EvidenceAlerts

Laurent G, Vereeck L, Verbecque E, et al. Effect of age on treatment outcomes in benign paroxysmal positional vertigo: A systematic review. J Am Geriatr Soc. 2021 Oct 26. doi: 10.1111/jgs.17485. (Systematic review)
Abstract

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) can lead to an increased fall risk in older adults. Therefore, we examined the influence of age on the effectiveness of canalith-repositioning procedures (CRPs) for the treatment of BPPV.

METHODS: Pubmed, Web of Science, and the bibliographies of selected articles were searched for studies conducted before September 2020 that examined the effectiveness of treatments for BPPV in various age groups. Meta-analyses were performed to compare treatment effectiveness and recurrence rates for younger and older adults. Odds ratios were calculated in a random-effects model. Mean differences were calculated using a fixed-effects model. A significance level of p < 0.05 (95% confidence interval) was set. The risk of bias and the methodological quality of all included articles were examined.

RESULTS: Forty-five studies were retrieved after full-text screening, of which 29 studies were included for a qualitative review. The remaining 16 studies were eligible for inclusion in the meta-analysis (3267 participants with BPPV). The success rate of a single CRP was higher in the younger group (72.5% vs. 67%, p < 0.001). An average of 1.4 and 1.5 CRPs was needed for complete recovery in the younger and older groups, respectively (p = 0.02). However, global treatment success did not differ between these groups (97.5% vs. 94.6%, p = 0.41). The recurrence rate was higher in the older population (23.2% vs. 18.6%, p = 0.007).

CONCLUSIONS: Although more CRPs are needed, the rate of complete recovery in older adults is similar to that observed in younger adults.

Ratings
Discipline Area Score
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Geriatrics 5 / 7
Neurology 5 / 7
Internal Medicine 4 / 7
Physical Medicine and Rehabilitation Coming Soon...
Comments from MORE raters

General Internal Medicine-Primary Care(US) rater

Interesting.

Neurology rater

The study serves mainly to alert practitioners to be alert to older patients with "dizziness" or "instability", as they often deny that there is an illusion of movement and one should do the Dix-Hallpike or other evaluations to look for BPPV in this population. The study shows, I think, a rather trivial difference (even though statistically significant) between younger and older individuals with respect to effectiveness of treatment.

Physical Medicine and Rehabilitation rater

Does not pertain to our practice.
Comments from EvidenceAlerts subscribers

Dr. Geoff Feben (11/12/2021 5:50 PM)

Over many years, I observed that requesting the seated patient to quickly turn the head to the right and left is consistent and highly predictive of the Hallpike maneuvre result - a very convenient assessment.