a solution?
It is not intuitive that watery eyes can be a symptom of dry eyes, but it is indeed often the case. Eye lubrication may come from several parts of the eye, including the conjunctiva (a tissue that lines the insides of the eyelids), which secretes a mucus that lasts a long time and keeps the eyes comfortably moist. When the mucus production is inadequate in quantity or quality, the eyes get dry. When they become dry and irritated, one of the body’s responses is to increase tear production from the lacrimal gland, which is what you are wiping away. The fluid from the lacrimal gland is not as long-lasting, nor comfortable.
There are many different kinds of treatments for dry eyes. Artificial teardrops (these can be used every few hours) are a great place to start and perfectly adequate for most.
Since those have failed, it’s time to try something new. I’d recommend going back to the eye doctor with the name of the prescription medicine you had from your previous doctor. If you don't recall what it was, call your old pharmacy.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu