Falls and fear of falling in vertigo and balance disorders: a controlled cross-sectional study

Schlick, Cornelia; Schniepp, Roman; Loidl, Verena; Wuehr, Max; Hesselbarth, Kristin and Jahn, Klaus (28. October 2015): Falls and fear of falling in vertigo and balance disorders: a controlled cross-sectional study. In: Journal of Vestibular Research, Vol. 25, No. 5-6: pp. 241-251

Abstract

BACKGROUND: Vertigo and dizziness are among the most prevalent symptoms in neurologic disorders. Although many of these patients suffer from postural instability and gait disturbances, there is only limited data on their risk of falling. METHODS: We conducted a controlled cross-sectional study at the tertiary care outpatient clinic of the German Center for Vertigo and Balance Disorders using a self-administered questionnaire to assess falls, fall-related injuries, and fear of falling. The recruitment period was 6 months. RESULTS: A total of 569 patients (mean age 59.6 ± 17.1 years, 55% females) and 100 healthy participants were included (response rate > 90%). Dizzy patients with central balance disorders (Parkinsonian, cerebellar, and brainstem oculomotor syndromes) had the highest fall rates (> 50% recurrent fallers, odds ratio > 10). The rate of recurrent fallers was 30% in bilateral vestibular failure and peripheral neuropathy (odds ratio > 5). Patients with functional dizziness (somatoform or phobic vertigo) were concerned about falling but did not fall more often than healthy controls (odds ratio 0.87). CONCLUSION: Falls are common in patients presenting to a dizziness unit. Those with central syndromes are at risk of recurrent and injurious falling. Fall rates and fear of falling should be assessed in balance disorders and used to guide the regimen of rehabilitation therapy. The identification of risk factors would help provide protective measures to these groups of patients.

• Item Type: Journal article
• Keywords: Accidental Falls; statistics & numerical data Adolescent Adult Aged Cross-Sectional Studies Dizziness; physiopathology; psychology Fear; psychology Female Humans Male Middle Aged; Postural Balance Risk Factors Sensation Disorders; complications; psychology Somatoform Disorders; physiopathology; psychology Surveys and Questionnaires Vertigo; complications; psychology Vestibular Diseases; physiopathology; psychology Young Adult Balance dizziness falls gait disorders vertigo
• Faculties: Medicine
• Subjects: 600 Technology > 610 Medicine and health
• Language: English

References

[1] S. Akram, J.S. Frank and M. Jog, Parkinson’s disease and segmental coordination during turning: I. Standing turns, Can J Neurol Sci 40(4) (2013), 512–519.

[2] S. Akram, J.S. Frank and M. Jog, Parkinson’s disease and segmental coordination during turning: II. Walking turns, Can J Neurol Sci 40(4) (2013), 520–526.

[3] N.E. Allen, A.K. Schwarzel and C.G. Canning, Recurrent falls in Parkinson’s disease: a systematic review. Parkinsons Dis. 2013.

[4] T. Brandt, D. Huppert, M. Strupp et al., Functional dizziness: diagnostic keys and differential diagnosis, J Neurol 262 (2015), 1977–1980.

[5] M. Davalos-Bichara, F.R. Lin, J.P. Carey et al., Development and validation of a Falls-Grading Scale, J Geriatr Phys Ther 35 (2012), 1–5.

[6] S. Deandrea, E. Lucenteforte, F. Bravi et al., Risk factors for falls in community-dwelling older people: A systematic review and meta-analysis, Epidemiology 21 (2010), 658–668.

[7] K. Delbaere, J.C. Close, A.S. Mikolaizak et al., The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study, Age Ageing 39(2) (2010), 210–216.

[8] E.M. Fonteyn, T. Schmitz-Hübsch, C.C. Verstappen et al., Prospective analysis of falls in dominant ataxias, Eur Neurol 69(1) (2013), 53–57.

[9] S.M. Friedman, B. Munoz, S.K. West et al., Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention, J Am Geriatr Soc 50(8) (2002), 1329–1335.

[10] D.A. Ganz, Y. Bao, P.G. Shekelle et al., Will my patient fall? JAMA 297(1) (2007), 77–86.

[11] S.A. Greenberg, Analysis of measurement tools of fear of falling for high-risk, community-dwelling older adults, Clin Nurs Res 21(1) (2012), 113–130.

[12] J.M. Hausdorff, H.K. Edelberg, M.E. Cudkowicz et al., The relationship between gait changes and falls, J Am Geriatr Soc 45 (1997), 1406

[13] J.M. Hausdorff, H.K. Edelberg, S.L. Mitchell et al., Increased gait unsteadiness in community-dwelling elderly fallers, Arch Phys Med Rehabil 78 (1997), 278–283.

[14] J.M. Hausdorff, D.A. Rios and H.K. Edelberg, Gait variability and fall risk in community-living older adults: a 1-year prospective study, Arch Phys Med Rehabil 82 (2001), 1050– 106.

[15] J.M. Hausdorff, J.D. Schaafsma, Y. Balash et al., Impaired regulation of stride variability in Parkinson’s disease subjects with freezing of gait, Exp Brain Res 149 (2003), 187–194.

[16] J.M. Hausdorff, Gait dynamics in Parkinson’s disease: common and distinct behavior among stride length, gait variability, and fractal-like scaling, Chaos 19 (2009), 026113.

[17] S.J. Herdman, P. Blatt, M.C. Schubert et al., Falls in patients with vestibular deficits, Am J Otol 21(6) (2000), 847–851.

[18] B. Homann, A. Plaschg, M. Grundner et al., The impact of neurological disorders on the risk for falls in the community dwelling elderly: a case-controlled study, BMJ Open 3 (2013), 1–9.

[19] K. Hüfner, D. Barresi,M. Glaser et al., Vestibular paroxysmia: diagnostic features and medical treatment, Neurology 71(13) (2008), 1006–1014.

[20] P. Kannus, H. Sievänen, M. Palvanen et al., Prevention of falls and consequent injuries in elderly people, Lancet 366(9500) (2005), 1885–1893.

[21] R.A. Kenny, L.Z. Rubenstein, M.E. Tinetti et al., Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons, J Am Geriatr Soc 59(1) (2011), 148–157.

[22] S.E. Lamb, E.C. Jørstad-Stein, K. Hauer et al., Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus, J Am Geriatr Soc 53(9) (2005), 1618–1622.

[23] T. Lempert, J. Olesen, J. Furman et al., Vestibular migraine: diagnostic criteria, J Vestib Res 22(4) (2012), 167–172.

[24] J.A. Lopez-Escamez, J. Carey and W.H. Chung, Diagnostic citeria for Menière’s disease, J Vestib Res 25(1) (2015), 1–7.

[25] L. Mackenzie, J. Byles and C. D’Este, Validation of selfreported fall events in intervention studies, Clin Rehabil 20 (2006), 331–339.

[26] S. Mari, M. Serrao, C. Casali et al., Turning strategies in patients with cerebellar ataxia, Exp Brain Res 222(1–2) (2012), 65–75.

[27] M.C. Nevitt, S.R. Cummings and E.S. Hudes, Risk factors for injurious falls: a prospective study, J Gerontol 46(5) (1991), 164–170.

[28] R.M. Pickering, Y.A. Grimbergen, U. Rigney et al., A metaanalysis of six prospective studies of falling in Parkinson’s disease, Mov Disord 22(13) (2007), 1892–1900.

[29] J.K. Richardson, C. Ching and E.A. Hurvitz, The relationship between electromyographically documented peripheral neuropathy and falls, J Am Geriatr Soc 40(10) (1992), 1008– 1012.

[30] R. Schniepp, M. Wuehr, S. Huth et al., Gait characteristics of patients with phobic postural vertigo: effects of fear of falling, attention, and visual input, J Neurol 261(4) (2014), 738–746.

[31] R. Schniepp, M. Wuehr, S. Huth et al., The gait disorder in downbeat nystagmus syndrome, PLoS One 9(8) (2014), e105463.

[32] R. Schniepp, M. Wuehr, M. Neuhaeusser et al., Locomotion speed determines gait variability in cerebellar ataxia and vestibular failure, Mov Disord 27(1) (2012), 125–131.

[33] R. Schniepp, M. Wuehr, C. Schlick et al., Increased gait variability is associated with history of falls in patients with cerebellar ataxia, J Neurol 261(1) (2014), 213–223.

[34] M. Schwenk, A. Lauenroth, C. Stock et al., Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: a systematic review, BMC Med Res Methodol 12 (2012), 501–514.

[35] M. Serrao, S. Mari, C. Conte et al., Strategies adopted by cerebellar ataxia patients to perform U-turns, Cerebellum 12(4) (2013), 460–468.

[36] M.E. Tinetti, D. Richman and L. Powell, Falls efficacy as a measure of fear of falling, J Gerontol 45(6) (1990), 239–243.

[37] B.P. Van deWarrenburg, J.A. Steijns, M. Munneke et al., Falls in degenerative cerebellar ataxias, Mov Disord 20(4) (2005), 497–500.

[38] WHO, WHO global report on falls prevention in older age. Geneva, Switzerland: World Health Organization, 2007.

[39] D.R. Williams, H.C. Watt and A.J. Lees, Predictors of falls and fractures in bradykinetic rigid syndromes: a retrospective study, J Neurol Neurosurg Psychiatry 77(4) (2006), 468–473.

[40] M. Wuehr, R. Schniepp, C. Schlick et al., Sensory loss and walking speed related factors for gait alterations in patients with peripheral neuropathy, Gait Posture 39(3) (2014), 852– 858.