Vestibular Loss in Older Patients Significantly Decreases Quality of Life

by Samara E. Kuehne •

What is the quality of life (QoL) burden of vestibular loss in older individuals?

Bottom line
Loss of vestibular function with aging significantly decreases QoL across multiple domains of well-being, and these reductions in well-being are also responsible for heavy societal economic burdens.

Background: The vestibular system is integral to balance control, locomotion, and spatial navigation. Loss of vestibular function can be a debilitating condition that causes imbalance, unsteady vision, and a 12-fold increased risk of falls and fall-associated morbidity. Vestibular function declines with age and older individuals are disproportionately affected by vestibular loss. The increased prevalence of vestibular loss in the older population has potentially substantial economic and societal consequences.

Despite the greater prevalence of vestibular loss in older adults and its associated functional limitations, the quality of life (QoL) burden of vestibular loss in this vulnerable population has not been well studied. The few studies that have reported QoL outcomes considered the broader symptom of dizziness rather than specifically vestibular physiologic impairment, did not have a normative-age-matched comparison group available, or were conducted across a broad age range including younger age groups.

Study design: Prospective, case-controlled.

Setting: Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore.

Synopsis: A convenience sample of 27 patients aged 60 or older with vestibular physiologic loss was recruited from an academic neurotology clinic. The patients did not have any identifiable cause of their vestibular loss other than aging. The convenience sample was compared with an age-matched cross-sectional sample of the general U.S. population (n = 1,266). The main outcome was QoL measured by the Ontario Health Utilities Index Mark III (HUI3).

Compared with the general population, patients with vestibular loss had significantly lower overall unadjusted HUI3 scores (−0.32, p < 0.001). Multivariate regression analysis showed vestibular loss was significantly associated with poorer performance in vision (−0.11 p < 0.0001), speech (−0.15, p < 0.0001), dexterity (−0.13, p < 0.0001), and emotion (−0.07, p = 0.0065). Adjusted aggregate HUI3 was also significantly lower for vestibular loss (−0.15, p = 0.0105). These QoL decrements resulted in an average loss of 1.30 quality-adjusted life Years (QALYs).

When using a $50,000/QALY willingness-to-pay threshold, vestibular loss was associated with a $64,929 lifetime economic burden per affected older adult, resulting in a total lifetime societal burden of $227 billion for the U.S. population aged 60 and older.

Citation: Agrawal Y, Pineault KG, Semenov YR. Health-related quality of life and economic burden of vestibular loss in older adults. Laryngoscope Inv Otol. 2018. [Published online ahead of print December 15, 2017. doi: 10.1002/lio2.129].