Recovery trajectories of dizziness-related symptom burden and their associations with functional recovery and adverse post-discharge outcomes in older adults with ischemic vertigo: a prospective longitudinal study

Background Recovery after ischemic vertigo in older adults is heterogeneous, but longitudinal patterns of dizziness-related symptom burden and their clinical correlates remain insufficiently characterized. We aimed to identify distinct symptom-recovery trajectories, characterize functional recovery and adverse post-discharge outcomes across these trajectories, and examine clinical factors associated with unfavorable trajectory membership. Methods We conducted a prospective longitudinal study of adults aged 65 years or older with confirmed ischemic vertigo who were recruited between February and December 2025 and followed for 6 months after discharge. Dizziness-related symptom burden was assessed using the Dizziness Handicap Inventory at discharge baseline, 7 days, 1 month, 3 months, and 6 months. Latent class growth analysis was used to identify distinct symptom-recovery trajectories. Functional recovery, falls or near-falls, and healthcare reutilization were compared across the identified classes. All enrolled participants contributed available repeated measurements through full-information maximum likelihood, and factors associated with unfavorable class membership were examined using a three-step approach that accounted for classification uncertainty. Results Among 231 enrolled participants, 214 completed at least three follow-up assessments and 189 completed all scheduled assessments; all 231 contributed available data to the trajectory analysis. A three-class solution was identified: favorable recovery (118 participants, 51.1%), intermediate recovery (74 participants, 32.0%), and unfavorable recovery (39 participants, 16.9%). Compared with the favorable class, the unfavorable class showed persistently higher dizziness-related handicap, slower Barthel Index improvement, lower recovery to pre-morbid mobility, and higher frequencies of emergency-department revisits and falls or near-falls. Prior stroke or transient ischemic attack, mobility limitation at discharge, and NIHSS score ≥3 were associated with unfavorable trajectory membership. Conclusions Recovery after emergency-department management of ischemic vertigo in older adults is heterogeneous. Early clinical features and recovery patterns were associated with persistent symptom burden, delayed functional recovery, and adverse post-discharge outcomes. Their potential role in guiding individualized follow-up and transitional care should be evaluated prospectively.