Falls remain a major healthcare burden from an individual to societal level. Vestibular disorders are recognised as a significant risk factor for falls in older adults, but identification and assessment of such conditions has only recently been included in national and international guidance. The extent to which National Health Service (NHS) falls services in England are including vestibular assessment is not well known.
Method
A freedom-of-information request was sent to 117 Falls Services run by NHS Trusts in England to identify if they included vestibular assessment/management, if so which professions were providing this and whether Trusts planned to develop this aspect.
Results
115 out of the 117 identified Trusts replied. 39/115 (33.9%) of Trusts reported that their falls prevention services included staff trained to assess and treat vestibular dysfunction. Physiotherapists were the most common profession delivering this. Despite the lack of provision, just 23/115 (20%) of Trusts reported this was an area of their service they were planning to develop.
Discussion
These results show a significant lack of vestibular management in falls services. Accordingly, in their current offering, a majority of NHS Trust falls services will not be able to fully implement recently updated NICE guidance (NG249) or World Falls Guidelines for falls prevention. Given the extensive burden of falls in older adults, steps to close this gap would appear important.
AdamCEFitzpatrickALLearyCS, et al.The impact of falls on activities of daily living in older adults: a retrospective cohort analysis. PLoS One2024; 19(1): e0294017.
2.
BergenGStevensMRBurnsER. Falls and fall injuries among adults aged ≥65 years - united States, 2014. MMWR Morb Mortal Wkly Rep2016; 65: 993–998.
3.
SchoeneDHellerCAungYN, et al.A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls?Clin Interv Aging2019; 24(14): 701–719.
4.
HartholtKAvan BeeckEFPolinderS, et al.Societal consequences of falls in the older population: injuries, healthcare costs, and long-term reduced quality of life. J Trauma2011; 71(3): 748–753.
5.
HouryDFlorenceCBaldwinG, et al.The CDC injury Center's response to the growing public health problem of falls among older adults. Am J Lifestyle Med2016; 10(1): 74–77.
6.
VaishyaRVaishA. Falls in older adults are serious. Indian J Orthop2020; 54(1): 69–74.
7.
National Institute for Health and Care Excellence. Falls: assessment and prevention in older people and in people 50 and over at higher risk. NG249. Available at: https://www.nice.org.uk/guidance/ng249(2025).
8.
AgrawalYCareyJPDella SantinaCC, et al.Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. Arch Intern Med2009; 169(10): 938–944.
9.
ListonMBBamiouDMartinF, et al.Peripheral vestibular dysfunction is prevalent in older adults experiencing multiple non-syncopal falls versus age-matched non-fallers: a pilot study age and ageing. Age Ageing2014; 43(1): 38–43.
10.
GazzolaJMGanançaFFArataniMC, et al.Circumstances and consequences of falls in elderly people with vestibular disorder. Braz J Otorhinolaryngol2006; 72(3): 388–392.
11.
DonovanJDe SilvaLCoxH, et al.Vestibular dysfunction in people who fall: a systematic review and meta-analysis of prevalence and associated factors. Clin Rehabil2023; 37(9): 1229–1247.
12.
HassettP. Incidence of vestibular dysfunction in frail older adults attending an integrated care programme for older persons (ICPOP). Age Ageing2024; 53(Issue Supplement_4): 85–86.
13.
Montero-OdassoMvan der VeldeNMartinFC, et al.World guidelines for falls prevention and management for older adults: A Global Initiative, Age Ageing2022; 51(9): afac205.
14.
LiYSmithRMWhitneySL, et al.Association between dizziness and future falls and fall-related injuries in older adults: a systematic review and meta-analysis. Age Ageing2024; 53(9): afae177.
15.
AllenDRibeiroLArshadQ, et al.Age-related vestibular loss: current understanding and future research directions. Front Neurol2016; 19(7): 231.
16.
LucieerFVonkPGuinandN, et al.Bilateral vestibular hypofunction: insights in etiologies, clinical subtypes, and diagnostics. Front Neurol2016; 4(7): 26.
17.
van de BergRvan TilburgMKingmaH. Bilateral vestibular hypofunction: challenges in establishing the diagnosis in adults. Orl2015; 77(4): 197–218.
18.
PauwelsSCastersLLemkensN, et al.Gait and falls in benign paroxysmal positional vertigo: a systematic review and meta-analysis. J Neurol Phys Ther2023; 47(3): 127–138.
19.
NutiDMasiniMMandalàM. Benign paroxysmal positional vertigo and its variants. Handb Clin Neurol2016; 137: 241–256.
20.
WestburyLDPearseCRambukwellaR, et al.Multimorbidity and risk of falls, fractures, and joint replacements over two decades: findings from the hertfordshire cohort study. Geriatr Gerontol Int2024; 24(9): 912–917.
21.
Arias-FernándezLCaballeroFFYévenes-BrionesH, et al.Association between multimorbidity and risk of falls and fear of falling among older adults: the mediation effect of physical function, use of sleeping pills, and pain relievers. J Am Med Dir Assoc2024; 25(10): 105201.
22.
HoeyMAZhuKMurrayK, et al.The associations of multimorbidity with fall- and fracture-related hospitalisations: the Busselton healthy ageing study. Arch Osteoporos2025; 20: 118.
23.
HubertySFreystätterGWieczorekM, et al.Association between multimorbidity and rate of falls: a 3-Year 5-Country prospective study in generally healthy and active community-dwelling adults aged ≥70 years. J Am Med Dir Assoc2023; 24(6): 804–810.e4.
24.
ChangJTMortonSCRubensteinLZ, et al.Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ2004; 328: 680.
25.
MaciasJDMassingaleSGerkinRD. Efficacy of vestibular rehabilitation therapy in reducing falls. Otolaryngol Head Neck Surg2005; 133(3): 323–325.
26.
CarenderWJGrzesiakMTelianSA. Vestibular physical therapy and fall risk assessment. Otolaryngol Clin North Am2021; 54(5): 1015–1036.
27.
GalgonAKTateAFitzpatrickM, et al.Agreement between physical therapists in diagnosing benign paroxysmal positional vertigo. J Neurol Phys Ther2021; 45(2): 79–86.
28.
TeggiRFamiliariMBattistaRA, et al.The social problem of presbystasis and the role of vestibular rehabilitation in elderly patients: a review. Acta Otorhinolaryngol Ital2023; 43(4): 227–234.
29.
Rossi-IzquierdoMGayoso-DizPSantos-PérezS, et al.Vestibular rehabilitation in elderly patients with postural instability: reducing the number of falls—a randomized clinical trial. Aging Clin Exp Res2018; 30: 1353–1361.
30.
FawzanSKozouHBakiF, et al.Fall risk assessment and effect of vestibular rehabilitation in the elderly population. Egypt J Otolaryngol2022; 38: 88.
31.
MetzDBryceK. The rationale and recommendations for inclusion of screening for benign paroxysmal positional vertigo in falls clinics. J Laryngol Otol2024; 138(S2): S32–S34.
32.
HylandSHawkeLJTaylorNF. Benign paroxysmal positional vertigo without dizziness is common in people presenting to falls clinics. Disabil Rehabil2024; 46(25): 6108–6113.
33.
MeldrumDBurrowsLCakrtO, et al.Vestibular rehabilitation in Europe: a survey of clinical and research practice. J Neurol2020; 267: 24–35.
34.
MaleAJRamdharryGMGrantR, et al.A survey of current management of Benign Paroxysmal Positional Vertigo (BPPV) by physiotherapists interested in vestibular rehabilitation in the UK. Physiotherapy2018; 105: 307–314.
35.
CookEMcRobertC. Investigating physiotherapy students’ perceptions of their ability to assess and treat vestibular pathology. A combined quantitative and qualitative survey. Physiotherapy2024; 123: e66–e67.
36.
LambSEFisherJDGatesS, et al.A national survey of services for the prevention and management of falls in the UK. BMC Health Serv Res2008; 8: 233.
YaleSEBrownMELByrneMHV. Using freedom of information requests to access novel data sources in health professions education research. Postgrad Med J2025; 101(1195): 481–486.
41.
FinchamJE. Response rates and responsiveness for surveys, standards, and the Journal. Am J Pharm Educ2008; 72(2): 43.
42.
Clifton-SpriggJJamesJVujićS. Freedom of information (FOI) as a data collection tool for social scientists. PLoS One2020; 15(2): e0228392.
43.
SullivanGMArtinoAR. Analyzing and interpreting data from likert-type scales. J Grad Med Educ2013; 5(4): 541–542.
44.
WalbyKLuscombeA. Ethics review and freedom of information requests in qualitative research. Research Ethics2018; 14(4): 1–5.
45.
JacobLShinJIKostevK, et al.Prospective association between multimorbidity and falls and its mediators: findings from the Irish longitudinal study on ageing. J Clin Med2022; 11(15): 4470.
46.
SchlickCSchnieppRLoidlV, et al.Falls and fear of falling in vertigo and balance disorders: a controlled cross-sectional study. J Vestib Res2016; 25(5-6): 241–251.
47.
ElyosephZGeisingerDZaltzmanR, et al.The overarching effects of vestibular deficit: imbalance, anxiety, and spatial disorientation. J Neurol Sci2023; 451: 120723.
48.
HawkeLJBarrCJMcLoughlinJV. The frequency and impact of undiagnosed benign paroxysmal positional vertigo in outpatients with high falls risk. Age Ageing2021; 50(6): 2025–2030.
49.
ChenXWeiDFangFet al.Peripheral vertigo and subsequent risk of depression and anxiety disorders: a prospective cohort study using the UK Biobank. BMC Med2024; 22: 63.
50.
LiYSmithRMWhitneySL, et al.We should be screening for benign paroxysmal positional vertigo (BPPV) in all older adults at risk of falling: a commentary on the World Falls Guidelines. Age Ageing2023; 52(11): afad206.
51.
SeemungalBM. The mechanisms and loci of human vestibular perception. University of London, University College, 2005.
52.
CalzolariEChepishevaMSmithRM, et al.Vestibular agnosia in traumatic brain injury and its link to imbalance. Brain2021; 144(1): 128–143.
53.
ChiarovanoEVidalP-PMagnaniC, et al.Absence of rotation perception during warm water caloric irrigation in some seniors with postural instability. Front Neurol2016; 7(4): 4.
54.
SeemungalBM. Screening for BPPV in falls: an easy but big clinical “win”. BMJ Br Med J (Clin Res Ed)2016; 353: i3004.
55.
WangYHChanCYLiuQH. Benign paroxysmal positional vertigo - recommendations for treatment in primary care. Ther Clin Risk Manag2019; 15: 719–725.
56.
HiltonMPPinderDK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev2014; 8(12): CD003162.
57.
BhattacharyyaNGubbelsSPSchwartzSR, et al.Clinical practice guideline: benign paroxysmal positional vertigo (Update). Otolaryngol Head Neck Surg2017; 156(3_suppl): S1–S47.
SeppalaLJLordSRMasudT, et al.The world falls guidelines: how is implementation progressing globally?Age Ageing2025; 54(8): afaf214.
60.
GomezFCurcioCLBrennan-OlsenSL, et al.Effects of the falls and fractures clinic as an integrated multidisciplinary model of care in Australia: a pre-post study. BMJ Open2019; 9(7): e027013.
61.
MarmorSKaraca-MandicPAdamsME. Use of physical therapy and subsequent falls among patients with dizziness in the US. JAMA Otolaryngol Head Neck Surg2023; 149(12): 1083–1090.
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