The elusive sense - vestibular dysfunction and falls risk in older adults

Abstract

Background: Falls are a significant and growing public health concern in the UK. Maintaining balance, involves the complex interaction of multiple systems. The vestibular system is a key sensory system in maintaining balance, that deteriorates with ageing. However, the impact of ageing on the vestibular system’s ability to maintain postural control and its impact on falls risk remains unknown. This multiple methods approach thesis, aimed to address the following questions in an older adult population: 1. Does dizziness increase the risk of falling? (Dizziness is a key symptom of vestibular dysfunction) 2. Does asking regarding dizziness effective at screening for vestibular dysfunction? 3. Does the presence of a wider range of vestibular symptoms increase falls risk? 4. How does this population define dizziness? 5. What are the barriers and enabling factors for accessing healthcare? 6. Is there an association between physical functioning and vestibular dysfunction? Methods: Primary data was collected via surveys, physical functioning tests and qualitative interviews. Longitudinal secondary data analysis was also undertaken. Results: Dizziness and wider vestibular symptoms are associated with an increased falls risk (Chapters 4 and 5). Chapter 6 reported that the reliance on the presence of dizziness to diagnosis a vestibular dysfunction lacks specificity. Clinicians need to be skilled in communication to ensure a shared understanding when a patient presents with dizziness. Significant barriers exist for this population in accessing healthcare at a personal and service level (Chapter 7). Increased severity of vestibular symptoms was associated with worsening performance on physical functioning tests indicating a possible reason for their increased falls risk (Chapter 8). Conclusion: In conclusion, dizziness and the vestibular system are elusive in their difficulty to be defined and their lack of clear, concrete symptoms, however, a clear link has been demonstrated between them and an increased falls risk.