Preferred Name
Jesus D. Gomez
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
ORCID
0009-0002-2837-4509
Date of Graduation
8-14-2026
Semester of Graduation
Summer
Degree Name
Doctor of Philosophy (PhD)
Department
Department of Communication Sciences and Disorders
First Advisor
Erin G. Piker
Second Advisor
Raghav H. Jha
Third Advisor
Shiree Harbick
Abstract
Falls are a leading cause of injury-related mortality among middle-aged and older adults. Although vestibular dysfunction, hearing loss, behavioral factors, and social determinants of health have been associated with increased fall risk, few studies have examined these relationships. Furthermore, limited research in audiology and vestibular science has investigated fall-risk vulnerability among Spanish-speaking individuals.
This study aimed to: (1) estimate the prevalence of fall risk among community-dwelling adults and compare prevalence between English-speaking and Spanish-speaking participants; (2) assess the prevalence of previously undiagnosed benign paroxysmal positional vertigo (BPPV) and compare prevalence between language groups; and (3) develop predictive models of fall risk incorporating audiologic, vestibular, behavioral, and social determinants of health variables.
A total of 75 participants completed a fall-risk assessment using the CDC STEADI framework. Assessments included audiologic testing; vestibular testing consisting of Dix-Hallpike positional testing, video head impulse testing (vHIT), rotary chair assessment, and cervical and ocular vestibular evoked myogenic potentials (VEMP); behavioral measures (i.e., balance confidence and physical activity); and social determinants of health measures including income, educational attainment, and health literacy.
Overall, 58.6% of participants were classified as at risk for falls and prevalence rates were similar between language groups. Previously undiagnosed BPPV was identified in 10.7% of all participants, including 14.3% of Spanish-speaking participants and 7.5% of English-speaking participants. Not all participants with BPPV met CDC STEADI criteria for elevated fall risk, suggesting that traditional screening approaches may fail to identify vestibular disorders when vestibular-specific assessments are not included.
Predictive patterns differed by language group. Behavioral factors including physical activity were the strongest predictors of fall risk among English-speaking participants, whereas vestibular and social determinant variables demonstrated larger associations among Spanish-speaking participants, who also exhibited greater burdens related to low health literacy, lower educational attainment, and lower household income.
Collectively, the results highlight the value of multidimensional fall-risk assessment approaches and the value of examining fall-risk vulnerability among both English-speaking and Spanish-speaking community-dwelling adults.
Included in
Population Health Commons, Preventive Medicine Commons, Public Health Education and Promotion Commons, Speech and Hearing Science Commons
