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The vestibular system and falls

The vestibular system has an important role to play in movement. The vestibular system helps to control posture and gait as well as maintain balance and orientation by sensing head movement and coordinating eye and postural movements, all factors that support falls prevention.

In addition, hearing or hearing loss can influence the quality of life of an older adult. Hearing loss can affect factors such as communication, cognition, and social participation.

More than one in two people who fall have signs of vestibular dysfunction.

Risk factors for falls in older adults with impaired vestibular function

Slower gait speed

Vestibular function declines with age and can be associated with deficits in gait, unsteadiness, and an increased risk of falls.

Lower standing balance

Vestibular disorders can cause dizziness, vertigo, and imbalance.

An older adult with reduced otolith (the part of the inner ear that can sense linear movements and gravity) function can experience increased postural sway whilst standing, a known risk factor for falls.

Postural instability

Reduced auditory cues, or hearing, can contribute to postural instability.

Reduced levels of physical activity

Individuals with hearing impairments have also been found to have lower walking endurance and lower physical activity levels, impacting the involvement in strength and balance falls prevention strategies.

How can I help older adults with impaired vestibular function?

The World Guidelines for Falls Prevention and Management for Older Adults recommend that the management of vestibular issues is considered as part of a multifactorial approach to falls prevention. This may involve:

  • Vestibular rehabilitation, including physiotherapy and occupational therapy intervention. Vestibular rehabilitation has been proven effective in treating stable vestibular problems in all ages.
  • Prescribing appropriate medication for inner ear viral infections. Individuals taking the appropriate medication within three days of the onset of infection has been shown to improve vestibular function.
  • Ensuring the consistent use of hearing aids by older adults with hearing loss. This has been found to decrease the likelihood of the individual experiencing a fall.

Screening and health checks for older adults

The Best Practice Guidelines for Preventing Falls and Harm from Falls in Older People recommends taking the following steps to assess vestibular function and minimise the risk of falls due to dizziness:

  • Ask the older adult about their symptoms.
  • Use the Halmagyi head-thrust test to assess peripheral vestibular function.
  • Complete audiology testing to assess hearing loss.
  • Use the Dix-Hallpike test to evaluate for dizziness and diagnose Benign Paroxysmal Positional Vertigo (BPPV).
  • Refer the older adult to a Specialist or a Neurologist if required.

Who can I collaboratively work with to support older adults with their vestibular health?

A multidisciplinary team to support older adults with their vestibular health or dysfunction may consist of a GP, Audiologist, and Otologist.

More information

For more information, resources, and support about vestibular and ear health, visit the Ear Science Institute Australia website.

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