The highly effective therapeutic maneuvers, e.g., Epley, Sémont and Gufoni liberation maneuvers, put even more strain on frail patients when performed at the bedside. Hence, BPPV in older dizzy patients is probably more prevalent than previously thought. These factors may also lead to hesitations by the treating physicians. However, in frail patients – who are mostly older individuals – the correct performance of the maneuvers at the bedside might be hampered, amongst other reasons, by stiffness, pain, and angst. In otherwise healthy individuals, BPPV can easily be diagnosed with the provocation maneuvers, e.g., Dix-Hallpike and supine roll maneuvers. Lastly, older patients have higher recurrence rates of BPPV even after successful repositioning. due to impaired mobility) might also facilitate detachment of otoconia. Both lead to a disruption of the calcium metabolism and have thus been implicated in easing fragmentation or displacement of otoconia. Both osteoporosis as well as vitamin D deficiency have been found to be more prevalent in patients with BPPV. Pathophysiologically, there are a variety of reasons why the prevalence of BPPV increases with age. Successful therapeutic maneuvers in older patients with BPPV lead to a significant reduction of falls, thus the underdiagnosing of BPPV needs to be urgently addressed. Despite the severe impact of BPPV on the quality of older individual’s lives and the associated higher risk of falls, BPPV often remains unrecognized and therefore the cause of dizziness remains unclear. Typically, the first episode of BPPV occurs between 49 and 60 years. ![]() Īmong older people the most frequent origin of dizziness or vertigo is BPPV, accounting for about one third of diagnoses. ![]() Neuro-otological bedside tests should always include diagnostic maneuvers for benign paroxysmal positional vertigo (BPPV). In most cases, a well-focused patient history, a small set of neuro-otological bedside tests and a orthostatic evaluation suffice for identifying the primary causes of dizziness. Įtiologies of dizziness include peripheral and central vestibular, cardio-vascular, ocular motor, visual, and somatosensory disorders. In particular, among nursing home residents prevalence of dizziness has been found to be up to almost 45% (peaking between 80 and 90 years of age). The prevalence of dizziness in people who exceeded the age of 65 is around 30% and rises to almost 50% in those older than 85. Various studies indicate a steady increase of dizziness with age. Trial registrationĬ Identifier NCT03643354.ĭizziness is one of the most common medical problems, especially in the older population. Our finding suggests that retirement home residents suffering from dizziness should be regularly tested for BPPV and treated with appropriate liberation maneuvers, ideally on turntable to reduce strain. Such point prevalence of BPPV translates to a much higher yearly prevalence if one assumes that BPPV is not present on every day. ConclusionsīPPV could be demonstrated in about one tenth of retirement home residents with dizziness or recent dizziness. In all BPPV patients, appropriate liberation maneuvers were successful. Time-related properties, triggering factors and qualitative attributes of vertigo or dizziness were not significantly different between the dizzy participants with and those without BPPV. Among the participants tested on the turntable ( n = 71), BPPV was present in 11.3% (point prevalence). Out of the 453 residents, 75 (16.6% average age: 87.0 years 68% female) were suffering from dizziness presently or in the recent past and gave their consent to participate in this study. Otherwise, taking the resident’s medical history, a neuro-otological bedside examination, and a review of the available medical documentation was used to identify other causes of dizziness. Participants were immediately treated with the appropriate liberation maneuver whenever BPPV was diagnosed. Testing consisted of the Dix-Hallpike and supine roll maneuvers to both sides. After a structured interview evaluating the presence and characteristics of dizziness, all willing patients were tested for positional vertigo and nystagmus on a portable and manually operated 2-axis turntable that was transported to the retirement home. 83 rejected inquiries by residents led to a potential study population of 453 residents. ![]() 10 retirement homes (with a total of 536 residents) agreed to participate in this study. ![]() We contacted all large retirement homes in or around the city of Zurich (Switzerland). Furthermore, we aimed to evaluate the efficacy of a 2-axis turntable based BPPV treatment. We aimed to determine the point prevalence of dizziness and, in particular, of benign paroxysmal positional vertigo (BPPV) among retirement home residents. The prevalence of dizziness increases with age.
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