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

Objectives: To evaluate the prevalence and factors associated with vestibular dysfunction in people who fall.

Data Sources: All electronic records from MEDLINE, CINAHL, Embase and psycINFO databases were searched to 9 December 2022.

Review Methods: Participants were adults with at least one fall within the previous year who were exposed to at least one vestibular function test. Any published peer reviewed trial designs were accepted. Included studies were assessed for risk of bias using a modified Epidemiological Appraisal Instrument. The quality of each meta-analysis was assessed using modified Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results: Ten trials (468 participants) were identified, six of which had high methodological quality. Vestibular dysfunction was found in 61% (48.01-72.32)  =  78% of participants. The most prevalent type of dysfunction was from tests of vestibulo-ocular reflex at 61% (49.79 to 70.49)  =  68%, followed by benign paroxysmal positional vertigo at 22% (10.30-40.32)   =  87% and central dysfunction at 11% (2.24-37.76)   =  50%. People who fall with vestibular dysfunction had reduced walking function compared to those without dysfunction -0.51 (-0.85 to -0.16)   =  11%. Dizziness was not related to vestibular dysfunction in people who fall 0.25 (-0.10 to 0.60),   =  0%. The quality of the body of evidence ranged from very low to high.

Conclusion: More than one in two people who fall have vestibular dysfunction. Clinicians cannot rely on dizziness report to indicate need for vestibular screening in those who fall. A vestibular screen should be incorporated into a comprehensive falls assessment.