Multisensory Imbalance and Presbystasis

Abstract

Presbystasis, akin to presbycusis (age-related hearing loss) and presbyopia (age-related vision loss), is simply age-related loss of balance function. As the US population ages (the first baby boomers turned 65 in 2011), dizziness in the elderly is becoming an increasingly common complaint seen in primary care and specialty clinics. Dizziness and imbalance can have profound effects on quality of life in the elderly – affecting cognitive function, mobility, independence, and overall general health (Popp et al., J Neurol 264(3):554–63, 2017; Mueller et al., Qual Life Res 23(8):2301–8, 2014;Mueller et al., Eur J Pub Health 24(5):802–7, 2014; Kannus et al., JAMA 281(20):1895–9, 1999; Ciorba et al. Eur Arch Otorhinolaryngol 274(3):1245–50, 2017). The magnitude of the problem cannot be underestimated, as some geriatricians have designated dizziness a “geriatric syndrome,” a term used to capture and highlight those unique clinical conditions prevalent in older persons, such as falls, delirium, incontinence, and frailty that do not fit into discrete disease categories (Inouye, J Am Geriatr Soc 55:780–91, 2007). A geriatric syndrome, then, encompasses “multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems (e.g., vision, vestibular, and proprioceptive) render (an older) person vulnerable to situational challenges” (Tinetti et al., JAMA 273(17):1348–53, 1995). One population-based, community cross-sectional study of 1087 persons at least 72 years of age reported a dizziness prevalence rate of 24%, with 56% of persons reporting multiple “dizzy” sensations, and 74% identifying triggering activities, including anxiety, depressive symptoms, impaired hearing, five or more medications, postural hypotension, impaired balance, and past myocardial infarction (Tinetti et al., Ann Intern Med 132(5):337–44, 2000; Kao et al., J Am Geriatr Soc 49(1):72–5, 2001). This chapter discusses the evaluation and management of the elderly patient with disequilibrium, imbalance, and/or dizziness. This chapter reviews demographic data surrounding dizziness in the elderly, discusses the physiological effects of aging on each of the components of the balance sytem - vestibular, viusal, and proprioceptive - and outlines the evaluation and management of the elderly patient complaining of dizziness.