Vestibular Suppressant Utilization and Subsequent Falls Among Patients 65 Years and Older With Dizziness in the United States

Background: Falls pose a significant public health threat to older adults. Due to potential fall risk, guidelines recommend against the routine prescription of several medications commonly used for vestibular suppression, including meclizine and benzodiazepines. Aims: We aimed to determine the factors associated with vestibular suppressant utilization among patients with dizziness >= 65 years of age and subsequent falls. Methods and Results: A retrospective longitudinal database of US commercial insurance and Medicare beneficiaries was used to study medical claims data (January 1, 2006, through December 31, 2015). Of 190,348 individuals >= 65 years old who presented with dizziness, 60,658 (32%) filled a vestibular suppressant prescription (27% anti-emetics, 73% anxiolytics), of which 20,448 were women (34%) within a month after their dizziness diagnosis. Of those individuals using suppressants, 8% experienced a fall resulting in a medical encounter within 60 days of filling the prescription. After adjusting for sociodemographics and comorbidity, individuals with dizziness who received vestibular suppressants were more likely to experience recorded fall incidents (hazard ratio (HR) 3.33, confidence interval (CI) 1.93-5.72, p < 0.0001), than those who did not receive vestibular suppressants. Conclusions: Although vestibular suppressants may provide immediate relief from symptoms during an acute vestibular crisis, use is incongruent with guideline-concordant care for most vestibular diagnoses and is also potentially counterproductive and injurious. Multi-faceted interventions that engage clinicians and patients are needed to improve the value of care for patients with vestibular disorders to de-implement the routine use of suppressants for dizziness.