The importance of screening for benign paroxysmal positional vertigo in older patients presenting to falls clinics

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BACKGROUND: Fall incidents are a rising problem amongst older people and can have multiple causes. Vestibular disturbances such as benign paroxysmal positional vertigo (BPPV) are often not recognized as risk factors. The aim of our study is to determine the prevalence of BPPV in an older population referred to the geriatric falls clinic. Second, we aim to examine whether there is a reduction in the number of fall incidents and severity of fall incidents after a successful repositioning manoeuvre in patients with BPPV. METHODS: Dutch adults, aged ≥ 65 years, referred to the specialised falls clinic with an increased risk of falling were included. Subjects with additional neuro-otologic disorders or with severe disability were excluded. All participants were subjected to diagnostic manoeuvres to determine whether they had BPPV. If positive, they were treated with a canalith repositioning manoeuvre and were followed up according to regular care. Participants were asked to recall the number and severity of fall incidents of the past six months at time of inclusion. During follow-up, they were asked to record every fall incident and the corresponding severity in a provided falls diary. After follow-up, fall incidents were compared between participants with and without BPPV and within participants with BPPV before and after treatment. RESULTS: A total of 79 (56%) out of 142 eligible subjects agreed to participate and were included. Fifty-eight (73%) were female and the median age was 82 years (± 6). We found a total of 15 subjects (19%) with BPPV of whom 7 (47%) reported no complaints of BPPV. We found no differences in the number and severity of fall incidents between the groups in the 6 months prior to inclusion. We determined a significant reduction of the number of fall incidents 6 months after treatment within the BPPV group (p = 0.04). CONCLUSION: Approximately one-fifth of geriatric patients presenting to the falls clinic appeared to have BPPV and half of these patients reported no complaints of BPPV. BPPV seems to contribute to the risk of fall incidents in older people. Since treatment is easy to perform and likely to reduce fall incidents, we think it is of great importance to routinely check for BPPV in older patients with an increased risk of falling. TRIAL REGISTRATION: Approval by the medical ethics review board of Leiden University Medical Centre (September 28th 2018; trial number: P18.113) and the institutional review board of Gelre Hospitals (October 16th 2018, trial number: 18.39).

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