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

不平衡导致跌倒，跌倒的风险随着年龄的增长而增加，跌倒会导致意外死亡和受伤。而当 跌倒和失衡的原因是多因素的，现代多变量统计分析使我们能够量化 年龄相关性前庭下降对跌倒的影响以及年龄相关性前庭下降对年龄的影响 相关余额下降。例如，我们最近报告称，近50%的横截面与年龄有关 使用标准Romberg测试变量(“闭着眼睛；站在泡沫上”)发现的平衡下降是有调节作用的 通过与年龄相关的翻滚倾斜阈值的增加，表明前庭功能的一个亚临床方面 是导致与年龄相关的平衡下降的重要因素。此外，对5000多名美国人的分析 结果显示，没有完成这一平衡测试条件的个体的几率显著增加 在过去12个月内报告“跌倒困难”(优势比为6.3)。我们建议在这些基础上继续努力 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。我们假设如下 链接：(I)前庭功能随年龄增长而下降，(Ii)这些与年龄相关的前庭功能下降影响平衡，(Iii) 不平衡会导致摔倒，(Iv)摔倒会导致死亡和受伤。具体地说，我们假设相关性 在衰老、前庭功能和平衡之间产生的部分原因是前庭不精确(即前庭 前庭阈值或前庭噪声)随年龄增长而增加，前庭阈值的大幅增加证明了这一点 年龄在40岁以上。前庭不精确度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联系，我们提出了前庭的综合分析。 功能，广泛的多方面平衡分析，以及跌倒的报告。我们还建议进一步发展和 测试旨在提高倾斜阈值(“前庭精确度”)的候选干预措施，这也可以改善 平衡和减少跌倒。鉴于生死攸关和广泛的影响，我们建议： 目的1：量化健康个体年龄、前庭功能、平衡和跌倒之间的联系 一个全面的前庭功能测试电池，广泛的多方面平衡测试，以及与跌倒相关的调查。 目标2：在有受试者的训练干预前后量化倾斜阈值和平衡 执行标准倾斜阈值任务，不同之处在于在每个任务之后提供反馈(正确或不正确 审判。这项任务旨在提高前庭阈值(“精确度”)，这也可能改善平衡。为 目标2A，我们建议对18-40岁的年轻人进行测试。对于目标2B，我们建议测试老年人(65岁-)。 目标1将首次量化前庭功能和跌倒之间的联系，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， 用作筛查测试，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模式。这将开发和测试旨在 提高前庭的精确度，这也可以改善平衡，减少跌倒。

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.