Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. Arch Intern Med

Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, MD 21287, USA.
Archives of internal medicine (Impact Factor: 17.33). 06/2009; 169(10):938-44. DOI: 10.1001/archinternmed.2009.66
Source: PubMed


Balance dysfunction can be debilitating and can lead to catastrophic outcomes such as falls. The inner ear vestibular system is an important contributor to balance control. However, to our knowledge, the prevalence of vestibular dysfunction in the United States and the magnitude of the increased risk of falling associated with vestibular dysfunction have never been estimated. The objective of this study was to determine the prevalence of vestibular dysfunction among US adults, evaluate differences by sociodemographic characteristics, and estimate the association between vestibular dysfunction and risk of falls.
We included data from the 2001-2004 National Health and Nutrition Examination Surveys, which were cross-sectional surveys of US adults aged 40 years and older (n = 5086). The main outcome measure was vestibular function as measured by the modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces.
From 2001 through 2004, 35.4% of US adults aged 40 years and older (69 million Americans) had vestibular dysfunction. Odds of vestibular dysfunction increased significantly with age, were 40.3% lower in individuals with more than a high school education, and were 70.0% higher among people with diabetes mellitus. Participants with vestibular dysfunction who were clinically symptomatic (ie, reported dizziness) had a 12-fold increase in the odds of falling.
Vestibular dysfunction, as measured by a simple postural metric, is common among US adults. Vestibular dysfunction significantly increases the likelihood of falls, which are among the most morbid and costly health conditions affecting older individuals. These data suggest the importance of diagnosing, treating, and potentially screening for vestibular deficits to reduce the burden of fall-related injuries and deaths in the United States.

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    • "Measurements of gait and balance with Tinnetti score and the number of falls have shown highly significant age-related changes every year.4 Vestibular function is important for navigation, and is therefore highly relevant to the everyday lives of older people.5 Evaluating with modified Romberg test, the prevalence of vestibular dysfunction showed a significant progression with age.6 Elderly people with benign paroxysmal positional vertigo have a significantly higher recurrence rate of vertigo and need to minimize the potential morbidity of their falls.7 "
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    ABSTRACT: Background Imbalance from degeneration of vestibular end organs is a common problem in the elderly. However, the decline of vestibular function with aging was revealed in few vestibular function tests such as vestibular autorotation test (VAT). In the current VAT, there are drawbacks of poor test–retest reliability, slippage of the sensor at high-speed rotations, and limited data about the effect of aging. We developed a correlational-VAT (cVAT) system that included a small, light sensor (less than 20 g) with wireless data transmission technique to evaluate the aging of vestibular function. Material and methods We enrolled 53 healthy participants aged between 25 and 75 years and divided them into five age groups. The test conditions were vertical and horizontal head autorotations of frequencies from 0 to 3 Hz with closed eyes or open eyes. The cross-correlation coefficient (CCC) between eye velocity and head velocity was obtained for the head autorotations between 1 Hz and 3 Hz. The mean of the CCCs was used to represent the vestibular function. Results Age was significantly and negatively correlated with the mean CCC for all test conditions, including horizontal or vertical autorotations with open eyes or closed eyes (P<0.05). The mean CCC with open eyes declined significantly at 55–65 years old and the mean CCC with closed eyes declined significantly at 65–75 years old. Conclusion Vestibular function evaluated using mean CCC revealed a decline with age, and the function of visual-vestibulo-ocular reflex declined 10 years earlier than the function of vestibulo-ocular reflex.
    Full-text · Article · Sep 2014 · Clinical Interventions in Aging
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    • "It is also critical for spatial orientation and navigation. Individuals with vestibular dysfunction present with gait abnormalities and those with bilateral hypofunction report 50% more falls than healthy individuals [2] [3] [4]. The high morbidity and mortality associated with falls cost the US health care system 30 billion dollars in 2010 [5]. "
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    ABSTRACT: The vestibular system plays an important role in locomotion. Individuals with vestibular pathology present with gait abnormalities, which may increase their fall frequency. Backward walking (BW) has been suggested as a predictor of falls in other patient populations; however it has not been studied in individuals with dizziness. Our aims were: 1) to investigate the differences in forward walking (FW) and BW both between and within 3 groups: Healthy controls, individuals with dizziness and vestibular pathology, and individuals with dizziness without vestibular pathology 2) describe differences in FW and BW between individuals that have fallen and those that have not. We studied 28 healthy controls (mean 53.8 ± 17 years), 21 individuals with pathophysiology of the vestibular system (mean 68.5 ± 13 years), and 18 individuals without a vestibular cause for their dizziness (mean 67.4 ± 17 years). Subjects performed 2 FW and 2 BW trials over the GAITRite walkway. Data on history of falls in the preceding year were collected. We found BW was different to FW within each group. When comparing between groups and correcting for age and gender, only BW velocity (beta = -11.390, p = 0.019), cadence (beta = -8.471, p = 0.021), step time (beta = 0.067, p = 0.007) and stride time (beta = 0.137, p-0.005) were significantly affected by having dizziness, with no differences in FW characteristics. There were no differences between FW and BW between fallers and non-fallers. BW appears to be a better biomarker than FW for identifying individuals with symptoms of dizziness; though it does not appear to characterize those who fall.
    Full-text · Article · Sep 2014 · Gait & Posture
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    • "Recent epidemiological studies have demonstrated that vestibular disorders occur in more than 35% of adults aged 40 or older; between the ages of 60 and 69, the prevalence increases to almost 50% and between 70 and 79, it is 69% (Agrawal et al., 2009). Saber Tehrani et al. (2013) has estimated that, of 3.9 million patients visiting a Hospital Emergency Department for dizziness or vertigo in the USA in 2011, 25.7% were attributable to otological or vestibular causes, costing US $757 million. "
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    ABSTRACT: In addition to the deficits in the vestibulo-ocular and vestibulo-spinal reflexes that occur following vestibular dysfunction, there is substantial evidence that vestibular loss also causes cognitive disorders, some of which may be due to the reflexive deficits and some of which are related to the role that ascending vestibular pathways to the limbic system and neocortex play in spatial orientation. In this review we summarize the evidence that vestibular loss causes cognitive disorders, especially spatial memory deficits, in animals and humans and critically evaluate the evidence that these deficits are not due to hearing loss, problems with motor control, oscillopsia or anxiety and depression. We review the evidence that vestibular lesions affect head direction and place cells as well as the emerging evidence that artificial activation of the vestibular system, using galvanic vestibular stimulation (GVS), can modulate cognitive function.
    Full-text · Article · Nov 2013 · Frontiers in Integrative Neuroscience
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