Vestibular Perception, Balance Impairment, and Fall Risk in Community-Dwelling Older Adults
Abstract
Background
Vestibular complaints are common in older adults and are linked to imbalance and falls. Some older adults show impaired vestibular perception despite preserved peripheral-reflex (“vestibular agnosia”). Yet it remains unclear if vestibular agnosia is independently linked to imbalance and falls in otherwise healthy older adults. We therefore investigated the prevalence of vestibular agnosia in community-dwelling older adults, and examined its association to balance and prospective falls.
Methods
Vestibular perceptual thresholds were measured during yaw-plane rotational chair testing. Postural sway and instrumented Timed-Up-and-Go were assessed using wearable sensors, and falls were recorded prospectively over six-month. Vestibular agnosia was identified using K-means clustering. Multivariable regressions examined associations between perceptual thresholds and balance outcomes; logistic and negative binomial regressions evaluated associations with prospective falls.
Results
Among 166 participants (75.4 years; 81.9% female), 18.7% were classified as having vestibular agnosia. These individuals had worse cognition and somatosensation. Elevated (i.e. worse) vestibular perceptual thresholds were independently associated with greater sway velocity when standing on foam with eyes-open (adjusted β=0.002, p=0.03). Associations with other balance outcomes were attenuated after adjustment. Vestibular perceptual thresholds were not associated with prospective falls (odds of ≥1 fall: adjusted OR=0.99, p=0.65; fall counts: adjusted IRR=1.02, p=0.35).
Conclusions
Approximately one-fifth of healthy older adults exhibit vestibular agnosia. While elevated perceptual thresholds are independently associated with poorer balance, they did not predict falls. Further research is needed to determine whether vestibular perceptual testing provides additional information beyond standard balance assessments for fall-risk prediction in community-dwelling healthy older adults.
Comments
Cognition and VA
Thank you for this fascinating work. The finding that participants with vestibular agnosia had poorer cognition and somatosensation raises the possibility that vestibular agnosia may be part of a broader age-related sensory-cognitive syndrome. Have the authors explored whether cognition mediates the relationship between vestibular perception and balance outcomes?
REQEUST FOR OPINION ABOUT REPLICATING- POSTERIOR STROKE PATIENT
Good afternoon,
This is a fantastic piece of work. I was just checking if this can be replicated in any way in survivors of posterior circulation stroke, and how this can be objectively quantified,
Again, Congratulations on the poster.
Kind regards
Thank you - that's very…
Thank you - that's very interesting. I cannot imagine many (guessing fewer than 5%) of the patients attending my falls clinic being fit enough to undergo this testing. Are you planning to follow-up falls in this cohort for a longer period?
Vestibular functioning
Dear Yuxiao Li,
Thank you for the interesting presentation this morning. I understand you looked at self-indicated thresholds. Did you also quantified vestibular functioning in a more objective way, eg from the eye EMG or eye tracking? Was the chair turning velocity controlled?
Is there going to be follow up work?
Best wishes,
Lizeth Sloot (Newcastle University)