Understanding Health-related Quality of Life in Older Adults with Vestibular Dysfunction: An Integrative Narrative Review
Vestibular dysfunction is a prevalent age-related condition that substantially impairs health-related quality of life (HRQoL) through its effects on physical, psychological, and social functioning. However, current evidence remains fragmented, with limited integration of the biological, functional, and psychosocial mechanisms underlying reduced HRQoL in older adults. This narrative review synthesises available evidence on the multidimensional impact of vestibular dysfunction on HRQoL among older adults. A literature search was conducted in the Scopus and PubMed databases to identify English-language studies investigating vestibular disorders, ageing, and HRQoL. Evidence was thematically synthesised within the International Classification of Functioning, Disability and Health (ICF) framework. The findings indicate that age-related vestibular degeneration initiates a cascade of impairments characterised by dizziness, balance deficits, gait instability, falls, and reduced functional independence. These physical limitations interact with cognitive impairment, anxiety, depression, fear of falling, diminished balance confidence, and social isolation, resulting in progressive participation restrictions and poorer HRQoL. The review further highlights that improvements in vestibular function alone do not consistently translate into meaningful gains in patient-perceived quality of life, emphasising the importance of comprehensive assessment using both generic and vestibular-specific outcome measures. An integrated conceptual framework is proposed to illustrate the interconnected biological, functional, psychosocial, and contextual pathways influencing HRQoL. This framework supports multidisciplinary, person-centred rehabilitation strategies that extend beyond symptom management to promote autonomy, resilience, social participation, and healthy ageing while providing a foundation for future longitudinal and intervention research.
