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

基本信息

批准号：
10840200
负责人：
Daniel M Merfeld
金额：
$ 7.52万
依托单位：
OHIO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
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

项目摘要

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.

失衡会导致跌倒，跌倒风险随着年龄的增长而增加，跌倒会导致意外死亡和伤害。尽管跌倒和失衡的原因是多因素，现代的多元统计分析，使我们能够量化与年龄相关的前庭下降对跌倒的影响以及与年龄相关的前庭下降对年龄的影响 - 相关余额下降。例如，我们最近报告说，几乎50％的横截面相关年龄相关使用标准Romberg测试变体发现的平衡下降（“闭合眼睛；站在泡沫上”）是介导的通过与年龄相关的倾斜阈值增加，这表明一个单一的前链置函数是与年龄相关的余额下降的重要贡献者。此外，对5,000多名美国人的分析表明未能完成相同平衡测试条件的个人赔率显着增加在过去的12个月中报告了“跌倒困难”（6.3的赔率）。我们建议以这些为基础量化衰老，前庭功能，平衡和跌倒之间的多个联系的发现。我们指出以下链接：（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下降的影响平衡，（iii）失衡会导致跌倒，（IV）跌倒会导致死亡和伤害。具体而言，我们将相关性定位在衰老，前庭功能和平衡之间出现，部分原因是前庭（即前庭阈值或前庭“噪声”）随着年龄的增长而增加超过40岁以上。进而增加的前庭灌注会导致不稳定性，这导致跌倒。为了量化这些相关性和假设的因果关系，我们提出了前庭的全面暗杀功能，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候选干预措施旨在改善倾斜阈值（“前庭精度”），这也可以改善平衡并减少跌倒。鉴于生命或死亡的意义和广泛的影响，我们建议：目标1：使用健康个体的年龄，前庭功能，平衡和跌倒之间的联系全面的前庭功能测试电池，广泛的多方面平衡测试以及与跌倒有关的调查。目标2：量化具有主题的培训干预之前和之后的倾斜阈值和平衡执行标准倾斜阈值任务，除了在每个后提供反馈（“正确”或“不正确”）审判。该任务旨在改善前庭阈值（“精度”），这也可能提高平衡。为了 AIM 2A，我们建议测试年轻人（18-40岁）。对于AIM 2B，我们建议测试老年人（65-89岁）。 AIM 1将首次量化前庭功能与跌倒之间的链接，还将量化新链接前庭功能和平衡之间。这将定义可能是可能的前庭和/或平衡测试用作筛选测试，以确定谁将受益于干预。 AIM 2将量化旨在减少倾斜阈值的训练范例。这将开发并测试旨在的干预措施提高前庭精度，这也可以改善平衡并减少跌倒。