Risk factors for falls and fall-related injuries in older adults with signs and symptoms of vestibular dysfunction.

摘要

Study objectives. The purpose of this study was to describe the prevalence of and risk factors and quality of life differences associated with falls, recurrent falls, and injurious falls in a sample of community-dwelling older adults with signs and symptoms of vestibular dysfunction.; Study design. Cross-sectional descriptive study.; Methods. The examination records of 441 adults age 65 and older referred for tertiary care evaluation and management of symptoms of dizziness and/or gait instability associated with vestibular dysfunction were surveyed. Self-reported fall and injury events in the 6 months prior to examination were used to classify subjects based on reports of single or recurrent (2 or more) falls, and injurious falls. Injuries were also described and classified using the Injury Severity Scale. Prevalence of each outcome was described for the entire valid sample as well as for subsamples defined by age, gender, vestibular diagnostic category, symptomatic complaint and co-morbid condition subgroups. Multivariate logistic and multinomial regression analysis was used to identify vestibular disease diagnostic, comorbid health condition, functional gait/balance and condition specific associations with fall/injury status. Condition-specific and general health-related quality of life differences were determined between fall-status groups.; Results. Fall data was obtained for 441 subjects receiving evaluation for complaints of dizziness or balance impairment. Fall prevalence was 42% and recurrent fall prevalence was 22.5%. Fall prevalence was greatest in the 85–89 year age group and for subjects with mixed peripheral and central basis for disease. Prevalence of self-reported injuries was 19% in a subsample of subjects surveyed between 1999 and 2001 and 41% among the sub-sample of fallers. Seventy-one percent of injuries were minor and 29% were moderate to severe. Multivariate models indicated that diabetes, neurological, visual, psychiatric and muscluoskeletal comorbid conditions, mixed vestibular diagnoses and fear of falling as measured by balance confidence were related to falls and recurrent falls. Subjects who had fallen had lower condition-specific and general health-related quality of life (QOL) compared with non-fallers, but there was no difference between one-time and recurrent fallers in both specific and general QOL.; Conclusion. Older adults with VD displayed fall rates 33% greater than community-dwelling. Recurrent falls accounted for most of the increase. Risk factors for falls and injuries included mixed vestibular disease, instability complaints and those identified in community-dwelling populations. QOL limitations associated with falls were primarily in the physical domain. This subset of community-dwelling older adults are at increased risk for falls and injuries. Clinical management must consider these risk factors in the design and evaluation of intervention programs to prevent falls and injuries.