March 15, 2021
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Balance disorders linked to increased risk for death

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Poor balance function was linked to an increased risk for death from all causes, CVD and cancer in adults aged 40 years and older, according to research published in JAMA Otolaryngology – Head & Neck Surgery.

“Dizziness and imbalance are common among U.S. adults and increases the risk of serious injuries,” Chao Cao, MPH, a PhD student in the Movement Science Program at the Washington University School of Medicine in St. Louis, told Healio Primary Care. “However, research related to balance overwhelmingly focuses on older adults; therefore, the evidence on the prospective relationship between balance function and long-term health outcomes in adults of different age group is limited.”

Risk for mortality among adults with balance disorders
Reference: Cao C, et al. JAMA Otolaryngol Head Neck Surg. 2021;doi:10.1001/jamaoto.2021.0057.

He said the study, “for the first time, found that overall and sensory-specific balance disorders — visual, proprioceptive, and vestibular — were associated with higher mortality risks driven by cancer and CVD death among U.S. middle-aged and older adults.”

Cao and colleagues conducted a prospective, population-based cohort study of a nationally representative sample of adults who participated in the U.S. National Health and Nutritional Examination Survey from 1999 to 2004. The researchers linked mortality data to participants through 2015.

Photo of Chao Cao
Chao Cao

A total of 5,816 adults aged 40 years or older who had completed a modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces were included in the study, with 2,509 adults identified as having a balance disorder at baseline. During follow up, 1,530 deaths occurred.

Balance disorders were identified in 18.2% of those aged 40 to 49 years, 33.5% of those aged 50 to 64 years, and 61.9% of those aged 65 years or older.

After adjusting for sociodemographic characteristics, lifestyle factors and chronic conditions, Cao and colleagues determined that those with balance disorders had an elevated risk for all-cause mortality (HR = 1.44; 95% CI, 1.23-1.69), CVD mortality (HR = 1.65; 95% CI, 1.17-2.31) and cancer mortality (HR = 1.37; 95% CI, 1.03-1.83).

They also found greater risks for death from accidents (HR = 2.32; 95% CI; 0.54-10) and other causes (HR = 1.17; 95% CI, 0.89-1.54) in those with balance disorders.

The researchers noted that these findings remained similar after excluding those with a history of CVD or cancer at baseline.

Cao and colleagues also found that vestibular balance disorder was associated with an increased risk for all-cause mortality (HR = 1.31; 95% CI, 1.08-1.58), CVD mortality (HR = 1.59; 95% CI, 1.12-2.27) and cancer mortality (HR = 1.39; 95% CI, 1.04-1.86).

“Herein, our findings suggested that balance function can be an indicator/marker of long-term health outcomes and mortality risks,” Cao said. “The screening of sensory-specific balance function should be implemented in not only older adults but also middle-aged adults and individuals with high risks of balance disorders, such as patients with chronic diseases.”

He added that physicians may potentially need to consider patients’ metabolic system during multifactorial assessments and the management of these disorders.

Cao said that patients with balance disorders or dizziness can be treated by primary care physicians, ear, nose and throat specialists, or a physician specializing in the brain and nervous system.

“The balance function may be improved through rehabilitation directed by specialized physical therapists,” he said. “Currently, long-term deficits in balance function may be without a cure but interventions are available to manage and potentially improve balance function through a multicomponent exercise program and/or holistic exercise (eg tai chi).”