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Walking  May Help Improve  Balance

Dear Dr. Roach: For the past couple of years, I have been noticing that my balance is not what it was. I never feel as though I am going to faint or pass out, but I find myself “listing,” and it is very uncomfortable. My doctor has changed my blood pressure medication, but it has not helped. I am 82 years old. I try to walk regularly, but feel I may look a little tipsy. — E.H.

Answer: Loss of balance as we get older is very important and often overlooked. Many different systems are involved — eyesight, joints, nerves and muscles are all necessary for proper balance, and all can be affected by aging. Fortunately, there is effective treatment for almost everybody.

Walking is great, and regular exercise of any kind will help your balance. But you need to be safe. Walk with someone, if possible; if not, walk where there are people, and have your phone. If you are unsteady, the best approach would be to get some help right away. Talk with your physician, who can work with you to decide the best place to start.

In my experience, physical therapy is the best way to prevent a fall — and a fall is potentially devastating. The therapist can help diagnose what is making you unsteady and can help design a program to get you stronger and safer. A physical therapist also can help decide if an aid, like a cane, will be helpful or harmful. Many community centers have programs that can help.

If you have already had a fall, then you may need even more help. In that case, make an appointment to see a neurologist, a joint specialist or a rehabilitation specialist. But everyone can improve with balance and strengthening exercises.

Dear Dr. Roach: I am 91 years old and have just been told I have blepharitis, which I have never heard of. Please tell me the cause and treatment. It affects my reading. — C.E.

Answer: Blepharitis is inflammation of the eyelid (one or both). It can be caused by excess oil on the skin or by bacteria. Once we get older than 80 or so, the skin of the lower eyelid tends to droop, exposing part of the inside of the eyelid to the air. This can make inflammation of the lower eyelid more likely in older people.

While there isn’t a cure for blepharitis, most people get better with regular washing of the eyelids (use a dilute mild soap or “no tears” baby shampoo). A warm compress ahead of time can loosen up any crusting that might occur. You may need to do this several times a day at first. Blepharitis sometimes brings with it blurry vision, but return to your eye doctor soon if your vision doesn’t get back to normal.

Dear Dr. Roach: We in New York state are suffering through a serious cold and flu season. I’m wondering what role a toothbrush plays in it. I try to replace mine every one or two months and submerge it in boiling water regularly. Does this make a difference? — L.S.

Answer: Flu is transmitted from person to person, either through hand contact (hand to hand, or hand to object to hand) or in the air. The best way of avoiding flu is not getting exposed to the virus, and you can reduce that with meticulous hand-cleaning. The flu vaccine reduces flu from both hand contact and aerosol. Regularly changing your toothbrush is a good idea for oral hygiene, but not to prevent flu.

Dear Dr. Roach: I have been taking Ambien for six years. I am unable to sleep without it. I have read some health scares regarding its use, and I wanted your take on this, please. I am a healthy female who is 58 years old. — T.F.

Answer: Although Ambien (zolpidem) is a relatively safe medication for occasional use, long-term use of any sleeping medication tends to become less effective over time. Further, zolpidem, like other classes of sleeping medications, increases the risk of falls when used on a long-term basis. It also puts people at higher risk for motor vehicle accidents. Also, zolpidem seems most likely to have the side effect of complex sleep behaviors, including sleep eating and sleep driving.

In general, I recommend trying to use sleeping medications no more than every other day, and for no longer a time period than four weeks. In people who have a history of falls, I recommend stopping the use of sleeping medications entirely. Stopping a medication you are used to taking for a long time, however, should be done slowly and with the advice of the physician who prescribed the medication.