{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T18:02:09Z","timestamp":1785348129933,"version":"3.55.0"},"reference-count":56,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Vestibular complaints are common in older adults and are linked to imbalance and falls. Some older adults show impaired vestibular perception despite preserved peripheral-reflex [\u2018vestibular agnosia (VA)\u2019]. Yet it remains unclear if VA is independently linked to imbalance and falls in otherwise healthy older adults. We therefore investigated the prevalence of VA in community-dwelling older adults, and examined its association to balance and prospective falls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Vestibular perceptual thresholds were measured during yaw-plane rotational chair testing. Postural sway and instrumented Timed-Up-and-Go were assessed using wearable sensors, and falls were recorded prospectively over six-months. VA was identified using K-means clustering. Multivariable regressions examined associations between perceptual thresholds and balance outcomes; logistic and negative binomial regressions evaluated associations with prospective falls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 166 participants (75.4\u00a0years; 81.9% female), 18.7% were classified as having VA. These individuals had worse cognition and somatosensation, and higher anxiety. Elevated (i.e. worse) vestibular perceptual thresholds were independently associated with greater sway velocity when standing on foam with eyes-open (adjusted \u03b2\u2009=\u20090.002, P\u2009=\u2009.03). Associations with other balance outcomes were attenuated after adjustment. Vestibular perceptual thresholds were not associated with prospective falls (odds of \u22651 fall: adjusted OR\u2009=\u20090.99, P\u2009=\u2009.65; fall counts: adjusted IRR\u2009=\u20091.02, P\u2009=\u2009.35).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Approximately one-fifth of healthy older adults exhibit VA. While elevated perceptual thresholds are independently associated with poorer balance, they did not predict falls. Further research is needed to determine whether vestibular perceptual testing provides additional information beyond standard balance assessments for fall-risk prediction in community-dwelling healthy older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ageing\/afag216","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T11:40:48Z","timestamp":1783424448000},"source":"Crossref","is-referenced-by-count":0,"title":["Vestibular perception, balance impairment, and fall risk in community-dwelling older adults"],"prefix":"10.1093","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7499-7638","authenticated-orcid":false,"given":"Yuxiao","family":"Li","sequence":"first","affiliation":[{"name":"Department of Brain Sciences, Centre for Vestibular Neurology , Imperial College London, London, W6 8RF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaeem","family":"Hadi","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Centre for Vestibular Neurology , Imperial College London, London, W6 8RF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca M","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Centre for Vestibular Neurology , Imperial College London, London, W6 8RF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry M","family":"Seemungal","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Centre for Vestibular Neurology , Imperial College London, London, W6 8RF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9595-6360","authenticated-orcid":false,"given":"Toby Jack","family":"Ellmers","sequence":"additional","affiliation":[{"name":"Department of Brain Sciences, Centre for Vestibular Neurology , Imperial College London, London, W6 8RF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"2026072913450784600_ref1","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1186\/s13018-022-03222-1","article-title":"Global prevalence of falls in the older adults: a comprehensive systematic review and meta-analysis","volume":"17","author":"Salari","year":"2022","journal-title":"J Orthop Surg"},{"key":"2026072913450784600_ref2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afaf157","article-title":"Epidemiology of falls in community-dwelling older adults in Europe: a systematic review and meta-analysis","volume":"54","author":"Rommers","year":"2025","journal-title":"Age Ageing"},{"key":"2026072913450784600_ref3","doi-asserted-by":"publisher","first-page":"714","DOI":"10.14336\/AD.2024.0124-1","article-title":"Age-related dysfunction in balance: a comprehensive review of causes, consequences, and interventions","volume":"16","author":"Wang","year":"2024","journal-title":"Aging Dis"},{"key":"2026072913450784600_ref4","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/B978-0-444-63437-5.00004-2","article-title":"Multisensory integration in balance control","volume":"137","author":"Bronstein","year":"2016","journal-title":"Handb Clin Neurol"},{"key":"2026072913450784600_ref5","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1146\/annurev.neuro.31.060407.125555","article-title":"Vestibular system: the many facets of a multimodal sense","volume":"31","author":"Angelaki","year":"2008","journal-title":"Annu Rev Neurosci"},{"key":"2026072913450784600_ref6","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.gaitpost.2023.09.011","article-title":"Human vestibular perceptual thresholds\u2014a systematic review of passive motion perception","volume":"107","author":"Fitze","year":"2024","journal-title":"Gait Posture"},{"key":"2026072913450784600_ref7","doi-asserted-by":"publisher","first-page":"643634","DOI":"10.3389\/fneur.2021.643634","article-title":"Vestibular thresholds: a review of advances and challenges in clinical applications","volume":"12","author":"Kobel","year":"2021","journal-title":"Front Neurol"},{"key":"2026072913450784600_ref8","doi-asserted-by":"publisher","first-page":"162","DOI":"10.3389\/fneur.2016.00162","article-title":"Vestibular perceptual thresholds increase above the age of 40","volume":"7","author":"Berm\u00fadez Rey","year":"2016","journal-title":"Front Neurol"},{"key":"2026072913450784600_ref9","doi-asserted-by":"publisher","first-page":"6426","DOI":"10.1038\/s41598-022-09807-4","article-title":"Age-related changes to vestibular heave and pitch perception and associations with postural control","volume":"12","author":"Gabriel","year":"2022","journal-title":"Sci Rep"},{"key":"2026072913450784600_ref10","doi-asserted-by":"publisher","first-page":"1207711","DOI":"10.3389\/fnagi.2023.1207711","article-title":"Increased roll tilt thresholds are associated with subclinical postural instability in asymptomatic adults aged 21 to 84 years","volume":"15","author":"Wagner","year":"2023","journal-title":"Front Aging Neurosci"},{"key":"2026072913450784600_ref11","doi-asserted-by":"publisher","first-page":"e3845","DOI":"10.1002\/dmrr.3845","article-title":"Deterioration of vestibular motion perception: a risk factor for postural instability and falls in elderly with type 2 diabetes","volume":"40","author":"La Scaleia","year":"2024","journal-title":"Diabetes Metab Res Rev"},{"key":"2026072913450784600_ref12","doi-asserted-by":"publisher","first-page":"578","DOI":"10.3389\/fneur.2017.00578","article-title":"Multivariate analyses of balance test performance, vestibular thresholds, and age","volume":"8","author":"Karmali","year":"2017","journal-title":"Front Neurol"},{"key":"2026072913450784600_ref13","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1152\/jn.00168.2020","article-title":"The role of vestibular cues in postural sway","volume":"125","author":"Karmali","year":"2021","journal-title":"J Neurophysiol"},{"key":"2026072913450784600_ref14","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1097\/AUD.0000000000000052","article-title":"Vestibular perception and the vestibulo-ocular reflex in young and older adults","volume":"35","author":"Chang","year":"2014","journal-title":"Ear Hear"},{"key":"2026072913450784600_ref15","doi-asserted-by":"publisher","first-page":"5216","DOI":"10.1007\/s00415-021-10695-3","article-title":"Bilateral vestibulopathy decreases self-motion perception","volume":"269","author":"Van Stiphout","year":"2022","journal-title":"J Neurol"},{"key":"2026072913450784600_ref16","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1007\/s00415-024-12876-2","article-title":"Balance recovery and its link to vestibular agnosia in traumatic brain injury: a longitudinal behavioural and neuro-imaging study","volume":"272","author":"Hadi","year":"2025","journal-title":"J Neurol"},{"key":"2026072913450784600_ref17","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1093\/brain\/awaa386","article-title":"Vestibular agnosia in traumatic brain injury and its link to imbalance","volume":"144","author":"Calzolari","year":"2021","journal-title":"Brain"},{"key":"2026072913450784600_ref18","doi-asserted-by":"publisher","first-page":"120458","DOI":"10.1016\/j.jns.2022.120458","article-title":"The human brain networks mediating the vestibular sensation of self-motion","volume":"443","author":"Hadi","year":"2022","journal-title":"J Neurol Sci"},{"key":"2026072913450784600_ref19","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1111\/ene.12947","article-title":"The effect of pedunculopontine nucleus deep brain stimulation on postural sway and vestibular perception","volume":"23","author":"Yousif","year":"2016","journal-title":"Eur J Neurol"},{"key":"2026072913450784600_ref20","doi-asserted-by":"publisher","first-page":"4","DOI":"10.3389\/fneur.2016.00004","article-title":"Absence of rotation perception during warm water caloric irrigation in some seniors with postural instability","volume":"7","author":"Chiarovano","year":"2016","journal-title":"Front Neurol"},{"key":"2026072913450784600_ref21","doi-asserted-by":"publisher","first-page":"e61862","DOI":"10.1371\/journal.pone.0061862","article-title":"Vestibular perception following acute unilateral vestibular lesions","volume":"8","author":"Cousins","year":"2013","journal-title":"PloS One"},{"key":"2026072913450784600_ref22","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/S0140-6736(12)61263-X","article-title":"Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study","volume":"381","author":"Robinovitch","year":"2013","journal-title":"The Lancet"},{"key":"2026072913450784600_ref23","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1007\/s00221-002-1146-1","article-title":"Differential effects of labyrinthine dysfunction on distance and direction during blindfolded walking of a triangular path","volume":"145","author":"Glasauer","year":"2002","journal-title":"Exp Brain Res"},{"key":"2026072913450784600_ref24","doi-asserted-by":"publisher","first-page":"4316","DOI":"10.1038\/s41598-018-22492-6","article-title":"Natural turn measures predict recurrent falls in community-dwelling older adults: a longitudinal cohort study","volume":"8","author":"Leach","year":"2018","journal-title":"Sci Rep"},{"key":"2026072913450784600_ref25","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J Am Geriatr Soc"},{"key":"2026072913450784600_ref26","doi-asserted-by":"publisher","first-page":"461","DOI":"10.3233\/VES-2004-14604","article-title":"Perceptual and nystagmic thresholds of vestibular function in yaw","volume":"14","author":"Seemungal","year":"2004","journal-title":"J Vestib Res"},{"key":"2026072913450784600_ref27","doi-asserted-by":"publisher","first-page":"137","DOI":"10.3758\/BF03203817","article-title":"A rapid technique to assess the resting states of the eyes and other threshold phenomena: the modified binary search (MOBS)","volume":"20","author":"Tyrrell","year":"1988","journal-title":"Behav Res Methods Instrum Comput"},{"key":"2026072913450784600_ref28","first-page":"007","article-title":"Mobility lab to assess balance and gait with synchronized body-worn sensors","volume":"Suppl 1","author":"Mancini","year":"2011","journal-title":"J Bioeng Biomed Sci"},{"key":"2026072913450784600_ref29","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The timed \u201cup & go\u201d: a test of basic functional mobility for frail elderly persons","volume":"39","author":"Podsiadlo","year":"1991","journal-title":"J Am Geriatr Soc"},{"key":"2026072913450784600_ref30","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/1743-0003-9-59","article-title":"ISway: a sensitive, valid and reliable measure of postural control","volume":"9","author":"Mancini","year":"2012","journal-title":"J Neuroengineering Rehabil"},{"key":"2026072913450784600_ref31","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1109\/TNSRE.2010.2047606","article-title":"iTUG, a sensitive and reliable measure of mobility","volume":"18","author":"Salarian","year":"2010","journal-title":"IEEE Trans Neural Syst Rehabil Eng"},{"key":"2026072913450784600_ref32"},{"key":"2026072913450784600_ref33","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1093\/ageing\/afm157","article-title":"The short FES-I: a shortened version of the falls efficacy scale-international to assess fear of falling","volume":"37","author":"Kempen","year":"2008","journal-title":"Age Ageing"},{"key":"2026072913450784600_ref34","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/S0022-3999(01)00296-3","article-title":"The validity of the hospital anxiety and depression scale: an updated literature review","volume":"52","author":"Bjelland","year":"2002","journal-title":"J Psychosom Res"},{"key":"2026072913450784600_ref35","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1076\/1380-3395(200008)22:4;1-0;FT518","article-title":"Trail making test, part B as a measure of executive control: validation using a set-switching paradigm","volume":"22","author":"Arbuthnott","year":"2000","journal-title":"J Clin Exp Neuropsychol"},{"key":"2026072913450784600_ref36","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1001\/archotol.1990.01870040046011","article-title":"The development of the dizziness handicap inventory","volume":"116","author":"Jacobson","year":"1990","journal-title":"Arch Otolaryngol Neck Surg"},{"key":"2026072913450784600_ref37","doi-asserted-by":"publisher","first-page":"153","DOI":"10.3233\/VES-2011-0412","article-title":"Visual vertigo analogue scale: an assessment questionnaire for visual vertigo","volume":"21","author":"Dannenbaum","year":"2011","journal-title":"J Vestib Res"},{"key":"2026072913450784600_ref38","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1093\/ptj\/85.10.1034","article-title":"Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the five-times-sit-to-stand test","volume":"85","author":"Whitney","year":"2005","journal-title":"Phys Ther"},{"key":"2026072913450784600_ref39","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.1016\/j.jocn.2009.03.010","article-title":"An assessment of vibration threshold using a biothesiometer compared to a C128-Hz tuning fork","volume":"16","author":"Temlett","year":"2009","journal-title":"J Clin Neurosci"},{"key":"2026072913450784600_ref40","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1136\/jnnp.58.3.335","article-title":"Body sway and vibration perception thresholds in normal aging and in patients with polyneuropathy","volume":"58","author":"Bergin","year":"1995","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2026072913450784600_ref41","doi-asserted-by":"publisher","first-page":"6108","DOI":"10.1080\/09638288.2024.2320271","article-title":"Benign paroxysmal positional vertigo without dizziness is common in people presenting to falls clinics","volume":"46","author":"Hyland","year":"2024","journal-title":"Disabil Rehabil"},{"key":"2026072913450784600_ref42","doi-asserted-by":"publisher","first-page":"1228453","DOI":"10.3389\/fresc.2023.1228453","article-title":"Surveying physical therapists\u2019 understanding of benign paroxysmal positional vertigo","volume":"4","author":"Harrell","year":"2023","journal-title":"Front Rehabil Sci"},{"key":"2026072913450784600_ref43","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1152\/jn.2002.88.3.1097","article-title":"Sensorimotor integration in human postural control","volume":"88","author":"Peterka","year":"2002","journal-title":"J Neurophysiol"},{"key":"2026072913450784600_ref44","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1001\/jamaoto.2021.3673","article-title":"Falls among people with bilateral vestibulopathy: a review of causes, incidence, injuries, and methods","volume":"148","author":"Herssens","year":"2022","journal-title":"JAMA Otolaryngol Neck Surg"},{"key":"2026072913450784600_ref45","doi-asserted-by":"publisher","first-page":"1582","DOI":"10.1093\/ptj\/pzaa083","article-title":"A systematic review on balance performance in patients with bilateral vestibulopathy","volume":"100","author":"Herssens","year":"2020","journal-title":"Phys Ther"},{"key":"2026072913450784600_ref46","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.exger.2018.01.025","article-title":"The physical capabilities underlying timed \u201cup and go\u201d test are time-dependent in community-dwelling older women","volume":"104","author":"Coelho-Junior","year":"2018","journal-title":"Exp Gerontol"},{"key":"2026072913450784600_ref47","doi-asserted-by":"publisher","first-page":"2824","DOI":"10.1093\/brain\/awy250","article-title":"Quantitative postural models as biomarkers of balance in Parkinson\u2019s disease","volume":"141","author":"Xiang","year":"2018","journal-title":"Brain"},{"key":"2026072913450784600_ref48","doi-asserted-by":"publisher","first-page":"400","DOI":"10.2522\/ptj.20140604","article-title":"Impact of diabetic complications on balance and falls: contribution of the vestibular system","volume":"96","author":"D\u2019Silva","year":"2016","journal-title":"Phys Ther"},{"key":"2026072913450784600_ref49","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1111\/nan.12476","article-title":"Relationship of type 2 diabetes to human brain pathology","volume":"44","author":"Pruzin","year":"2018","journal-title":"Neuropathol Appl Neurobiol"},{"key":"2026072913450784600_ref50","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/bs.pbr.2019.04.019","article-title":"Vestibular roll tilt thresholds partially mediate age-related effects on balance","volume":"248","author":"Beylergil","year":"2019","journal-title":"Prog Brain Res"},{"key":"2026072913450784600_ref51","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.3758\/s13414-024-02886-7","article-title":"Intra-individual consistency of vestibular perceptual thresholds","volume":"86","author":"Clark","year":"2024","journal-title":"Atten Percept Psychophys"},{"key":"2026072913450784600_ref52","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1007\/s00221-023-06570-4","article-title":"Vestibular perceptual thresholds for rotation about the yaw, roll, and pitch axes","volume":"241","author":"Allred","year":"2023","journal-title":"Exp Brain Res"},{"key":"2026072913450784600_ref53","doi-asserted-by":"publisher","first-page":"e70981","DOI":"10.1371\/journal.pone.0070981","article-title":"Force-controlled balance perturbations associated with falls in older people: a prospective cohort study","volume":"8","author":"Sturnieks","year":"2013","journal-title":"PloS One"},{"key":"2026072913450784600_ref54","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1111\/j.1532-5415.1994.tb06218.x","article-title":"Physiological factors associated with falls in older community-dwelling women","volume":"42","author":"Lord","year":"1994","journal-title":"J Am Geriatr Soc"},{"key":"2026072913450784600_ref55","doi-asserted-by":"crossref","first-page":"afad206","DOI":"10.1093\/ageing\/afad206","article-title":"We should be screening for benign paroxysmal positional vertigo (BPPV) in all older adults at risk of falling: a commentary on the world falls guidelines","volume":"52","author":"Li","year":"2023","journal-title":"Age Ageing"},{"key":"2026072913450784600_ref56","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.joto.2017.10.005","article-title":"Age predicts the absence of caloric-induced vertigo","volume":"13","author":"Jacobson","year":"2018","journal-title":"J Otol"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/55\/7\/afag216\/70362927\/afag216.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/55\/7\/afag216\/70362927\/afag216.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:45:12Z","timestamp":1785347112000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/doi\/10.1093\/ageing\/afag216\/8747042"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":56,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afag216","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,7]]},"article-number":"afag216"}}