More than a third of U.S. adults older than age 40 years have some form of vestibular dysfunction, but many don’t know it. These asymptomatic people were three times more likely to fall than those with no impairment; those who reported such symptoms as dizziness had a 12-fold higher risk, according to researchers at The Johns Hopkins School of Medicine (JHSM) in Baltimore.

The team analyzed data on 5,086 individuals from the 2001-2004 National Health and Nutrition Examination Surveys. Outcomes were measured with the modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces (Arch Intern Med. 2009;169:938-944).

Overall, 35.4% had vestibular dysfunction. Within this group, almost half (49.4%) reported at least one episode of dizziness, but 31.8% reported no such incidents. Prevalence rose steadily with age, from 18.5% (ages 40-49 years) to 49.4% (60-69 years), culminating with 84.8% (age 80 years and older).

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Education was another significant factor. People who did not finish 12th grade had a sharply higher prevalence than those whose education went beyond high school (50.9% vs. 28.6%). A history of diabetes or hypertension was also associated with higher rates (53.6% vs. 33.2% and 44.6% vs. 27.9%), respectively.

Vestibular dysfunction is diffi-cult to diagnose. Dizziness and dysequilibrium may be tied to “deficits in vision, proprioception, and musculoskeletal, autonomic, and vestibular function.” And tests, such as electronystagmography, caloric reflex test, and assessment of postural function, are complex.

Nonetheless, “our survey shows that balance testing needs to be part of basic primary care,” the authors report. “All clinicians need to monitor and screen their patients for vestibular dysfunction so that we can take preventive measures to guard against falling.”