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 took 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 B, and 3.12 (95% CI 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.