Investigation of the Effects of Age-Related Changes in the Vestibular System on Balance: A Review

Aygül Köseoğlu; Mehmet Kaan Altunok; Mustafa Oğuz Kethüdaoğlu; Suzan Aydın; Havva Ezgi Albayrak; Hande Besna Göçen; Bülent Abut Özsezikli

doi:10.18614/deutip.1330102

Review

Vestibüler Sistemde Yaşa Bağlı Değişikliklerin Denge Üzerine Etkilerinin Araştırılması: Bir Derleme

Year 2023, Volume: 37 Issue: 3, 309 - 321, 25.01.2024

Aygül Köseoğlu Mehmet Kaan Altunok Mustafa Oğuz Kethüdaoğlu Suzan Aydın Havva Ezgi Albayrak Hande Besna Göçen Bülent Abut Özsezikli

https://doi.org/10.18614/deutip.1330102

Abstract

Vestibüler sistem (VS), başın yer çekimine göre hareketini algılayıp denge, otonomik fonksiyon, uzaysal algı ve oryantasyon üzerine düzenlemeler yaparak bireyin hayatta kalabilmesi için hayati görevler üstlenir. VS’nin intraüterin dönemde gelişmeye başlayan ilk sistem olmasının yanı sıra çocukluk dönemiyle birlikte gelişimine devam etmektedir. Başlangıç zamanı çeşitli faktörlere bağlı olarak değişmekle birlikte yaşlanmayla VS dejenere olduğu bilinmektedir. Literatürde duyusal vestibüler tüylü hücre sayısının doğumdan yaşlılığa her on yılda yaklaşık %6 oranında azaldığı da gösterilmiştir. Bunun yanı sıra vestibüler çekirdeklerdeki nöronlar, 40 ila 90 yaşları arasında her on yılda yaklaşık %3 oranında azaldığı da bilinmektedir. VS’deki yaşa bağlı bu değişiklikler yaşlı bireylerde baş dönmesi, denge kaybı, dengesiz yürüme, artan düşmeler ve hatta ajitasyona, yalnızlık ve özgüven kayıplarına neden olabilmektedir. Bunun yanı sıra literatürde vestibüler bozukluğa bağlı düşmelerin yaşlı yetişkinler arasında ölüm sebepleri arasında üçüncü ila onuncu önde gelen ölüm nedeni arasında olduğu da bildirilmektedir. Bu anlamda ülkelerin sağlık sistemlerinin sağlıklı yaşlanma eylem planlamalarında ve yaşa bağlı düşmeleri engelleyici stratejilerin geliştirilmesinde yaşa bağlı VS disfonksiyonlarının belirlenmesi oldukça önemlidir. Aynı zamanda özellikle geriatrik rehabilitasyon alanında çalışan fizyoterapistlerin muhtemel vestibüler rehabilitasyon programlarının oluşturulmasında VS’nin yaşa bağlı değişimlerini ve denge üzerine olan etkilerini iyi bilmeleri oldukça değerlidir. Vestibüler bozukluklar için vestibüler rehabilitasyona ek olarak uygulanan sanal gerçeklik uygulamalarının ümit vadettiği, yaşlı popülasyonda özellikle işitme problemlerinin gözden kaçırılmaması ve ihtiyaç halinde işitme cihazlarının reçete edilmesi gerektiğini düşünmekteyiz.

Keywords

geriatrik rehabilitasyon, postural denge, vestibüler disfonksiyon, vestibüler rehabilitasyon

Supporting Institution

Yoktur.

Project Number

Yoktur.

Thanks

Yoktur.

References

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Investigation of the Effects of Age-Related Changes in the Vestibular System on Balance: A Review

Year 2023, Volume: 37 Issue: 3, 309 - 321, 25.01.2024

Aygül Köseoğlu Mehmet Kaan Altunok Mustafa Oğuz Kethüdaoğlu Suzan Aydın Havva Ezgi Albayrak Hande Besna Göçen Bülent Abut Özsezikli

https://doi.org/10.18614/deutip.1330102

Abstract

The vestibular system (VS) undertakes vital tasks for the survival of the individual by perceiving the movement of the head according to gravity and adjusting on balance, autonomic function, spatial perception, and orientation. In addition to being the first system to develop in the intrauterine period, the VS continues to develop with childhood. Although the onset time varies depending on various factors, it is known that VS degenerates with aging. It has also been shown in the literature that the number of sensory vestibular hair cells decreases by approximately 6% per decade from birth to old age. In addition, neurons in the vestibular nuclei are known to decrease by about 3% per decade between the ages of 40 and 90. These age-related changes in VS may cause dizziness, loss of balance, unsteady gait, increased falls and even agitation, loneliness, and loss of self-confidence in elderly individuals. In addition, it is reported in the literature that falls due to vestibular disorder are among the third to tenth leading causes of death among older adults. In this sense, it is very important to determine age-related VS dysfunctions in the healthy aging action plans of the health systems of the countries and in the development of strategies to prevent age-related falls. At the same time, it is very valuable for physiotherapists working in the field of geriatric rehabilitation to know well the age-related changes of VS and its effects on balance in the creation of possible vestibular rehabilitation programs. We think that virtual reality applications applied in addition to vestibular rehabilitation for vestibular disorders are promising, especially hearing problems in the elderly population should not be overlooked and hearing aids should be prescribed if needed.

Keywords

geriatric rehabilitation, postural balance, vestibular dysfunction, vestibular rehabilitation

Project Number

Yoktur.

References

1. Sturnieks DL, St George R, Lord SR. Balance disorders in the elderly. Neurophysiologie Clinique/Clinical Neurophysiology. 2008;38(6):467-78.
2. Kristinsdottir EK, Jarnlo GB, Magnusson M. Asymmetric vestibular function in the elderly might be a significant contributor to hip fractures. Scandinavian journal of rehabilitation medicine. 2000;32(2):56-60.
3. Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2000;122(5):630-4.
4. Pothula VB, Chew F, Lesser TH, Sharma AK. Falls and vestibular impairment. Clinical otolaryngology and allied sciences. 2004;29(2):179-82.
5. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. Arch Intern Med. 2009;169(10):938-44.
6. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. Archives of internal medicine. 2009;169(10):938-44.
7. Lin HW, Bhattacharyya N. Balance disorders in the elderly: epidemiology and functional impact. The Laryngoscope. 2012;122(8):1858-61.
8. Bermúdez Rey MC, Clark TK, Wang W, Leeder T, Bian Y, Merfeld DM. Vestibular perceptual thresholds increase above the age of 40. Frontiers in neurology. 2016;7:162.
9. Fattal D, Hansen M, Fritzsch B. Aging‐related balance impairment and hearing loss. The Wiley handbook on the aging mind and brain. 2018:315-36.
10. Lewis ER, Leverenz EL, Bialek WS. Vertebrate inner ear: CRC-Press; 1985.
11. Majeed S, Farooqi S, Jamshed A. Vestibular Disorders and Their Impact on Balance and Mobility. Pakistan Journal of Medical & Health Sciences. 2023;17(03):686-.
12. Wolfe J, KLUENDER K, LEVI D, BARTOSHUK L, HERZ R, KLATZKY R, et al. Sensation and Perception (Sunderland, MA: Sinauer). 2006.
13. Goldberg JM, Wilson VJ, Cullen KE, Angelaki DE, Broussard DM, Buttner-Ennever J, et al. The vestibular system: a sixth sense: Oxford University Press, USA; 2012.
14. Nandi R, Luxon LM. Development and assessment of the vestibular system. Int J Audiol. 2008;47(9):566-77.
15. Ornitz EM, Atwell CW, Walter DO, Hartmann EE, Kaplan AR. The maturation of vestibular nystagmus in infancy and childhood. Acta Oto-Laryngologica. 1979;88(1-6):244-56.
16. Jones SM, Jones TA, Mills KN, Gaines GC. Anatomical and Physiological Considerations in Vestibular Dysfunction and Compensation. Seminars in hearing. 2009;30(4):231-41.
17. Tian J-R, Shubayev I, Baloh RW, Demer JL. Impairments in the initial horizontal vestibulo-ocular reflex of older humans. Experimental brain research. 2001;137:309-22.
18. Minor LB. Gentamicin-induced bilateral vestibular hypofunction. Jama. 1998;279(7):541-4.
19. McCall AA, Miller DM, Yates BJ. Descending influences on vestibulospinal and vestibulosympathetic reflexes. Frontiers in neurology. 2017;8:112.
20. Murray AJ, Croce K, Belton T, Akay T, Jessell TM. Balance control mediated by vestibular circuits directing limb extension or antagonist muscle co-activation. Cell reports. 2018;22(5):1325-38.
21. Mohl JT, Pearson JM, Groh JM. Monkeys and humans implement causal inference to simultaneously localize auditory and visual stimuli. Journal of Neurophysiology. 2020;124(3):715-27.
22. Agrawal Y, Smith PF, Rosenberg PB. Vestibular impairment, cognitive decline and Alzheimer’s disease: balancing the evidence. Aging & mental health. 2020;24(5):705-8.
23. Gassmann KG, Rupprecht R. Dizziness in an older community dwelling population: a multifactorial syndrome. The journal of nutrition, health & aging. 2009;13(3):278-82.
24. Barin K, Dodson EE. Dizziness in the elderly. Otolaryngologic clinics of North America. 2011;44(2):437-54, x.
25. Boult C, Murphy J, Sloane P, Mor V, Drone C. The relation of dizziness to functional decline. Journal of the American Geriatrics Society. 1991;39(9):858-61.
26. Redfern MS, Jennings JR, Martin C, Furman JM. Attention influences sensory integration for postural control in older adults. Gait & posture. 2001;14(3):211-6.
27. Westlake KP, Culham EG. Sensory-Specific Balance Training in Older Adults: Effect on Proprioceptive Reintegration and Cognitive Demands. Physical therapy. 2007;87(10):1274-83.
28. Adkin AL, Frank JS, Carpenter MG, Peysar GW. Fear of falling modifies anticipatory postural control. Experimental brain research. 2002;143(2):160-70.
29. Hadjistavropoulos T, Carleton RN, Delbaere K, Barden J, Zwakhalen S, Fitzgerald B, et al. The relationship of fear of falling and balance confidence with balance and dual tasking performance. Psychology and aging. 2012;27(1):1-13.
30. Wetmore SJ, Eibling DE, Goebel JA, Gottshall KR, Hoffer ME, Magnusson M, et al. Challenges and opportunities in managing the dizzy older adult. Otolaryngology--Head and Neck Surgery. 2011;144(5):651-6.
31. Rauch SD, VELAZQUEZ‐VILLASEÑOR L, Dimitri PS, Merchant SN. Decreasing hair cell counts in aging humans. Annals of the New York Academy of Sciences. 2001;942(1):220-7.
32. Alvarez JC, Díaz C, Suárez C, Fernández JA, González del Rey C, Navarro A, et al. Aging and the human vestibular nuclei: morphometric analysis. Mechanisms of ageing and development. 2000;114(3):149-72.
33. Kevetter GA, Leonard RB. Decreased expression of calretinin and calbindin in the labyrinth of old gerbils. Brain research. 2002;957(2):362-5.
34. Taylor RR, Jagger DJ, Saeed SR, Axon P, Donnelly N, Tysome J, et al. Characterizing human vestibular sensory epithelia for experimental studies: new hair bundles on old tissue and implications for therapeutic interventions in ageing. Neurobiology of aging. 2015;36(6):2068-84.
35. Maes L, Dhooge I, D'Haenens W, Bockstael A, Keppler H, Philips B, et al. The effect of age on the sinusoidal harmonic acceleration test, pseudorandom rotation test, velocity step test, caloric test, and vestibular-evoked myogenic potential test. Ear and hearing. 2010;31(1):84-94.
36. Agrawal Y, Zuniga MG, Davalos-Bichara M, Schubert MC, Walston JD, Hughes J, et al. Decline in semicircular canal and otolith function with age. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2012;33(5):832-9.
37. Wan G, Ji L, Schrepfer T, Gong S, Wang GP, Corfas G. Synaptopathy as a Mechanism for Age-Related Vestibular Dysfunction in Mice. Frontiers in aging neuroscience. 2019;11:156.
38. Tighilet B, Bordiga P, Cassel R, Chabbert C. Peripheral vestibular plasticity vs central compensation: evidence and questions. Journal of neurology. 2019;266:27-32.
39. Deems DA, Deems RO, O’Malley Jr BW. Managing challenges in an aging vestibular system: Rehabilitation strategies normalize balance function in a cohort of patients up to 99 years. Ear, Nose & Throat Journal. 2019;98(1):37-43.
40. Mancini M, Salarian A, Carlson-Kuhta P, Zampieri C, King L, Chiari L, et al. ISway: a sensitive, valid and reliable measure of postural control. Journal of neuroengineering and rehabilitation. 2012;9:59.
41. MacKinnon CD. Sensorimotor anatomy of gait, balance, and falls. Handbook of clinical neurology. 2018;159:3-26.
42. Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age and ageing. 2006;35 Suppl 2:ii7-ii11.
43. Westlake KP, Johnson BP, Creath RA, Neff RM, Rogers MW. Influence of non-spatial working memory demands on reach-grasp responses to loss of balance: Effects of age and fall risk. Gait & posture. 2016;45:51-5.
44. Horak FB, Wrisley DM, Frank J. The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits. Physical therapy. 2009;89(5):484-98.
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Details

Primary Language	English
Subjects	Geriatrics and Gerontology, Otorhinolaryngology, Rehabilitation
Journal Section	Reviews
Authors	Aygül Köseoğlu 0000-0001-7180-3693 Mehmet Kaan Altunok 0000-0002-3851-0685 Mustafa Oğuz Kethüdaoğlu 0000-0001-9723-9680 Suzan Aydın 0000-0002-8470-9425 Havva Ezgi Albayrak 0000-0002-4595-2043 Hande Besna Göçen 0000-0002-4208-0366 Bülent Abut Özsezikli 0000-0003-0805-8146
Project Number	Yoktur.
Publication Date	January 25, 2024
Submission Date	July 21, 2023
Published in Issue	Year 2023 Volume: 37 Issue: 3

Cite

Vancouver	Köseoğlu A, Altunok MK, Kethüdaoğlu MO, Aydın S, Albayrak HE, Göçen HB, Özsezikli BA. Investigation of the Effects of Age-Related Changes in the Vestibular System on Balance: A Review. J DEU Med. 2024;37(3):309-21.

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