A pilot study of falls risk and vestibular dysfunction in older fallers presenting to hospital Emergency Departments

Purpose. To compare falls risk in older fallers and non-fallers, with an emphasis on dizziness and signs of vestibular dysfunction. Method. The fallers had presented to the Emergency Department of the Royal Melbourne Hospital, Australia following a fall and were discharged directly home ( n = 20) (75% female, mean age 78 years). The non-fallers were an age and gender matched group, who had not fallen in the past 12 months ( n = 20). All clients received a home-based assessment, which involved a comprehensive assessment of falls risk. Results. Over three-quarters of the fallers took four or more medications, had balance impairments, and used a gait aid in the community. The fallers had a significantly higher falls risk score (P<0.001), demonstrated significantly poorer balance (P<0.001) and walked significantly more slowly (P<0.001) than the non-fallers. There was no significant difference between the groups in their reports of dizziness ( P = 0.68), although static balance testing (CTSIB condition 5) suggested a greater degree of underlying vestibular dysfunction in the group of fallers (P<0.001). Conclusion. Older people discharged home from the ED following a fall are at high risk of falling in the future and have a greater level of vestibular dysfunction based on simple clinical testing. Additional clinically applicable tests of vestibular function are required to further investigate the relationship between vestibular dysfunction and falling in older people.