The older adult
Falls & prevention
Falls are where older-adult dizziness becomes dangerous. The vestibular system is one of the few fall-risk factors you can actively rehabilitate — so it is worth finding.
Why vestibular loss matters for falls
Falls are a leading cause of injury and loss of independence in older people. When the balance organs work poorly, the body is less able to correct itself — so the risk of falling goes up. The good news is that balance can be retrained.
Vestibular dysfunction is an independent, modifiable contributor to falls: impaired vestibular function is associated with substantially higher odds of falling, and dizziness in older adults predicts falls and functional decline.1,4 It rarely acts alone — it compounds visual, proprioceptive, cardiovascular and medication-related risks.
Because falls are multifactorial, the vestibular contribution is best addressed within a structured, multifactorial falls assessment rather than in isolation — but it deserves specific attention because, unlike age or comorbidity, it responds to rehabilitation.2
Multifactorial falls assessment
Current guidelines recommend risk-stratifying older adults and giving those at increased risk a multifactorial assessment that maps the modifiable contributors.2 The factors to screen for include:
- Previous fall or fear of falling
- Gait and balance impairment (incl. vestibular hypofunction)
- Polypharmacy and psychotropic/sedative medication
- Orthostatic hypotension
- Visual impairment
- Lower-limb weakness and peripheral neuropathy
- Cognitive impairment
- Environmental hazards (rugs, poor lighting, no rails)
A vestibular lens adds value at two points: screening for BPPV (common, treatable, and an under-recognised falls contributor) and identifying presbyvestibulopathy or other hypofunction that will respond to targeted exercise.
What actually reduces risk
The interventions with the best evidence are exercise programmes that challenge balance, medication review (deprescribing sedatives, re-evaluating antihypertensives and stopping prolonged vestibular suppressants), correcting orthostatic hypotension and vision, treating BPPV, and home-hazard modification.2 For those with vestibular hypofunction, vestibular rehabilitation improves balance and gait and reduces falls, and should be tailored and progressive.3
The reframe:in an older adult, “dizziness” is a falls-risk flag. Treat the dizziness and the fall risk together — most of the gains come from the modifiable contributors, with vestibular rehabilitation doing the part that medication cannot.
Key points
- Falls are a leading cause of injury and lost independence; vestibular dysfunction is a modifiable contributor.
- Risk-stratify, then give at-risk older adults a multifactorial falls assessment.
- Screen specifically for BPPV and for treatable vestibular hypofunction.
- Balance-challenging exercise, medication review, BP/vision correction and home safety reduce falls.
- Vestibular rehabilitation does the rehabilitative work that drugs cannot.