Deems Daniel A, Deems Rhonda O, O'Malley Bert W
1 Department of Clinical Sciences, Florida State University School of Medicine, Regional Medical School Campus, Sarasota, FL, USA.
2 University Health Park Medical Campus, Bldg 2, Sarasota, FL, USA.
Ear Nose Throat J. 2019 Jan;98(1):37-43. doi: 10.1177/0145561318824541. Epub 2019 Jan 30.
Imbalance is a major health problem affecting 90 million Americans and is the primary risk factor in falls, which consume $50 billion annually in medical costs (US). A person is often unaware of their balance challenge and its potential impact on fall risk and subsequent injury. Even when balance deficits and fall risk are realized, older patients may not pursue intervention for their disorder due to a fatalistic view of their advanced age. In this retrospective study, a cohort of older patients who had completed a course of vestibular rehabilitation therapy was studied for extent of recovery using computerized dynamic posturography (CDP) as the outcomes measure. The study group was comprised of sequential outpatients from a community-based balance treatment facility for whom pre- and posttherapy CDPs were available for analyses (N = 76). Patients had been referred for imbalance, vertigo, unsteadiness, and falls-age range 66 to 99 years (mean 80.5 years). Balance function, measured by composite sensory organization test (SOT) CDP scores, improved on average 35% ( P < .0001). Average posttherapy SOT score was 72.8, equivalent to the oldest SOT normative scores available (70 to 79 year age bracket; SOT Norm = 72.9). A subset 10 years above this eldest norm, mean age 89.4 years (N = 25, range 85 to 99 years), was then analyzed. Results revealed an improvement in balance function of 42.1% ( P < .0001), with average posttherapy SOT score of 74.2. Data confirm that vestibular therapy programs can significantly recover, if not normalize imbalance even to age 99. Given that the eldest participants were well above average life expectancy in the United States (78.9 years), this study could be used by allied health professionals to encourage older patients to engage in balance and falls prevention programs.
平衡失调是一个影响9000万美国人的主要健康问题，也是跌倒的主要风险因素，在美国每年的医疗费用高达500亿美元。一个人往往意识不到自己的平衡挑战及其对跌倒风险和后续伤害的潜在影响。即使意识到平衡缺陷和跌倒风险，老年患者可能由于对高龄的宿命论观点而不寻求针对其病症的干预。在这项回顾性研究中，对一组完成了前庭康复治疗疗程的老年患者进行研究，使用计算机动态姿势描记法（CDP）作为结果指标来评估恢复程度。研究组由来自社区平衡治疗机构的连续门诊患者组成，他们有治疗前和治疗后的CDP数据可供分析（N = 76）。患者因平衡失调、眩晕、不稳和跌倒前来就诊，年龄范围为66至99岁（平均80.5岁）。通过综合感觉组织测试（SOT）CDP分数衡量的平衡功能平均改善了35%（P < .0001）。治疗后的平均SOT分数为72.8，与现有的最老SOT正常分数（70至79岁年龄组；SOT标准 = 72.9）相当。然后分析了一个比这个最老标准大10岁的子集，平均年龄89.4岁（N = 25，范围85至99岁）。结果显示平衡功能改善了42.1%（P < .0001），治疗后的平均SOT分数为74.2。数据证实，前庭治疗方案即使不能使平衡失调恢复正常，也能显著改善，甚至到99岁。鉴于最年长的参与者远高于美国的平均预期寿命（78.9岁），这项研究可供健康专业人员用来鼓励老年患者参与平衡和跌倒预防计划。
