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

不平衡导致福尔斯，随着年龄的增长，跌倒风险增加，福尔斯会导致意外死亡和伤害。而 福尔斯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 年龄相关性前庭功能减退对福尔斯的影响以及年龄相关性前庭功能减退对年龄的影响- 相关余额下降。例如，我们最近报告说，近50%的横截面年龄相关的 使用标准Romberg测试变体（“闭上眼睛;站在泡沫上”）发现的平衡下降被介导 与年龄相关的滚动倾斜阈值增加，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，一项对5,000多名美国人的分析显示， 没有完成同样平衡测试的人， 在过去12个月内报告“跌倒困难”（优势比为6.3）。我们建议在此基础上， 量化老化、前庭功能、平衡和福尔斯之间多重联系的发现。我们承诺以下事项 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影响平衡，（iii） 不平衡导致福尔斯，以及（iv）福尔斯导致死亡和受伤。具体来说，我们认为相关性 老化、前庭功能和平衡之间的关系，部分是因为前庭不精确（即，前庭 前庭阈值或前庭“噪声”）随着年龄的增长而增加，如前庭阈值的大幅增加所证明的 超过40岁。前庭不精确性的增加反过来又会导致不稳定，从而导致福尔斯。 为了量化这些相关性和假设的因果关系，我们提出了前庭神经系统的综合分析。 功能，广泛的多方面平衡测定，以及福尔斯的报告。我们还建议进一步发展和 测试候选干预措施，旨在提高倾斜阈值（“前庭精度”），这也可以提高 平衡和减少福尔斯。考虑到生死攸关的重要性和广泛的影响，我们建议： 目的1：使用以下方法量化健康个体的年龄、前庭功能、平衡和福尔斯之间的联系： 一个全面的前庭功能测试电池，广泛的多方面的平衡测试，和跌倒相关的调查。 目标2：量化受试者在训练干预前后的倾斜阈值和平衡 执行标准的倾斜阈值任务，除了在每个倾斜阈值任务之后提供反馈（“正确”或“不正确”）之外， 审判这项任务旨在提高前庭阈值（“精确度”），这也可以改善平衡。为 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和福尔斯之间的联系，也将量化新的联系 前庭功能和平衡之间的联系这将定义潜在的前庭和/或平衡测试， 用作筛选测试，以确定谁将从干预中受益。目标2将量化 训练模式旨在降低倾斜阈值。这将开发和测试一种干预措施， 改善前庭精度，这也可以改善平衡并减少福尔斯。

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.