Towards healthy aging: Quantifying vestibular contributors to age-related changes in balance and fall risk

迈向健康老龄化：量化前庭对与年龄相关的平衡变化和跌倒风险的影响

• 批准号: 10274937
• 负责人: Daniel M Merfeld
• 金额: $ 79.08万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10274937
• 关键词: Accounting; Address; Adult; Age; Aging; American; Biological Assay; Cause of Death; Cessation of life; Clinical; Data; Educational Intervention; Elderly; Equation; Equilibrium; Etiology; Eye; Failure; Feedback; Human; Impairment; Individual; Injury; Intervention; Intuition; Life; Link; Measures; Mediating; Mediation; Medical Care Costs; Methods; Modeling; Modernization; National Health and Nutrition Examination Survey; Noise; Odds Ratio; Participant; Perception; Perceptual learning; Peripheral; Population; Posture; Public Health; Publishing; Rehabilitation therapy; Reporting; Research; Romberg test procedure; Sensory; Statistical Data Interpretation; Structure; Surveys; System; Testing; Time; Training; Variant; Vestibular Function Tests; Work; age related; balance testing; base; demographics; design; fall risk; falls; healthy aging; improved; novel; screening; therapy design; young adult

Imbalance contributes to falls, fall risk increases with age, and falls cause accidental death and injury. While causes of falls and imbalance are multifactorial, modern multivariate statistical analyses allow us to quantify the impact of age-related vestibular declines on falls as well as the impact of age-related vestibular declines on age- related balance declines. For example, we have recently reported that nearly 50% of cross-sectional age-related balance declines found using a standard Romberg test variant (“eyes closed; standing on foam”) are mediated by an age-related increase in roll tilt thresholds, suggesting that a single sub-clinical facet of vestibular function is a substantial contributor to age-related balance declines. Furthermore, an analysis of over 5,000 Americans showed that individuals who failed to complete this same balance test condition had significantly increased odds to have reported “difficulty with falling” in the past 12 months (odds ratio of 6.3). We propose to build upon these findings to quantify the multiple links between aging, vestibular function, balance, and falls. We posit the following links: (i) vestibular function declines with age, (ii) these age-related vestibular declines impact balance, (iii) imbalance contributes to falls, and (iv) falls cause death and injuries. Specifically, we posit that correlations between aging, vestibular function, and balance arise, in part, because vestibular imprecision (i.e., vestibular thresholds or vestibular “noise”) increases with age as demonstrated by large increases in vestibular thresholds above the age of 40. Increased vestibular imprecision, in turn, contributes to instability, which contributes to falls. To quantify these correlations and hypothesized causal links, we propose comprehensive assays of vestibular function, broad multi-faceted balance assays, as well as reports of falls. We also propose to further develop and test candidate interventions designed to improve tilt thresholds (“vestibular precision”), which could also improve balance and reduce falls. Given life-or-death significance and broad impact, we propose: Aim 1: To quantify the links between age, vestibular function, balance, and falls in healthy individuals using a comprehensive vestibular function test battery, broad multi-faceted balance tests, & fall-related surveys. Aim 2: To quantify both tilt thresholds and balance before and after a training intervention that has subjects performing a standard tilt threshold task, except that feedback (“correct” or ”incorrect”) is provided after each trial. This task is designed to improve vestibular thresholds (“precision”), which may also improve balance. For Aim 2A, we propose to test young adults (age 18-40). For Aim 2B, we propose to test older adults (age 65-89). Aim 1 will quantify links between vestibular function and falls for the first time and will also quantify new links between vestibular function and balance. This will define potential vestibular and/or balance tests that can be used as screening tests to determine who would benefit from intervention. Aim 2 will quantify the impacts of a training paradigm designed to reduce tilt thresholds. This will develop and test an intervention designed to improve vestibular precision, which could also improve balance and reduce falls.

不平衡会导致跌倒，跌倒风险随着年龄的增长而增加，跌倒会导致意外死亡和受伤。尽管 跌倒和失衡的原因是多因素的，现代多元统计分析使我们能够量化 与年龄相关的前庭衰退对跌倒的影响以及与年龄相关的前庭衰退对年龄的影响 相关余额下降。例如，我们最近报道称，近 50% 的横截面与年龄相关 使用标准 Romberg 测试变体（“闭上眼睛；站在泡沫上”）发现的平衡下降得到调节 与年龄相关的翻滚倾斜阈值增加，表明前庭功能的单一亚临床方面 是与年龄相关的平衡下降的一个重要因素。此外，对 5,000 多名美国人的分析 结果表明，未能完成相同平衡测试条件的个体的几率显着增加 在过去 12 个月内报告过“跌倒困难”（优势比为 6.3）。我们建议在此基础上 研究结果量化了衰老、前庭功能、平衡和跌倒之间的多重联系。我们提出如下 链接：（i）前庭功能随着年龄的增长而下降，（ii）这些与年龄相关的前庭功能下降影响平衡，（iii） 不平衡会导致跌倒，并且 (iv) 跌倒会导致死亡和受伤。具体来说，我们假设相关性 衰老、前庭功能和平衡之间的差异部分是由于前庭不精确（即前庭 阈值或前庭“噪音”）随着年龄的增长而增加，前庭阈值大幅增加就证明了这一点 40 岁以上。前庭不精确的增加反过来又会导致不稳定，从而导致跌倒。 为了量化这些相关性和假设的因果关系，我们提出了前庭的综合分析 功能、广泛的多方面平衡测定以及跌倒报告。我们还建议进一步发展和 测试旨在提高倾斜阈值（“前庭精度”）的候选干预措施，这也可以提高 平衡并减少跌倒。鉴于生死攸关的重要性和广泛的影响，我们建议： 目标 1：使用以下方法量化健康个体的年龄、前庭功能、平衡和跌倒之间的联系 全面的前庭功能测试、广泛的多方面平衡测试以及跌倒相关调查。 目标 2：量化受试者训练干预前后的倾斜阈值和平衡 执行标准倾斜阈值任务，除了在每次任务后提供反馈（“正确”或“不正确”） 审判。这项任务旨在提高前庭阈值（“精度”），这也可能会提高平衡能力。为了 目标 2A，我们建议测试年轻人（18-40 岁）。对于目标 2B，我们建议测试老年人（65-89 岁）。 目标 1 将首次量化前庭功能与跌倒之间的联系，并将量化新的联系 前庭功能和平衡之间的关系。这将定义潜在的前庭和/或平衡测试，可以 用作筛选测试以确定谁将从干预中受益。目标 2 将量化 旨在降低倾斜阈值的训练范例。这将开发和测试旨在 提高前庭精确度，这也可以改善平衡并减少跌倒。