Researchers have confirmed dizziness as an independent predicting factor for falls in older people for the first time, adding that a common cause is benign positional vertigo (BPV) where crystals in the inner ear’s balance system become dislodged.
They said dizziness was not just a normal part of ageing but was caused by specific and distinct diagnoses with various treatments and cures.
The most common causes in older people included BPV (also called benign paroxysmal positional vertigo or BPPV), orthostatic hypotension due to blood pressure falling on standing, and vestibular migraine, they added.
Their meta-analysis found a conclusive link between older adults experiencing spells of dizziness and a dramatically elevated risk of falling and for the first time, confirmed dizziness as an independent factor for falls.
Dizziness includes sensations such as vertigo, imbalance, light-headedness and disorientation and affects one in three people aged 65 years and older.
The researchers assessed the link by systematically reviewing and meta-analysing 29 peer-reviewed research studies, including three Australian studies, involving 103,000 participants. The systematic review and meta-analysis were published in the September edition of Age and Ageing.
They found older adults who experienced dizziness were over 60% more likely to fall in the future, even considering other factors that might have contributed to a risk of a fall. In another finding, those with dizziness had approximately double the likelihood of falling more than once.
Dr Toby Ellmers from the Centre for Vestibular Neurology, Department of Brain Sciences at Imperial College London was senior author of the study. “Our study conclusively shows that older people with dizziness are at high risk of experiencing falls,” he said.
Falls are the most common cause of death from injury in the over 65s in England. Hip fractures from falls affect mobility and quality of life and can lead to increased institutionalisation and death, the researchers said.
But their results however suggested “dizziness was not associated with future injurious falls.”
Dr Ellmers said dizziness was the commonest reason for patients to be referred to his colleague’s general neurology clinics.
See a doctor for dizzy spells
“Older adults with even non-bothersome dizzy spells should make an appointment with their GP to enable early diagnosis and treatment to prevent falling. That will help to avoid a hospital admission or worse,” he said.
The researchers said their results had important implications for clinical practice.
“The 2022 World Falls Guidelines recommended assessment of dizziness and vestibular disorders,” they wrote. “The findings from our review further underline the importance of including dizziness as part of a multicomponent falls assessment.
“We recommend that clinicians working in fall prevention should regularly ask older adults about any dizziness experienced.
“Those presenting with dizziness should undergo a thorough neuro-otological and cardiovascular assessment to identify the specific cause of symptoms. The results of the examination will assist the development of an effective treatment plan for modifiable risk factors for falls.”
For example, evidence highlighted that repositioning manoeuvres in older people with BPPV led to a reduced risk of falling.
“A recent paper describes the success and feasibility of adopting such targeted approach within a community falls service,” they wrote.
In repositioning manoeuvres, the doctor shows the patient how to get into various sitting and lying positions while holding their head at certain angles. In benign paroxysmal positional vertigo (BPPV), the vertigo is caused by loose calcium deposits (crystals or “ear rocks”) in the organ of the balance (vestibular system).
The canalith repositioning procedure (CRP) is a treatment for BPPV. The most well-known and performed CRP, the Epley manoeuvre, involves a series of head movements that aim to relieve vertigo symptoms.
“However, as common causes of dizziness can sometimes occur without conscious percept of symptoms, it is therefore also important to conduct objective assessments of neuro-otological and cardiovascular function in all older people with imbalance/deemed to be at risk of falling, not only those who report symptoms of dizziness,” they said.
