Vestibular perception, balance impairment, and fall risk in community-dwelling older adults
File(s)
Accepted version
Author(s)
Ellmers, Toby
Yuxiao, Li
Type
Journal Article
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.
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.
Date Acceptance
2026-06-16
Citation
Age and Ageing
ISSN
0002-0729
Publisher
Oxford University Press
Journal / Book Title
Age and Ageing
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted