Significant Vestibular System Impairment Is Common in a Cohort of Elderly Patients Referred for Assessment of Falls Risk

Abstract

Background: Falls in elderly patients are associated with morbidity, mortality, and cost to the health-care system. The development of falls risk assessment programs have represented a method of responding to what is known about injurious falls. The multidimensional assessments involve the comparison against normative data of a patient's performance on metrics known to influence the likelihood of future falls. The factors assessed usually include falls and medication history, measures of mentation, depression, orthostatic hypotension, simple or choice reaction time, gait stability, postural stability, and the integrity of the patient's vision, somesthetic, and vestibular senses. Purpose: This investigation was conducted to measure the proportion of patients referred for falls risk assessment who have evidence of vestibular system impairment. Research Design: Qualitative, retrospective review of data collected from 2003 to 2007. Study Sample: The cohort was 185 consecutive patients referred for multidimensional assessments of falls risk. Data Collection and Analysis: Patients underwent quantitative assessments of peripheral and central vestibular system function consisting of electro- or videonystagmography (i.e., ENG/VNG), and sinusoidal harmonic acceleration testing. Results of these tests were compared to normative data. Results: We found that 73% of the sample who underwent vestibular system assessment had quantitative evidence of either peripheral or central vestibular system impairment. Conclusions: Our results suggest that quantitative assessments of the vestibulo-ocular reflex should be conducted on patients who are evaluated for falls risk. These examinations should include at least caloric testing and, where available, rotational testing.