{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T06:27:31Z","timestamp":1787120851110,"version":"build-2736575974"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:p>Falls, delirium and functional decline are commonly treated as distinct geriatric outcomes despite sharing vulnerabilities in sensory integration, gait regulation, attention and physiological reserve. We propose silent neurovestibular frailty as a conceptual model describing a latent ageing phenotype in which vestibular dysfunction, dual-task gait deterioration and sensitivity to cognitive load interact before overt disability becomes apparent. This construct is presented as a hypothesis-generating framework rather than a validated diagnostic entity, intended to integrate currently separate lines of evidence into a testable model. Vestibular impairment in later life is associated with balance deficits, mobility limitation and reduced functional reserve, whilst dual-task gait assessment may reveal cognitive-motor interference that remains undetected during routine walking evaluation, although dual-task cost may reflect impairment, strategic task prioritisation, or both. Delirium introduces additional clinical urgency because acute cognitive deterioration frequently develops in older adults with sensory impairment, immobility, multimorbidity, medication exposure and diminished adaptive reserve. We argue that vestibular function, dual-task mobility and cognition deserve coordinated assessment as a candidate translational risk triad for older adults vulnerable to falls, hospital-acquired delirium and accelerated functional decline, whilst recognising that prospective evidence validating this integrated phenotype is currently lacking. The model extends rather than replaces multifactorial fall prevention and provides an empirical agenda for operationalisation, validation and intervention testing across community, perioperative, inpatient and rehabilitation settings.<\/jats:p>","DOI":"10.3389\/fnagi.2026.1879751","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T05:46:19Z","timestamp":1787118379000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Silent neurovestibular frailty: a conceptual model integrating vestibular dysfunction, dual-task mobility and cognitive load as candidate contributors to falls, delirium and functional decline in older adults"],"prefix":"10.3389","volume":"18","author":[{"given":"Samaher Mohammed","family":"Alowaydhah","sequence":"first","affiliation":[{"name":"Department of Physiotherapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University","place":["Sakaka, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugwu Okechukwu","family":"Paul-Chima","sequence":"additional","affiliation":[{"name":"Department of Research and Publication, Kampala International University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulmajeed","family":"Alfayyadh","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University","place":["Sakaka, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulaiman","family":"Alanazi","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University","place":["Sakaka, Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1001\/archinternmed.2009.66","article-title":"Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004","volume":"169","author":"Agrawal","year":"2009","journal-title":"Arch. Intern. Med."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.bjpt.2017.03.010","article-title":"Gait, dual task and history of falls in elderly with preserved cognition, mild cognitive impairment, and mild Alzheimer's disease","volume":"21","author":"Ansai","year":"2017","journal-title":"Braz. J. Phys. Ther."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1097\/AUD.0000000000001040","article-title":"Vestibular function in older adults with cognitive impairment: a systematic review","volume":"42","author":"Bosmans","year":"2021","journal-title":"Ear Hear."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.1007\/s10072-012-1126-6","article-title":"The neurobiology of falls","volume":"33","author":"Fasano","year":"2012","journal-title":"Neurol. Sci."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"CD007146","DOI":"10.1002\/14651858.CD007146.pub3","article-title":"Interventions for preventing falls in older people living in the community","volume":"2021","author":"Gillespie","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.bjpt.2018.03.011","article-title":"Dual task as a predictor of falls in older people with mild cognitive impairment and mild Alzheimer's disease: a prospective cohort study","volume":"22","author":"Goncalves","year":"2018","journal-title":"Braz. J. Phys. Ther."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1093\/gerona\/glr068","article-title":"fNIRS study of walking and walking while talking in young and old individuals","volume":"66","author":"Holtzer","year":"2011","journal-title":"J. Gerontol. Ser. A"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/1743-0003-10-91","article-title":"Review of fall risk assessment in geriatric populations using inertial sensors","volume":"10","author":"Howcroft","year":"2013","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1001\/jamainternmed.2014.7779","article-title":"Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis","volume":"175","author":"Hshieh","year":"2015","journal-title":"JAMA Intern. Med."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1016\/S0140-6736(13)60688-1","article-title":"Delirium in elderly people","volume":"383","author":"Inouye","year":"2014","journal-title":"Lancet"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1007\/s12603-013-0367-2","article-title":"Cognitive frailty: rationale and definition from an (I.A.N.A.\/I.A.G.G.) international consensus group","volume":"17","author":"Kelaiditi","year":"2013","journal-title":"J. Nutr. Health Aging"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/j.neucli.2008.09.005","article-title":"Posture control, aging, and attention resources: models and posture analysis methods","volume":"38","author":"Lacour","year":"2008","journal-title":"Neurophysiol. Clin."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"913","DOI":"10.3389\/fneur.2018.00913","article-title":"Cognitive involvement in balance, gait and dual tasking in aging: a focused review from a neuroscience of aging perspective","volume":"9","author":"Li","year":"2018","journal-title":"Front. Neurol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1858","DOI":"10.1002\/lary.23376","article-title":"Balance disorders in the elderly: epidemiology and functional impact","volume":"122","author":"Lin","year":"2012","journal-title":"Laryngoscope"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1001\/archinternmed.2011.728","article-title":"Hearing loss and falls among older adults in the United States","volume":"172","author":"Lin","year":"2012","journal-title":"Arch. Intern. Med."},{"key":"ref16","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511722233","volume-title":"Falls in Older People: Risk Factors and Strategies for Prevention","author":"Lord","year":"2007"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e70153","DOI":"10.1002\/trc2.70153","article-title":"Vestibular-related dizziness duration and cognitive deficits in older adults","volume":"11","author":"Ma","year":"2025","journal-title":"Alzheimers Dementia Trans Res Clin Intervent"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"afac205","DOI":"10.1093\/ageing\/afac205","article-title":"World guidelines for falls prevention and management for older adults: a global initiative","volume":"51","author":"Montero-Odasso","year":"2022","journal-title":"Age Ageing"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1016\/j.jamda.2020.09.032","article-title":"Visual and hearing impairment are associated with delirium in hospitalized patients: results of a multisite prevalence study","volume":"22","author":"Morandi","year":"2021","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1093\/ageing\/afs012","article-title":"The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis","volume":"41","author":"Muir","year":"2012","journal-title":"Age Ageing"},{"key":"ref21","doi-asserted-by":"publisher","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":"ref22","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1001\/jama.2017.12067","article-title":"Delirium in older persons: advances in diagnosis and treatment","volume":"318","author":"Oh","year":"2017","journal-title":"JAMA"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"104020","DOI":"10.1016\/j.archger.2020.104020","article-title":"The link between falls, social isolation and loneliness: a systematic review","volume":"88","author":"Petersen","year":"2020","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"874","DOI":"10.3390\/ijerph19020874","article-title":"A review on aging, sarcopenia, falls, and resistance training in community-dwelling older adults","volume":"19","author":"Rodrigues","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.1586\/ern.11.69","article-title":"The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk?","volume":"11","author":"Segev-Jacubovski","year":"2011","journal-title":"Expert. Rev. Neurother."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"CD012424","DOI":"10.1002\/14651858.CD012424.pub2","article-title":"Exercise for preventing falls in older people living in the community","volume":"2019","author":"Sherrington","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1159174","DOI":"10.3389\/fneur.2024.1159174","article-title":"Cognition in vestibular disorders: state of the field, challenges, and priorities for the future","volume":"15","author":"Smith","year":"2024","journal-title":"Front. Neurol."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e0158623","DOI":"10.1371\/journal.pone.0158623","article-title":"Daily life gait quality as predictor of falls in older people: a 1 year prospective cohort study","volume":"11","author":"van Schooten","year":"2016","journal-title":"PLoS One"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1136\/jnnp.2006.106914","article-title":"Quantitative gait dysfunction and risk of cognitive decline and dementia","volume":"78","author":"Verghese","year":"2007","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"728799","DOI":"10.3389\/fnagi.2021.728799","article-title":"Motoric cognitive risk syndrome: symptoms, pathology, diagnosis, and recovery","volume":"13","author":"Xiang","year":"2022","journal-title":"Front. Aging Neurosci."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"173","DOI":"10.3389\/fneur.2017.00173","article-title":"Vestibular loss in older adults is associated with impaired spatial navigation: data from the triangle completion task","volume":"8","author":"Xie","year":"2017","journal-title":"Front. Neurol."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1002\/mds.21720","article-title":"The role of executive function and attention in gait","volume":"23","author":"Yogev-Seligmann","year":"2008","journal-title":"Mov. Disord."}],"container-title":["Frontiers in Aging Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2026.1879751\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T05:46:20Z","timestamp":1787118380000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2026.1879751\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,19]]},"references-count":32,"alternative-id":["10.3389\/fnagi.2026.1879751"],"URL":"https:\/\/doi.org\/10.3389\/fnagi.2026.1879751","relation":{},"ISSN":["1663-4365"],"issn-type":[{"value":"1663-4365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,19]]},"article-number":"1879751"}}