Intended for healthcare professionals

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Clinical Review State of the Art Review

Prevention of falls in older people living in the community

BMJ 2016; 353 doi: (Published 28 April 2016) Cite this as: BMJ 2016;353:i1419

Rapid Response:

Screening for BPPV in falls: an easy but big clinical 'win'. Re: Prevention of falls in older people living in the community

To the Editor,

It is surprising that Vieira and colleagues [1] do not mention Benign Paroxysmal Positional Vertigo (BPPV) in their article on falls’ prevention in older people. BPPV causes falls [2]; it is common, affecting circa 10% of the elderly population [3]; it can be cured in over 80% of cases [4] with standard 2-minute clinical manoeuvres; and treating BPPV in older people reduces falls [5].

A key consideration is that the history may be unreliable in many elderly patients who may not have a sensation of vertigo with BPPV [6], partially explaining why 10% of unbalanced elderly patients in the community had unrecognised BPPV [1]. Additionally, some clinicians may be hesitant to use the clinical manoeuvres that diagnose (and treat) BPPV in elderly patients on safety grounds. These clinical manoeuvres, however, can be adapted to accommodate for frailty without sacrificing clinical efficacy [7] [8 – online video resource for treating dizziness including BPPV].

It is time that local and national guidelines [9] recognise this missed clinical opportunity and explicitly call for the screening of BPPV in all older people with falls.



1. Vieira ER, Palmer RC, Chaves PHM. Prevention of falls in older people living in the community. BMJ 2016;353:i1419.
2. Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngol Head Neck Surg. 2000;122(5):630-4.
3. von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78(7):710-5.
4. Prokopakis E, Vlastos IM, Tsagournisakis M, Christodoulou P, Kawauchi H, Velegrakis G. Canalith repositioning procedures among 965 patients with benign paroxysmal positional vertigo. Audiol Neurootol. 2013;18(2):83-8.
5. Ganança FF, Gazzola JM, Ganança CF, Caovilla HH, Ganança MM, Cruz OL. Elderly falls associated with benign paroxysmal positional vertigo. Braz J Otorhinolaryngol. 2010;76(1):113-20.
6. Imbaud Genieys S. [Vertigo, dizziness and falls in the elderly]. Ann Otolaryngol Chir Cervicofac. 2007;124(4):189-96.
7. Kollén L, Frändin K, Möller M, Fagevik Olsén M, Möller C. Benign paroxysmal positional vertigo is a common cause of dizziness and unsteadiness in a large population of 75-year-olds. Aging Clin Exp Res. 2012;24(4):317-23.

Competing interests: No competing interests

02 May 2016
Barry M Seemungal
consultant neurologist/neuro-otologist & senior lecturer
Imperial College London
St Mary’s and Charing Cross Hospitals, Division of Brain Sciences, Imperial College London, W6 8RF