20IDENTIFICATION OF BENIGN PAROXYSMAL POSITIONAL VERTIGO IN PATIENTS ATTENDING A COMMUNITY BASED FALLS PREVENTION SERVICE

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Abstract

Introduction: Benign paroxysmal positional vertigo (BPPV) is a significant risk factor for falls in older persons but under diagnosed. The North Tyneside Falls Prevention service (NTFPS) aims to identify and modify risk factors for falls in a large community based population working as an integrated care model with primary and secondary care, GP based IT expertise and the third sector- AGE UK.

Methods: An audit of GP computerized records followed by simple postal questionnaire identified all older persons over 60 living independently with recognized risk factors for falls .This group underwent a comprehensive community based assessment per NICE guidelines.

All patients in whom BPPV was suspected (history of postural or positional dizziness / vertigo, dizziness lying or turning over in bed, injurious falls with postural change) underwent Dix- Hallpike testing.

Results: 2450 patients assessed in first 2 years

95 new diagnoses of posterior canal BPPV were made as a result of a positive Dix-Hallpike test -3.8% prevalence.

Mean age 74.3 years; Range 60-89; 76 females; 48 had fallen; 50 right BPPV; 37 left BPPV; and 8 bilateral.

Of this BPPV cohort, additional diagnoses made were:

• lower level gait disorder in 45, - 20 referred to Age UK balance group

• 5 required osteoporosis medication as per guidelines

• 14 referred on for DEXA on basis of FRAX tool,

• 7 orthostatic hypotension,

• 3 bradycardia requiring medication review,

• 1 new atrial fibrillation,

• 1 new cognitive impairment

• 3 depression.

Conclusion: Active identification and treatment of BPPV must be part of falls prevention services. Any service seeing older persons with BPPV should consider additional modifiable risk factors for falls including gait disorders, osteoporosis screening and cardiovascular diagnoses with the aim of reducing falls and falls related hospital admissions .

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