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  do not mention Benign Paroxysmal Positional Vertigo (BPPV) in their article on falls’ prevention in older people. BPPV causes falls ; it is common, affecting circa 10% of the elderly population ; it can be cured in over 80% of cases  with standard 2-minute clinical manoeuvres; and treating BPPV in older people reduces falls .
A key consideration is that the history may be unreliable in many elderly patients who may not have a sensation of vertigo with BPPV , partially explaining why 10% of unbalanced elderly patients in the community had unrecognised BPPV . 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  [8 – online video resource for treating dizziness including BPPV].
It is time that local and national guidelines  recognise this missed clinical opportunity and explicitly call for the screening of BPPV in all older people with falls.
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1. Vieira ER, Palmer RC, Chaves PHM. Prevention of falls in older people living in the community. BMJ 2016;353:i1419.
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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