BALTIMORE, May 25, 2009 (ASCRIBE NEWS via COMTEX) -- A full third of American
adults, 69 million men and women over age 40, are up to 12 times more likely to
have a serious fall because they have some form of inner-ear dysfunction that
throws them off balance and makes them dizzy, according to Johns Hopkins
experts.
Among the other key findings of the three-year survey and study on the subject
by the Johns Hopkins team are that a third of this group, or more than 22
million, were unaware of their vulnerability, having had no previous incidents
of disequilibrium or sudden falls to suggest that anything was wrong.
In the survey, to be published in the Archives of Internal Medicine online May
25, these asymptomatic people were three times more likely to suffer a
potentially fatal fall than people with a healthy sense of balance, whereas
people already experiencing symptoms of imbalance had a 12-fold increase in
risk.
Accidental falls are among the leading causes of death in the elderly, killing
an estimated 13,000 seniors each year in the United States and resulting in more
than one and a half million visits to hospital emergency rooms, experts say.
"Vestibular imbalances need to be taken seriously because falls can be fatal and
injuries can be painful, lead to long hospital stays and result in significant
loss in quality of life," says Lloyd B. Minor, M.D., the Andelot Professor and
director of otolaryngology - head and neck surgery at the Johns Hopkins
University School of Medicine. Minor says that recent government reports
estimate that fatal falls in the elderly cost the U.S. Medicare program nearly
$1 billion in hospital charges, and those injured with broken bones cost an
additional $19 billion.
More than 5,000 men and women over age 40 participated in the survey, which took
three years to complete and involved specialized exams and balance testing to
find out who had vestibular dysfunction, its early signs and symptoms, and who
did not.
And the chance of having a balance problem, survey results showed, increases
with age and diabetes. Eighty-five percent of men and women over age 80 had an
imbalance problem, 23 times more than people in their 40s. And people with
diabetes were 70 percent more likely to suffer from vestibular problems.
Researchers say this is likely due to damage done by high blood sugar levels to
the hair cells in the inner ear that facilitate balance control and to the
long-term damage from diabetes to the inner ear's small blood vessels.
"Our survey shows that balance testing needs to be part of basic primary care,
and that all physicians need to be monitoring and screening their patients for
vestibular dysfunction so that we can take preventive measures to guard against
falling," says Minor.
Lead study investigator Yuri Agrawal, M.D., says one reason for the large
numbers of undiagnosed and untreated individuals is that balance testing
requires specialized training and the tests take more time and effort to perform
than other diagnostic or screening procedures.
As part of the new survey, study participants were subjected to a half dozen key
tests of unsteadiness, including physical exams.
Balance function was assessed by subjects' ability to stand upright with and
without visual cues, such as being able to stand upright while wearing a
blindfold or with their eyes closed, or by not having to use their arms to
maintain balance while standing on a foam-padded mat.
"Now that we have identified the magnitude of balance problems, primary care
physicians are more likely to be on the look out for its early signs and
symptoms, and more attuned to when a patient needs to be referred to a physical
therapist," Agrawal says.
Minor points out that physical rehabilitation exercises can aid people with
vestibular dysfunction. Balancing and walking exercises can be used to train the
brain to compensate for inner-ear deficits and episodes of dizziness. One such
exercise has unsteady people practice standing on one leg, while resting the
other leg on a Styrofoam cup and trying not to crush it. Another exercise has
people turning their head while walking.
Minor adds that people with vestibular dysfunction can take preventive steps to
avoid falls in their homes, such as installing guard rails along stairs or
hallways where a fall might occur, making sure rooms are well lit, and removing
carpeting in places where people are more prone to trip.
Agrawal says the team's next steps are to evaluate screening tools for
identifying as early as possible which people are at a heightened risk of
falling. She also says other risk factors, such as sleep patterns and nutrient
deficiencies, which may play a role in predicting risk of falling, need further
study. Various rehabilitation techniques should also be examined to pinpoint
which techniques work best at preventing falls and, ultimately, to allow people
to live longer and healthier lives.
Funding for this study was provided in part by The Johns Hopkins Hospital.
However, the National Health and Nutrition Examination Surveys are funded
directly by the National Institutes of Health.
In addition to Minor and Agrawal, other researchers involved in this research,
conducted solely at Hopkins, were John Carey, M.D.; Charles Della Santina, M.D.,
Ph.D.; and Michael Schubert, Ph.D., P.T.
For additional information, please go to: The Johns Hopkins Center for Hearing
and Balance
http://ww2.jhu.edu/chb
Video clips of Minor and Agrawal commenting about the study plus clips of
Schubert with a patient with vestibular dysfunction demonstrating some
specialized balance tests can be found online May 26 at
http://www.hopkinsmedicine.org .
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