Unrecognized benign paroxysmal positional vertigo in older adults

Introduction: Dizziness is a common complaint, and its incidence increases with age (von Brevern et al., 2007). It is often associated with balance disorders and predisposes patients to falls, which are associated with high morbidity and mortality in older adults. Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder in adults and has been shown to impair postural control and increase fall risk (Fancello et al., 2023; Pauwels et al., 2023). BPPV can be treated with repositioning maneuvers, which have been shown to improve gait and postural control (Cohen-Shwartz et al., 2020; Oghalai et al., 2000). However, it is frequently not recognized by professionals. This study aimed to determine the prevalence of unrecognized BPPV in hospitalized older patients compared with age-matched active older individuals.Methods: Participants were recruited from two groups. The first group consisted of patients admitted for inpatient care to the Department of Geriatrics at Motol and Homolka University Hospital, who were invited to participate in the study. Inclusion criteria were the ability to sit and undergo diagnostic maneuvers, ability to communicate and no prior diagnosis of BPPV. All participants were interviewed and examined by the study authors. A questionnaire was used to obtain a uniform and detailed history. A clinical neuro-otologic examination included the Romberg test, assessment of nystagmus, as well as Dix-Hallpike and Supine-Roll test. The control group consisted of active older adults recruited from participants in a course for active older adults at the Faculty of Physical Education and Sport, Charles University in Prague.Results: We evaluated a group of 103 patients (34 men, 69 women) over an 11-month period. Their ages ranged from 50 to 95 years (78.8 ± 5.99, mean ± SD). The control group consisted of 63 subjects (21 men, 42 women), aged 65 to 93 (72.4 ± 9.04). There were no statistically significant differences in age (p < 0.001, Mann-Whitney U test) between the groups. Based on examination findings, the patient group was divided into BPPV and non-BPPV subgroups. Unrecognized BPPV was found only in the inpatient group (6.7 %) and not in the control group. At least one fall within the past six months was reported by 42.9 % of the BPPV group, 54.6 % of the non-BPPV inpatient group and 34.9 % of controls. Dizziness was reported by 71.4 % of the BPPV group, 42.7 % of the non-BPPV group, and 25.4 % of controls, showing a statistically significant difference between patients and controls (p < 0.01). A spinning sensation during dizziness was reported by 71.4 % of BPPV patients, 14.6 % of non-BPPV patients, and 9.5 % of controls. This difference was statistically significant within the patient group (p < 0.01). Dizziness after rolling over in bed was reported by 85.7 % of the BPPV group, 9.4 % of the non-BPPV group, and 1.6 % of controls. Fisher’s exact test showed significant differences between BPPV and non-BPPV patients (p < 0.001) and between all patients and controls (p < 0.01). Dizziness after bending over was reported by 28.6 % of BPPV patients, 18.8 % of non-BPPV patients, and 4.8 % of controls. A significant difference was found only between patients and controls (p < 0.05). All patients who tested positive for BPPV were successfully treated.Conclusions: Unrecognized BPPV is common in older inpatients and may contribute to impaired postural stability and an increased risk of falls. As many patients present with nonspecific dizziness rather than typical positional symptoms, diagnostic positional maneuvers are crucial for the diagnosis of BPPV. We should be screening for BPPV in all older inpatient adults. Early identification and treatment of BPPV may reduce fall risk, improve balance, and decrease fall-related morbidity.