Citation

Tuunainen E, Poe D, Jäntti P, Varpa K, Rasku J, Toppila E, Pyykko I. Aging Clin. Exp. Res. 2011; 23(5-6): 364-371.

Affiliation

Department of Otorhinolaryngology, University of Eastern Finland, Kuopio, Finland. eeva.tuunainen@uku.fi.

Copyright

(Copyright © 2011, Holtzbrinck Springer Nature Publishing Group)

DOI

10.3275/7623

PMID

21447995

Abstract

Background and Aims: Dizziness, impairment of balance and fear of falling are common complaints in the elderly. We evaluated the association of these symptoms to vestibular findings in the elderly with posturography and video-oculography (VOG). Methods: We studied 38 oldest olds (≥85 y, mean age of 89) living in a residential home. The vestibular symptoms were taken with a structured questionnaire, the Mini Mental State Examination (MMSE) was scored and falls were recorded during a period of 12 months. Posturography was measured with force platform and eye movements were measured with video-oculography. Results: In the majority of the elderly, vestibular abnormalities were found, as reduced vestibulo-ocular reflex gain 6/38, spontaneous nystagmus 5/38, gaze deviation nystagmus 5/38, head shaking nystagmus 9/38, pathologic head thrust test 10/38 and positional nystagmus in 17/38. The posturography demonstrated two major findings: the body support area was limited and the use of vision for postural control was reduced. In principal component analysis of character of vertigo, 4 major factors could be retrieved describing elements of failure in the vestibular and other systems important to maintenance of balance: episodic vertigo, postural instability, multisystem failure (frail) and presyncopal imbalance. These four factors were associated in different degrees to vestibular abnormalities and falls. During the follow up period, in 19 elderly (19/38), one or more falls were recorded. Conclusions: Progressive loss of balance in the aged, or "presbyequilibrium," is a complex and incompletely understood process involving vestibular, oculomotor, visual acuity, proprioception, motor, organ system and metabolic weaknesses and disorders. These factors provide some potential basis for streamlining the diagnostic evaluation and aiding in planning for effective therapy. In the oldest olds, these problems are magnified, raising the need for additional expertise in their care that could be met by training specialized health care staff.

Language: en