Skip to main content
SpringerLink
Log in

Understanding the Experience of Age-Related Vestibular Loss in Older Individuals: A Qualitative Study

The Patient - Patient-Centered Outcomes Research Aims and scope Submit manuscript

Cite this article

Abstract

Background

Inner ear balance (or vestibular) function declines with age and is associated with decreased mobility and an increased risk of falls in older individuals. We sought to understand the lived experience of older adults with vestibular loss in order to improve care in this population.

Methods

Qualitative data were derived from semi-structured interviews of individuals aged 65 years or older presenting to the Balance and Falls Prevention Clinic from February 1, 2014 to March 30, 2015 for evaluation of age-related vestibular loss. Transcripts were analyzed using interpretive phenomenological analysis. We created a taxonomy of overarching superordinate themes based on the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) Framework, and classified key dimensions within each of these themes.

Results

Sixteen interviews were conducted with individuals (mean age 76.0 years, 75 % female) with age-related vestibular loss. The three superordinate themes and associated key dimensions were (1) body impairment (including depression, fatigue, fear/anxiety, and problems with concentrating and memory); (2) activity limitation and participation restriction (isolation, needing to stop in the middle of activities, reduced participation relative to expectations, reduced ability to drive or travel, and problems with bending/looking up, standing, and walking); and (3) environmental influences (needing help with daily activities). All participants reported difficulty walking.

Conclusions

Older adults report that vestibular loss impacts their body functioning and restricts their participation in activities. The specific key dimensions uncovered by this qualitative study can be used to evaluate care from the patient’s perspective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. 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. doi:10.1001/archinternmed.2009.66.

    Article  PubMed  Google Scholar 

  2. Ishiyama G. Imbalance and vertigo: the aging human vestibular periphery. Sem Neurol. 2009;29(5):491–9. doi:10.1055/s-0029-1241039.

    Article  Google Scholar 

  3. Iwasaki S, Yamasoba T. Dizziness and imbalance in the elderly: age-related decline in the vestibular system. Aging Dis. 2015;6(1):38–47. doi:10.14336/ad.2014.0128.

    Article  PubMed  Google Scholar 

  4. Jonsson R, Sixt E, Landahl S, Rosenhall U. Prevalence of dizziness and vertigo in an urban elderly population. J Vestib Res. 2004;14(1):47–52.

    PubMed  Google Scholar 

  5. Agrawal Y, Davalos-Bichara M, Zuniga MG, Carey JP. Head impulse test abnormalities and influence on gait speed and falls in older individuals. Otol Neurotol. 2013;34(9):1729–35. doi:10.1097/MAO.0b013e318295313c.

    Article  PubMed  Google Scholar 

  6. Layman AJ, Li C, Simonsick E, Ferrucci L, Carey JP, Agrawal Y. Association between saccular function and gait speed: data from the Baltimore Longitudinal Study of Aging. Otol Neurotol. 2015;36(2):260–6. doi:10.1097/mao.0000000000000544.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Marchetti GF, Whitney SL, Blatt PJ, Morris LO, Vance JM. Temporal and spatial characteristics of gait during performance of the Dynamic Gait Index in people with and people without balance or vestibular disorders. Phys Ther. 2008;88(5):640–51. doi:10.2522/ptj.20070130.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Herdman SJ, Blatt P, Schubert MC, Tusa RJ. Falls in patients with vestibular deficits. Am J Otol. 2000;21(6):847–51.

    CAS  PubMed  Google Scholar 

  9. Whitney SL, Hudak MT, Marchetti GF. The dynamic gait index relates to self-reported fall history in individuals with vestibular dysfunction. J Vestib Res. 2000;10(2):99–105.

    CAS  PubMed  Google Scholar 

  10. Honrubia V, Bell TS, Harris MR, Baloh RW, Fisher LM. Quantitative evaluation of dizziness characteristics and impact on quality of life. Am J Otol. 1996;17(4):595–602.

    CAS  PubMed  Google Scholar 

  11. Li C, Layman AJ, Carey JP, Agrawal Y. Epidemiology of vestibular evoked myogenic potentials: data from the baltimore longitudinal study of aging. Clin Neurophysiol. 2015. doi:10.1016/j.clinph.2015.01.008.

    Google Scholar 

  12. Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngol Head Neck Surg. 2000;122(5):630–4.

    CAS  PubMed  Google Scholar 

  13. Schrack JA, Zipunnikov V, Goldsmith J, Bai J, Simonsick EM, Crainiceanu C, et al. Assessing the “physical cliff”: detailed quantification of age-related differences in daily patterns of physical activity. J Gerontol A Biol Sci Med Sci. 2014;69(8):973–9. doi:10.1093/gerona/glt199.

    Article  PubMed  Google Scholar 

  14. Clark J. How to peer review a qualitative manuscript. Peer Rev Health Sci. 2003;2:219–35.

    Google Scholar 

  15. Halmagyi GM, Yavor RA, McGarvie LA. Testing the vestibulo-ocular reflex. Adv Otorhinolaryngol. 1997;53:132–54.

    CAS  PubMed  Google Scholar 

  16. Rosengren SM, Welgampola MS, Colebatch JG. Vestibular evoked myogenic potentials: past, present and future. Clin Neurophysiol. 2010;121(5):636–51. doi:10.1016/j.clinph.2009.10.016.

    Article  CAS  PubMed  Google Scholar 

  17. Nguyen KD, Welgampola MS, Carey JP. Test-retest reliability and age-related characteristics of the ocular and cervical vestibular evoked myogenic potential tests. Otol Neurotol. 2010;31(5):793–802. doi:10.1097/MAO.0b013e3181e3d60e.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, et al. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010;25(10):1229–45. doi:10.1080/08870440903194015.

    Article  PubMed  Google Scholar 

  19. Maura D. ATLAS.ti (Software). The SAGE encyclopedia of qualitative research methods. CA: SAGE Publications, Inc. p. 37–38.

  20. Larkin M, Watts S, Clifton E. Giving voice and making sense in interpretative phenomenological analysis. Qual Res Psychol. 2006;3(2):102–20.

    Article  Google Scholar 

  21. Smith JA. Qualitative psychology: a practical guide to research methods. Thousand Oaks: SAGE Publications; 2007.

  22. Smith JA, Flowers P, Larkin M. Interpretative phenomenological analysis: theory method and research. Thousand Oaks: SAGE Publications; 2009.

    Google Scholar 

  23. Ustun TB, Chatterji S, Bickenbach J, Kostanjsek N, Schneider M. The international classification of functioning, disability and health: a new tool for understanding disability and health. Disabil Rehabil. 2003;25(11–12):565–71. doi:10.1080/0963828031000137063.

    Article  CAS  PubMed  Google Scholar 

  24. Grill E, Bronstein A, Furman J, Zee DS, Muller M. International Classification of Functioning, Disability and Health (ICF) Core Set for patients with vertigo, dizziness and balance disorders. J Vestib Res. 2012;22(5–6):261–71. doi:10.3233/VES-120459.

    PubMed  Google Scholar 

  25. Obermann M, Bock E, Sabev N, Lehmann N, Weber R, Gerwig M, et al. Long-term outcome of vertigo and dizziness associated disorders following treatment in specialized tertiary care: the Dizziness and Vertigo Registry (DiVeR) Study. J Neurol. 2015. doi:10.1007/s00415-015-7803-7.

    PubMed  Google Scholar 

  26. Ward BK, Agrawal Y, Hoffman HJ, Carey JP, Della Santina CC. Prevalence and impact of bilateral vestibular hypofunction: results from the 2008 US National Health Interview Survey. JAMA Otolaryngol Head Neck Surg. 2013;139(8):803–10. doi:10.1001/jamaoto.2013.3913.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Killington MJ, Speck K, Kahlbaum J, Fabian J, Edwards D, Stobie J. Quality-of-life for individuals with a vestibular impairment following an acquired brain injury (ABI); the clients’ perspective. Brain Inj. 2015;29(4):490–500. doi:10.3109/02699052.2014.995226.

    Article  CAS  PubMed  Google Scholar 

  28. Kirby SE, Yardley L. Physical and psychological triggers for attacks in Meniere’s disease: the patient perspective. Psychother Psychosom. 2012;81(6):396–8. doi:10.1159/000337114.

    Article  PubMed  Google Scholar 

  29. Morris AE, Lutman ME, Yardley L. Measuring outcome from vestibular rehabilitation, part I: qualitative development of a new self-report measure. Int J Audiol. 2008;47(4):169–77. doi:10.1080/14992020701843129.

    Article  PubMed  Google Scholar 

  30. Yardley L. Vertigo and dizziness. London: Routledge; 1994.

    Google Scholar 

  31. Brandt T, Schautzer F, Hamilton DA, Bruning R, Markowitsch HJ, Kalla R, et al. Vestibular loss causes hippocampal atrophy and impaired spatial memory in humans. Brain. 2005;128(Pt 11):2732–41. doi:10.1093/brain/awh617.

    Article  PubMed  Google Scholar 

  32. Hartmann M, Farkas R, Mast FW. Self-motion perception influences number processing: evidence from a parity task. Cogn Process. 2012;13(Suppl 1):S189–92. doi:10.1007/s10339-012-0484-6.

    Article  PubMed  Google Scholar 

  33. Loetscher T, Schwarz U, Schubiger M, Brugger P. Head turns bias the brain’s internal random generator. Curr Biol. 2008;18(2):R60–2. doi:10.1016/j.cub.2007.11.015.

    Article  CAS  PubMed  Google Scholar 

Download references

Author contributions

A. Harun contributed to the study design, data acquisition, data analysis and interpretation, and drafting of the manuscript. C. Li contributed to the study design, data acquisition, data analysis, and drafting of the manuscript. J. Bridges contributed to study design and critical revision of the manuscript. Y. Agrawal contributed to study design, data analysis, and critical revision of the manuscript. Y. Agrawal had full access to all of the study data and takes responsibility for the integrity of the data and accuracy of the data analysis.

Author information

Authors and Affiliations

  1. The Johns Hopkins Department of Otolaryngology-Head and Neck Surgery, 601 N. Caroline St Suite 6210, Baltimore, MD, 21287, USA

    Aisha Harun, Carol Li & Yuri Agrawal

  2. The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    John F. P. Bridges

Authors
  1. Aisha Harun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carol Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John F. P. Bridges
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuri Agrawal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aisha Harun.

Ethics declarations

Aisha Harun was funded by a T32 Award (5T32DC000027-25). Yuri Agrawal was funded by a NIH K23 Award (5K23DC013056-02). Aisha Harun, Carol Li, John F. P. Bridges, and Yuri Agrawal have no conflicts of interest to report. The hospital institutional review board approved this study (Baltimore, MD: study number CR00007456) and the study was performed in accordance with the ethical standards of the Declaration of Helsinki. Informed consent was obtained from all individuals who participated in the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 21 kb)

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harun, A., Li, C., Bridges, J.F.P. et al. Understanding the Experience of Age-Related Vestibular Loss in Older Individuals: A Qualitative Study. Patient 9, 303–309 (2016). https://doi.org/10.1007/s40271-015-0156-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40271-015-0156-6

Keywords

search

Navigation