Bedside balance testing in elderly people

Balance impairment in older people is a problem for both patients and physicians. Patients suffer from dizziness and fear of falling, and as many of them also have mobility problems the risk of falling is higher than in younger patients with balance impairment. Balance testing in young patients is often a time-consuming task requiring expensive devices such as videonystagmography, posturography or evoked potentials. The task is more difficult in elderly patients, who have mobility problems, hearing loss, chronic pathology, medication, etc., or who cannot afford expensive testing. In this paper, we briefly review the physiopathology of the balance system considered as a data-processing system. Based on these concepts, we review the main tests that can be easily performed at bedside or in the patient's home using no devices at all. These tests are basic oculomotor testing (like spontaneous nystagmus, head impulse test, dynamic visual acuity, head-shaking nystagmus), provocation tests (like Dix-Hallpike manoeuvre and variants for positional vertigo). Finally, stance tests with a special focus on those which can identify altered postural control patterns and high risk of falling (like the modified Clinical Test for Sensory Interaction in Balance and the Timed Up and Go test). We comment their utility, how they should be performed and what results can be obtained.