PP1407 - Common Fall Risk Factors Among Older Deaf Adults

Abstract:
This study investigates common fall risk factors among older Deaf adults, recognizing fall as the leading cause of injury and death in seniors. Both psychogenic (e.g., anxiety, depression) and physiological factors (e.g., vestibular impairments) contribute to heightened risk. Methods include self-report measures like the Fall Risk Questionnaire (FRQ), Dizziness Handicap Inventory (DHI), Activities-specific Balance Confidence scale (ABC), and PROMIS-Deaf anxiety/depression subscales, alongside vestibular and balance assessments (e.g., vHIT, cVEMPs, TUG). Preliminary data from 14 participants (aged 51-88) indicate that 20% exhibit significant risk factors such as prolonged TUG times and recent fall history. Data collection is ongoing.

Summary:
Introduction
This study aims to identify common fall risk factors among older Deaf adults. Fall is the leading cause of injury and death in older populations (CDC 2022). Severe hearing loss and vestibular impairment increase fall risk (Tamaki, 2024).  Fall risk factors include both psychogenic (e.g., anxiety, depression) and physiological components associated with dizziness and balance difficulties (Axer, 2020).

Increased fall risks are identified in patients with vestibular abnormalities, such as abnormal head-impulse test (HIT; Agrawal et al. 2013) and vestibular-evoked myogenic potentials (VEMP; Choi et al. 2024). Postural instability (Johansson et al. 2019), timed-up-and-go (TUG) time >10.5 sec (Demirci et al, 2021), and < 10.5 sits on 30-second sit-to-stand tests (Vereek, 2007) are also associated with increased risk of unintentional falls. 

Additional risk factors include a recent history of a fall, polypharmacy, anxiety and depression, diminished confidence in getting around, as well as peripheral neuropathy (Rubenstein, et al. 2017).

We administered questionnaires and vestibular and balance tests to identify common fall risk factors among older Deaf adults. Knowledge of common risk factors will enable clinicians to efficiently identify Deaf adults who are at especially high risk of falling.

Methods
Community-dwelling Deaf adults 50 years and older were recruited. The participants completed online questionnaires and assessments of vestibular and balance functions. 

Self-report measures
Participants completed the following questionnaires: Fall Risk Questionnaire (FRQ), a 12-item questionnaire included in the CDC’s Live Independently brochure, probing an individual's fall risk factors; Dizziness Handicap Inventory (DHI), a 25-item questionnaire assessing the impact of dizziness on an individual’s life (higher score = greater handicap); Activities-specific Balance Confidence scale (ABC), a 16-item questionnaire assessing an individual's balance confidence (higher percentage = more balance confidence); and PROMIS-Deaf anxiety and depression subscales (Kushalnagar et al. 2020). 

Vestibular and balance assessments
The vestibuloocular reflex was assessed with the sinusoidal harmonic acceleration (SHA) test at 0.64 Hz (Neurolign NOTC) and the video head impulse test (vHIT; Interacoustics EyeSeeCam). Otolith functions were assessed through the cervical and ocular vestibular-evoked myogenic potentials (cVEMPs, oVEMPs; IHS SmartEP). The postural stability in four sensory conditions (eyes open/closed, firm/foam surface) was assessed via a modified clinical test of sensory integration of balance (mCTSIB; Natus BalanceMaster). Timed-Up-and-Go Test (TUG), the time it takes for an individual to stand up from a chair, walk 10 ft, turn around, walk back, and sit down; and the 30-sec Sit-to-Stand (5xSTS), the number of times an individual sit-to-stand repeatedly in 30 seconds without the arm support; were also measured.

This study was approved by Gallaudet University’s Internal Review Board.

Results/Conclusion
Currently we have data from 14 participants (age range 51-88 years) and data collecting is ongoing. Approximately 1/5 of the participants have one or more risk factors (aside from age) based on the questionnaire scores and vestibular and balance assessments. 5xSTS, TUG, and experiencing a fall in the past 12 months are some of the most common risk factors observed in this sample. Knowledge of these common risk factors can facilitate efficient triage of Deaf individuals with high fall risk.