Vestibular dysfunction in people who fall: A systematic review and meta-analysis of prevalence and associated factors

Donovan, Jacquelin; Silva, Luckshica De; Cox, Hayley L.; Palmer, G. G.; Semciw, Adam

doi:10.1177/02692155231162423

Cited by 5 publications

(6 citation statements)

References 44 publications

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“…The physiological degeneration of the vestibular system can be easily ignored by older individuals due to its slow progression. However, damage to the body's balance ability accumulates over time, resulting in exercise intolerance, instability, and gait issues [24]. This study also found that the ability of older patients in the OH group to control their direction decreased.…”

Section: Discussionmentioning

confidence: 53%

Quantitative Assessment of Balance Function Characteristics in Older Patients with Orthostatic Hypotension

Cui,

Liu,

Zhou

et al. 2023

Geriatrics

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Background: Orthostatic hypotension (OH) is a common blood pressure abnormality in older adults that makes them prone to balance disorders and falls. The maintenance of balance relies on a complex regulatory system. The use of computerized dynamic posturography (CDP) can provide a quantitative evaluation of balance function. The objective of this study was to utilize CDP to measure balance indicators in older individuals with OH. Methods: A total of 303 older adults were divided into an OH group of 91 and a non-OH group of 212. Various factors, including chronic diseases, medication history, laboratory tests, and balance indicators, were compared between the two groups. Results: ① Participants with OH had more chronic diseases, including coronary heart disease (p = 0.049) and a history of falls (p < 0.001), than those without OH. A history of multiple medications in the OH group was significantly more likely than in the non-OH group (p = 0.006). ② There was a significant reduction in the composite equilibrium score (SOT-COM) (p < 0.001), vision ratio score (VIS) (p < 0.001), vestibular ratio score (VEST) (p < 0.001), and directional control (DCL) (p = 0.028) in the OH group. ③ A logistic regression analysis revealed that SOT-COM was a significant independent factor associated with OH. The area under the curve (AUC) of SOT-COM was 0.833 (95% confidence interval: 0.778–0.887, p < 0.001), with a sensitivity of 0.826 and a specificity of 0.759. Conclusions: This study demonstrates that older individuals with OH are more prone to falls, due to decreased sensory integration for balance.

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Section: Discussionmentioning

confidence: 53%

Quantitative Assessment of Balance Function Characteristics in Older Patients with Orthostatic Hypotension

Cui,

Liu,

Zhou

et al. 2023

Geriatrics

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“…Adults over 40 with vestibular dysfunction have a 12-fold increase in the odds of falling ( 25 ). BPPV has been correlated to falls ( 4 , 6 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…Transient subjective dizziness or vertigo with nystagmus in the plane of the involved semicircular canals from positional testing are diagnostic of definite BPPV (2). If left untreated, BPPV is correlated with a decrease in activities of daily living scores, an increased rate of falling, and increased rates of depression (3)(4)(5)(6). According to the American Academy of Otolaryngology-Head and Neck Surgery (AAHN) 2018 Clinical Practice Guidelines and recommendations by the American Academy of Neurology, positional tests are the gold standard for diagnosing BPPV, with strong recommendations for treating BPPV with canalith repositioning maneuvers (3,7).…”

Section: Introductionmentioning

confidence: 99%

Surveying physical therapists' understanding of benign paroxysmal positional vertigo

Harrell,

Hart,

Jen

et al. 2023

Front. Rehabil. Sci.

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IntroductionBenign paroxysmal positional vertigo (BPPV) is a common condition with disabling symptoms that is diagnosed and effectively treated at the bedside. Our encounter with patients experiencing prolonged BPPV who may not have received appropriate physical therapy prompted us to explore barriers to the diagnosis and treatment for BPPV among physical therapists, which has not been extensively investigated. We hypothesize that a potential barrier may be a lack of understanding of subtle symptoms of BPPV that deviate from the classical presentation. The gold standard for diagnosing definite BPPV is subjective dizziness or vertigo with nystagmus in response to positional testing. There are variants of BPPV including subjective BPPV (subjective dizziness or vertigo without nystagmus) and vestibular agnosia (nystagmus without subjective dizziness or vertigo) that do not meet the diagnostic criteria for definite BPPV but are equally responsive to the same repositioning maneuvers. The purpose of this project was to survey physical therapists for their understanding of BPPV including subjective BPPV and vestibular agnosia.MethodsA panel of experts created a 16-question survey, designed for physical therapists, with three categories: (1), inquiring if they treat persons with BPPV, (2) three clinical vignettes for definite BPPV, subjective BPPV, and BPPV with vestibular agnosia, and (3) demographic information. Data collection occurred at two large physical therapy meetings, one of which was a national professional meeting and the other was a professional continuing medical education course geared towards advancing vestibular rehabilitation skills.ResultsThere were 426 people who completed the survey, 364 of whom treat BPPV in their practice. In the first clinical vignette created to assess the respondents' understanding of definite BPPV, 229 (62%) of respondents would always assess a patient for BPPV based on complaints of a “room spinning” vertigo from head movement. When asked if the complaint was lingering “lightheadedness or feelings of imbalance” from head movement, only 158 (43%) reported they would perform positional testing to reassess. In the BPPV variant vignettes, 187 (51%) identified the patient with subjective BPPV as having BPPV and 305 (85%) identified the patient with vestibular agnosia as having BPPV.DiscussionThe results of this survey demonstrate gaps in knowledge regarding BPPV across practice settings and experience, with opportunities to bridge these gaps to improve treatment for BPPV.

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“…Most patients with VS have vestibular deficits in the tumor-affected ear [7], and numerous studies have presented the risk of fall-related injury among patients with asymmetric vestibular function originating from other vestibular disorders [33][34][35][36]. According to Donovan et al, more than one in two patients who suffered falls had objective signs of vestibular deficit [37]. Baldursdottir et al reported an increased prevalence of vestibular deficits in patients aged 50-75 years with fall-related wrist fractures [38].…”

Section: Plos Onementioning

confidence: 99%

Fall-related injury among patients with vestibular schwannoma

Ölander,

Feychting,

Eriksson

et al. 2024

PLoS ONE

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Vestibular schwannoma can cause vestibular dysfunction; however, conflicting evidence exists regarding whether this affects the incidence of fall-related injuries in this patient population. This matched cross-sectional and cohort study assess the risk of fall-related injuries in patients with vestibular schwannoma. The study included patients with vestibular schwannoma treated at a tertiary referral hospital in Sweden between 1988 and 2014. Information on fall-related injuries was obtained from the National Patient Register, and matched population comparisons were randomly selected in a 1:25 ratio. Fall-related injuries occurring pre- (within 5 years before the diagnosis of vestibular schwannoma) and post-diagnostically (up to 3 years after diagnosis or intervention) were registered. The association between vestibular schwannoma and fall-related injuries was estimated using logistic regression and Cox proportional hazards analyses. We identified 1153 patients with vestibular schwannoma (569 [49%] women and 584 [51%] men), and 28815 population comparisons. Among the patients, 9% and 7% had pre- and post-diagnostic fall-related injuries, respectively, and among the comparisons, 8% and 6% had pre- and post-diagnostic fall-related injuries, respectively. There was no increased risk of pre- (OR 1.14; CI 0.92–1.41) or post-diagnostic 1 year (HR 1.16; CI 0.87–1.54) or 3 years (HR 1.11; CI 0.89–1.29) fall-related injury among the total patient cohort. In age-stratified analyses, we found an increased risk of pre-diagnostic fall-related injury among patients aged 50–69 years (OR 1.42; CI 1.10–1.88). Patients who underwent middle fossa surgery, regardless of age, had an increased risk of post-surgery fall-related injury within 3 years of follow-up (HR 2.68; CI 1.06–6.81). We conclude that patients with vestibular schwannoma have a low risk of enduring fall-related injuries. Middle-aged patients with dizziness and fall-related injuries should be considered for a vestibular clinical evaluation. Our results highlight the importance of rehabilitation in avoiding future fall-related injuries among patients undergoing middle fossa surgery.

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Vestibular dysfunction in people who fall: A systematic review and meta-analysis of prevalence and associated factors

Cited by 5 publications

References 44 publications

Quantitative Assessment of Balance Function Characteristics in Older Patients with Orthostatic Hypotension

Quantitative Assessment of Balance Function Characteristics in Older Patients with Orthostatic Hypotension

Surveying physical therapists' understanding of benign paroxysmal positional vertigo

Fall-related injury among patients with vestibular schwannoma

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