Correlation between vestibular function and hip fracture following falls in the elderly: a case-controlled study

Objective To examine vestibular function following falls in the elderly. Design A case-controlled study to compare vestibular function in elderly people with hip fractures and elderly people with no prior hip fractures. Participants One hundred and sixty-nine people aged 65 years or older look part in the study. Study Group A consisted of 84 hospitalised volunteers who had received hip surgery due to a fall and who were undergoing rehabilitation. Control Group B consisted of 85 volunteers from retirement homes with no prior history of hip fracture. Intervention All participants underwent four clinical tests to determine their level of vestibular functioning in order to allow comparison between the groups. Three methods were used to test the vestibulo-ocular reflex (VOR), and one method was used to test benign paroxysmal positional vertigo. Results Thirty-eight percent of the participants in Study Group A and 11% of the participants in Control Group B demonstrated a positive Visual acuity test (P < 0.001). The odds ratio suggests that the participants of Study Group A were 4.83 [95% confidence interval (CI) 2.1 to 11.0] times more likely to present a positive static and dynamic visual acuity test than the participants of Control Group 13, and 3.12 (95% Cl 1.62 to 6.02) times more likely to have a positive head impulse test. There were no differences in the head shaking nystagmus test or the Dix-Hallpike test between groups, and no association between the side of the fracture and the side of the vestibular impairment. Conclusions Study Group A exhibited greater VOR impairment than Control Group B. Therefore, impairment of this reflex may be considered as a risk factor for falls. (c) 2006 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.